MUA

WHAT IS MUA?

Manipulation under anesthesia (MUA) is the use of manual manipulation of the spine, hips, shoulders and knees while under light anesthesia.

After medical clearance has been given according to the standards of care as described by the National Academy of MUA Physicians; the patient is lightly anesthetized, allowing 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. MUA uses a combination of specific manipulations and passive stretches.

For more and more patients who are not finding relief through conventional treatments and other invasive procedures such as surgery, spinal injections, MUA combined with consistent but simple post-procedure treatment and physical therapy can eliminate or greatly reduce pain and restore or greatly improve range of motion. Plus, MUA procedures are cost-effective - thousands of dollars less than traditional surgery and other more invasive treatments - and usually qualify for insurance coverage.

In addition, return-to-work is much faster, allowing MUA patients to get back to work and the pleasure of living much sooner than expected.

IS MUA NEW OR EXPERIMENTAL?                                                          

MUA is neither new nor experimental. It’s actually been practiced since the late 1930s and used by osteopathic physicians and orthopedic surgeons. Countless studies have documented the effectiveness of MUA in treating musculoskeletal disorders.

Today, MUA is a multi-disciplinary outpatient procedure that takes place in a controlled hospital or ambulatory surgical setting, usually over the course of one to three days.

Using specialized techniques supported by the expertise of MDs, RNs and anesthesiologists, MUA achieves maximum results for qualified patients.

WHO CAN BENEFIT FROM MUA?

MUA can be a valuable procedure for people with chronic neck, back and joint problems - conditions caused by long-term disabilities, accidents, and injuries that have not been responsive to conventional treatment - but MUA is not for everybody.

Common, general indications that MUA could be effective include:

• Scar tissue build up
• Pinched Nerves
• Arthritis
• Chronic disc problems
• Herniated disc without fragmentation
• Chronic myofascitis
• Intractable pain from neuromusculoskeletal conditions
• Torticollis
• Chronic re-injury
• Failed back surgery

Patients who have reached a plateau using traditional therapy also can significantly improve their quality of life using MUA.

WHY DOES MUA WORK?

MUA achieves results where other treatments fail because it allows your doctor to manipulate the bones and muscles - the therapy of choice - without the usual resistance and pain.

Manipulations are completed gently, and without the patient’s usual pain-trained psychological resistance.

Fibrotic adhesions, which limit range of motion and contribute to pain, are altered; muscles are stretched; collagen fibers are remodeled to eliminate or reduce restriction. Pain and discomfort are decreased.

DOES INSURANCE COVER MUA?

MUA is covered by most insurance, including workers compensation and no fault policies. The coverage is dependent on medical necessity for the procedure. You will be carefully evaluated for medical necessity before a decision as whether you are a candidate for MUA. The evaluation will consist of a complete history and physical examination, an x-ray examination which may include CT scan, and or MRI. You may further need a laboratory examination and electro diagnostic tests.

WHAT IS THE MUA PROCEDURE LIKE?

The day before the procedure the patient is instructed regarding food restrictions and the use of medication. On the day of the MUA, 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 following this procedure.

The patient then confers with the anesthesiologist, is gowned and the anesthesia - usually Diprivan and/or Versed, and sometimes Fentanyl or Propofal is administered to achieve the relaxed state that makes treatment possible.

If the full spinal procedure is performed, MUA begins with specialized techniques that first methodically start in the cervical spine with gentle axial traction, forward flexion and lateral flexion movements and adjustive procedures. This is followed by soft tissue massage to relax the muscle groups.

The doctor then moves on to the thoracic spine, using mild stretching techniques and adjustment . . . and finally into the lumbar spinal regions using flexion and traction techniques plus stretching, targeted massage and knee-to-chest rolls as well as lumbar adjustment.

WHAT HAPPENS AFTER THE PROCEDURE?

After the procedure is completed, the patient is repositioned and awakened. then taken to recovery where he or she is carefully monitored by the OR nurse.

Recovery time is generally fifteen to twenty minutes. After recovery, the patient receives fluids and a light snack. The doctor and anesthesiologist will remain in attendance until the patient is discharged.

To achieve results in the most chronic cases, the MUA procedure is repeated. The doctor may adjust only the area of abnormality depending on the doctor’s assessment of the condition.

Post-procedure care is one of the most important parts of the MUA procedure and makes it truly effective.

The therapy begins immediately - the same day - after each MUA procedure is completed.

At this time the patient visits the doctor’s office and undergoes a combination of stretching exercises, cryo-therapy and electrical stimulation to eliminate or reduce soreness. The patient then returns home to rest.

Following the last MUA procedure, the patient should follow an intensive therapy program for five days. This post MUA therapy should be the same stretches accomplished during the MUA procedure and adjustments made in the doctor’s office.

This is followed by rehabilitation for the next four to six weeks including stretching, flexibility and strengthening exercises, plus periodic adjustments as required by the doctor.

A regimented program of post-MUA therapy will help the patient regain both pre-injury strength and help prevent future pain and disability.

