What Is Manipulation Under Anesthesia/Fibrosis Release Procedures?

Manipulation Under Anesthesia/Fibrosis Release Procedures (MUA/FRP) is the use of manual manipulation of the spine combined with the use of anesthesis. The addition of anesthesia allows for the benefits of manipulation to be shared with those patients who cannot tolerate manual techniques because of pain response, spasm, muscle contractures, and guarding. It is also a proven procedure for those patients whose chronic pain has not responded satisfactorily to in-office chiropractic care and other adjunctive procedures. MUA/FRP uses a combination of specific short-level arm manipulations, passive stretches, and specific articular and postural kinesthetic integrations to obtain a desired outcome. It is a multidisciplinary procedure where a medical doctor and chiropractors work together to offer you the most benefit from these procedures. The chiropractors provide the services that they are expert in and are within their scope of practice, such as the spinal adjustments, traction, stretching, and myofascial release techniques. The medical physician, board certified in anesthesiology, provides all of the medical treatment, including medical management and the dispensing of any necessary medicines at their discretion and based on their area of expertise. This assures you the safest and most effective combination of expertise to assure that you receive optimal benefit from these very safe and effective procedures.  

Who Can Benefit From MUA/FRP And Why Does MUA/FRP Work?

The goals in treatment of mechanical spine pain is to correct the aberrant spinal motion of the involved segments, thereby improving function and decreasing pain. This is achieved via a variety of techniques, most of which can be simplified into two types of forces : (1) high-velocity, short-duration and (2) low velocity, long-duration.

These two applications of force will affect different aspects of the restricted components. The former affects the osseous disrelationship or misalignment. The latter addresses the "tough soft tissue" component. These applications are used in an isolated or combined fashion, depending on the nature of the lesion. Office based SMT (spinal manipulative therapy) is rendered via specific short-lever arm-adjustive forces typically combined with traditional physiotherapeutic modalities such as ultrasound, electrical stimulation, cryotherapy, traction, and passive/active rehabilitation.

A percentage of these patients ultimately will not respond to in-office spinal manipulative therapy on the basis of one or more of the following criteria:

• Chronicity of the case because of joint or soft tissue fibrosis, which has inhibited restoration of appropriate joint mechanics.
• Acute myofascial rigidity and painful inhibition, which disallows conscious SMT.
• Severe joint dysfunction and subluxation such that correction of evident spinal biomechanical misalignment is not achievable through conscious SMT.
• Contained disc herniation (bulge) that has become refractory to conscious SMT.
• Multiple recurrences during the active-resistive phase of joint rehabilitation.

What Is The MUA/FRP Procedure Like?

Before the day of the procedure, the patient is instructed regarding their nothing-by-mouth status and medications pursuant to instructions by a medical physician. The patient must be accompanied by a friend or family member to drive the patient home after the procedure. No patient will be allowed to drive home after this procedure. The patient then signs an informed consent affidavit and right after placed on the procedure table and hemodynamic monitoring is instituted, including electrocardiography, blood pressure, and pulse oximetry. Supplemental oxygen is given via nasal cannula. The patient is initially sedated mildly with Versed.

All medical procedures, including the use of drugs, are provided by a Board Certified Medical Anesthesiologist.

The MUA/FRP procedure generally takes between fifteen and twenty-five minutes. The patient is continually monitored by the anesthesiologist. Blood pressures are obtained at least every five minutes, and a complete anesthesia record is maintained. The patient is taken to the recovery room at the completion of the procedure. He or she will then be continually monitored in the recovery room, with supplemental oxygen administered on the basis of the facility protocol, which includes stable vital signs, and a fully awake condition.

Post-procedure care

Post-procedure care is one of the most important parts of the MUA/FRP procedure and helps to make it highly effective. The therapy begins soon after the procedure to prevent subsequent adhesion formation.

After the last MUA/FRP procedure, the patient should follow an intensive therapy program for six to eight weeks in their doctor's office, which will consist of the same stretches and adjustments accomplished during the procedure.

Post-MUA/FRP rehabilitation includes stretching, flexibility and strengthening exercises, plus periodic adjustment as required by the doctor. This regimented post-MUA/FRP therapy will help the patient regain pre injury strength, maintain motion improvements obtained from the MUA/FRP procedures, and help prevent future pain and disability.