Our practice provides patients who have not benefited from conservative care an alternative to surgery. By utilizing the most advanced techniques in pain management such as Epidurals, Facet Joint Blocks, and Sacroiliac Injections under x-ray guided fluoroscopy, our patients can return to their normal lifestyles. For the more advanced cases, procedures such as Percutaneous Discectomy and Neural Ablation have been utilized with great success.

Both Manipulation Under Anesthesia (MUA) and Manipulation Under Joint Anesthesia (MUJA) are two procedures that would prove excellent choices for patients who continue to suffer from recalcitrant pain.

These procedures are executed in a properly equipped surgical suite to allow for optimal setting of both injections and the manipulation being performed. Upon completion of the injection, whether it is an epidural, facet block, trans-foraminal, or sacroiliac, the manipulation under joint anesthesia is then performed. A series of facial lengthening, tendon stretching and ligamentous mobilization along with the realignment of the joint are carried under conscious sedation. These results are attained by using passive stretches, myofascial release, and specific articular and adjustment procedures.

“The basic concepts behind the mobilization, manipulation, and adjusting procedures while the patient is under a sedative/hypnotic, is to increase ligamentous, tendinous, and muscular flexibility that has not been achieved in the office therapeutic routine. Standard manipulative techniques are used, but the physiologic state of the patient is changed and the procedure is done in a controlled environment. When used on properly selected patients, it is more cost effective and more productive to the patient’s return to normal lifestyle than prolonged conservative care or possible surgical intervention.” (1)

The rational for using sedation is to allow those patients who cannot tolerate any use of manual techniques due to muscle guarding, spasm, severe pain, and muscle contractors to regain their activities of daily living and begin a structured regime of home exercise.

Chronic cases which have shown no improvement with conventional approaches should consider this in the next phase of their treatment, prior to surgical intervention.

1 — Gordon R. Conservative. Chiropractic adjustive therapy versus MUA adjustive therapy. Florida Chiropractic J 1993;1:22-3.