Manipulation Under Anesthesia is a non-invasive procedure increasingly offered for various acute and chronic conditions. By lightly anesthetizing a patient, once painful adjustments and movements are accomplished quickly and without pain, helping to greatly improve or even restore range-of-motion. MUA uses a combination of specific short-lever spinal manipulations, passive stretches, massage, and specific articular and postural kinesthetic maneuvers in order to break up fibrous adhesions and scar tissue around the spine and surrounding tissue.

Established and widely recognized in the manual medical arena for more than sixty years, MUA is a viable alternative for those patients who do not respond to traditional care such as physical therapy, chiropractic, injections, or other invasive surgical procedures.

Who would be a candidate for Manipulation Under Anesthesia?

In general, patients selected for Manipulation Under Anesthesia have received conservative care for six to eight weeks with limited or no improvement in symptoms or findings.

Common indications for MUA include:

Not all patients qualify for MUA as certain contraindications prevent some from undergoing the procedure

Individuals who have not tried a six to eight week trial of chiropractic or physical therapy should not have MUA first. The procedure is designed for those individuals who have failed with conservative care.

Other conditions which would make a patient unqualified for MUA include: osteoporosis, heart disease and uncontrolled hypertension, advanced age, bone weakening diseases, cancer, some circulatory diseases, uncontrolled diabetes, and previous stroke.

What are the effects of Manipulation Under Anesthesia?

The proposed effects of MUA therapy include the following:

• Breaking up scar tissue (adhesions) both in and around the spinal joints, commonly caused by multiple injuries or failed back surgery
• Decreasing chronic muscle spasm
• Overcoming super-sensitivity of injured areas, making the patient unable to cooperate for effective treatment
• Stretching persistent shortened muscles, ligaments, and tendons
• Relief from pain and radiating symptoms caused by damaged invertebral discs

**Most importantly however, MUA affords patients immediate relief and noticeable difference in their daily lives post-procedure. These positive results only continue to improve with time and post-MUA therapy.**

Manipulation Under Anesthesia is a team approach. Dr. Mishock will be performing the manipulation procedure. He will be assisted by an anesthesiologist, as well as a chiropractor and trained nursing staff. The procedure is commonly performed in a hospital or surgical center.

Dr. Mishock is both a licensed chiropractor and physical therapist with board certification in MUA through the American Board of Manipulation Under Anesthesia Practitioners. He has extensive training and experience in hands-on techniques to relieve pain and improve function; and is one of only a few clinicians in the country who have doctorate degrees in both chiropractic and physical therapy. Dr. Mishock received his Masters degree in physical therapy from the University of Pittsburgh and completed his doctorate in physical therapy from Temple University. He received his doctorate of chiropractic from the National College of Chiropractic.

The MUA procedure involves three consecutive days of treatment. During these three days a patient is treated with hands-on techniques, different types of massage, and stretches.

On the day of the MUA, the patient must be accompanied by a family member or friend to drive him/her home afterwards. An intravenous catheter is inserted in the patient's arm and a small amount of anesthesia is administered by a qualified anesthesiologist. MUA is not an invasive surgery; it is simply spinal manipulation, mobilization, and myofascial work performed in an operating room environment. It is somewhat similar to what is done in the chiropractor's office, but with the added aid of anesthesia. The actual adjustments are very gentle. The procedure usually lasts about 30 minutes.

After the patient has fallen asleep, the muscles affecting spinal function are stretched and the dysfunctional areas of the spine are worked on. The patient wakes up quickly thereafter and is monitored by qualified personnel until he/she is ready to be discharged.

Since the patient is lightly sedated during the MUA procedure, there is no discomfort associated with the manipulation. Through the use of "conscious sedation," a patient is conscious and responsive, but relaxed, allowing Dr. Mishock to administer the hands-on treatment similar to that received during a regular office visit.

Post-procedure care is one of the most important parts of the MUA procedure and is what helps to make it truly effective. The patient is seen in the office for four to six weeks of physical therapy/chiropractic. Treatment may include spinal stabilization, flexibility training, aerobic conditioning, hands-on treatments, and/or aquatic therapy. Post-procedure care ensures lasting changes for the work that was accomplished during the MUA. Physical therapy will help the patient regain pre-injury strength, improve function, and help prevent future pain and disability.

Manipulation Under Anesthesia has been practiced since the late 1930's and used by osteopathic physicians, chiropractic physicians, and orthopedic surgeons for many years as a proven form of safe and effective treatment.

Most insurance pay for manipulation under anesthesia. Prior to the procedure our staff will verify your insurance and preauthorize you for the procedure.

If you have questions about the procedure, please call Dr. Mishock 610-327-2600.