Bodybuilding Medicine--M.U.A.

MUA is a safe, proven treatment that has worked for thousands of patients over the last 50 years. Many people are not familiar with MUA, including doctors. MUA is not new and it is non-surgical.

We have treated over 350 patients in that time period. Those patients include several bodybuilders, rugby players, professional MMA fighters, professional football players, and a professional boxer. High level athletes respond well because a lot of their chronic, recurrent problems are from trauma from their sport/activity that results in scar tissue/adhesion within tendons/ligaments/muscles thereby restricting movement and function.

The procedure itself is exactly what it sounds like. After proper medical evaluation and testing, a patient is lightly anesthetized to achieve total relaxation. Then, a specially trained team of physicians perform specific maneuvers and muscle stretching movements on the affected portion of the spine or limb that would normally be too painful for a chronic pain patient to even consider.

To gain full relief, the procedure is normally repeated over the course of 3 days in a surgical center with an anesthesiologist as part of the team.

Manipulation Under Anesthesia (MUA) is a non-invasive procedure offered for acute and chronic conditions, including:

• Pain syndromes of major joints/muscles due to repetitive micro trauma/injury.
• Neck pain
• Back pain
• Joint pain
• Muscle spasm
• Shortened muscles
• Fibrous adhesions/scar tissue from previous injuries.
• Long term pain syndromes.

Manipulation under anesthesia uses a combination of specific short-lever spinal manipulations, passive stretches and specific articular and postural kinesthetic maneuvers in order to break up fibrous adhesions and scar tissue around the joints, tendons, ligaments, and surrounding tissue. The treatment is performed in a hospital or surgery center by licensed physicians with specialized training and certification specifically for the procedure. A team approach is required to have a safe and successful outcome. Our center in Atlanta uses a physician (me), a chiropractor, an anesthesiologist, and a team of nurses.

Certain pain conditions in the shoulder, hip, knee, ankle, neck, mid back, pelvis, and low back respond poorly to conventional care. One proposed theory for this is that it is a result of past or present injury. Adhesions and scar tissue build up around spinal joints and within the surrounding muscles, tendons, and ligaments; and causes chronic pain. Patients often undergo various treatments, such as physical therapy, chiropractic care, epidural injections, back surgery, or other treatments that do not address fibrous adhesions. Some patients feel temporarily better with these treatments. However, their pain often returns and leads to a frustrated feeling for the patient. Proposed manipulations under anesthesia effects 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 spasms
• Overcoming super sensitivity of injured areas, making the patient unable to cooperate for effective treatment.
• Stretching persistent shortened muscles, ligaments and tendons.
• Relieving pain and radiating symptoms from damaged inter-vertebral discs. Some disc injuries are serious enough to require surgery, but these types of injuries are relatively infrequent.

Anesthesia provides several benefits. When movement of the affected body part is extremely and intolerably painful to the patient, being unconscious is one obvious benefit of the anesthesia's effects. Other benefits/effects to anesthesia:

ñ Shutting off the muscle spasm cycle to allow restricted movement.

ñ Sedating the pain-perceiving nerves that have been irritated due to the dysfunctional spine.

ñ Allowing complete elimination of muscle tone to allow the doctor to stretch shortened muscle/tendon groups and to break up adhesions caused by scar tissue.

Some manipulation under anesthesia techniques may include:

ñ Soft tissue procedures like lateral stretching, linear stretching, deep pressure massage, traction and/or separation of muscle origin and insertion. Such manipulations, under anesthesthetic, aim to decrease muscle spasms and increase tissue mobility.

ñ Articulatory procedures (mobilization without impulse, low velocity techniques). These manipulative techniques involving putting the articulation through a full anatomic range of motion and applying a passive serial repetitive oscillatory rhythmic springing force in the direction of the restriction. Treating the periarticular and articular tissue, such manipulation under anesthesia procedures aim to increase both the quantity of motion (by gradually moving the restrictive barrier and restoring the range of motion) and the quality of motion (by reestablishing a smooth range of motion with normal elasticity and feel).

ñ Specific joint mobilization procedure (mobilization with impulse, high velocity technique). This manipulative procedure involves an extrinsic operator-applied thrust overcoming restrictive articular movement to achieve normal joint movement. Treating the articular and intra articular tissue, this manipulation under anesthesia procedure aims to increase the joint's range of motion, reduce joint restrictions, decrease hypertonicity (increased tension of the muscles) and stretch the shortened, fibrosed connective tissues of the articulation.

Even though there is usually some temporary muscle soreness (similar to the feeling of having completed an aggressive exercise session) after the manipulation, the patient should experience an immediate increase in range of motion post-anesthesia care. In cases involving symptoms caused by disturbance from adhesions and shortened tissues, there should be a significant change immediately (or within a short period) following the manipulation procedures.

In an effort to minimize the re-formation of adhesions, passive manipulation and active exercises are often prescribed for 6 weeks after the manipulation under anesthesia procedure. Some use of additional therapies may also be prescribed, such as:

• Electrical muscle stimulation
• Ultrasound
• Hot moist packs
• Massage

The medical literature demonstrates that for over 40 years, chronic neuromuscular skeletal conditions that have failed the conservative protocol may respond well to manipulation under anesthesia.

1. 83% of 600 patients with EMG-verified radiculopathies reported significant improvement following manipulation under anesthesia (Robert Mensor, MD).

2. Patients that had back pain for a minimum of 10 years reported an 87% recovery rate after MUA (1987 with Ongly et al).

3. 51% of patients with unrelieved symptoms after conservative care had been exhausted reported good to excellent results three years post MUA (Donald Chrisman, MD).

4. 71% of 723 MUA patients had good results (return to normal activity relatively symptom free) and 25.3% had fair results (return to normal activity with slight residuals) after manipulation under anesthesia. MUA was also found able to restore flexibility, elasticity and range of motion (Bradford and Siehl).

5. 83% of 517 patients treated with MUA responded well (Paul Kuo, MD professor of Orthopedic Surgery).