References
Journal of Manipulative and Physiological Therapeutics Vol22, Number 5, June 1999
Effective Management of Spinal Pain in One Hundred Seventy – seven Patients evaluated for MUA
Daniel T. West, DC, Robert S Matthews, MD, Matthew Miller, and George M. Kent, MD
Journal of manipulative and physiological therapeutics Vol 22, Number 3, March/April 1999

Spinal Pelvic Stabilizers
 

The Foundation of Your Body

Your feet are the foundation of your body. They support you when you stand, walk, or run. And they help protect your spine, bones, and soft tissues from damaging stress as you move around. Your feet perform better when all their muscles, arches, and bones are in their ideal stable positions.

The foot is constructed with three arches which, when properly maintained, give exceptional supportive strength. These three arches form a supporting vault that distributes the weight of the entire body.

If there is compromise of one arch in the foot, the other arches must compensate and are subject to additional stresses, which usually leads to further compromise.

It’s a chain reaction.

Healthcare professionals know alleviating pain in one part of your body often requires treating a different part. The pain you feel in your neck could be caused by a misalignment in your spine that is caused by unbalanced positioning in your feet. See? It’s a chain reaction.

By stabilizing and balancing your feet, Foot Levelers orthotics enhance your body’s performance and efficiency, reduce pain, and contribute to your total body wellness. Our orthotics complement your healthcare professional’s treatment when you stand, walk, and live your active life.

How Spinal Pelvic Stabilizers Work

Patients with certain types of spinal problems benefit from custom made orthotic support (SPS Stabilizers, Shoethotics®, or Sandalthotics®). These devices stabilize the foundation of the pelvis and spine by first addressing structural problems with the feet, thereby reducing abnormal forces and stresses, while enhancing structural and functional relationships.

• Understanding Human Biomechanics
• Understanding Pronation
• Postural Effects from Imbalances in the Feet
• Benefits of Spinal Pelvic Stabilizers
• How Spinal Pelvic Stabilizers Work
• About Foot Levelers’ Spinal Pelvic Stabilizer (SPS) Orthotics

Understanding Human Biomechanics:

• The joints and muscles of the body function most efficiently when they are in physical balance. Principles of engineering have shown that with any physical entity, whether it is a bridge, a building, or the human body— Structure dictates function.
• The body is a biomechanical kinetic chain where abnormal movements at one line, or joint, can interfere with proper movements at other joints.
• During standing and walking, our bodies are subjected to natural forces and postures that can inflict mechanical stress and strain throughout the interrelated chain of joints and muscles.
• When foot imbalance is present, there is a negative impact on the knees, hips, pelvis, and spine. Some patients must have these abnormal forces reduced before they can achieve improved spinal function.

Understanding Pronation:

• Pronation describes the rotation of a body part downward or inward. It is actually a normal motion that occurs when walking; however, if it happens excessively, pronation can cause global postural problems. The major cause of over-pronation is a decrease in the arch height.

Postural Effects from Imbalances in the Feet:

• A loss of arch height will cause a flattening and rolling in of the foot— this is termed pronation. Because everything is connected, the bones of the leg also inwardly rotate.
• Excessive rotation of the bones of the leg (tibia and femur) will cause unnecessary stresses on the knee as well as twisting of the pelvis and spine. If the pronation is more prevalent on one side, there can be a resultant unleveling of the pelvis and a functional scoliosis.
• Tilting of the pelvis places tension on muscles and connective tissues, which can eventually lead to chronic back problems.
• High levels of heel-strike shock can result from breakdown of the body’s natural “shock absorbers.” The shock wave then transmits up the kinetic chain causing painful symptoms all the way up to the head, slowed recovery of leg and spine injuries, and aggravation of other conditions.

Benefits of Spinal Pelvic Stabilizers:

• Properly fitted Spinal Pelvic Stabilizers support the foot to control excessive and unwanted pronation and supination. This helps to reduce unwanted stress on the body.
• Improved shock absorption reduces repetitive stress on joints and muscles, permitting smoother function and decreasing arthritic symptoms.
• Use of Spinal Pelvic Stabilizers represents a long-term, yet cost-effective intervention for many types of functional and structural problems.

How Spinal Pelvic Stabilizers Work:

• Wearing Spinal Pelvic Stabilizers inside your shoes is similar to placing a shim beneath the leg of a wobbly table: it adds support to eliminate unwanted motion in the entire structure.
• The foot is formed of three distinct arches, which create an architectural vault. The result of supporting these three arches is improved stability and postural integrity.
• Flexible Spinal Pelvic Stabilizers encourage optimal muscle and nerve function by guiding the feet through a more normal pattern with each step taken.

About Foot Levelers’ Spinal Pelvic Stabilizer (SPS) Orthotics:

• Foot Levelers, Inc., a leading supplier for 50 years, creates custom-made, flexible Spinal Pelvic Stabilizers to match each patient’s unique needs.
• Using weightbearing impression images of the feet in the position of function (either from a foam casting kit or a digital scanning system), along with instructions from the healthcare professional,
• Skilled laboratory technicians create unique Spinal Pelvic Stabilizers designed to correct and support areas of weakness.
• The combination of flexible, yet supportive and durable construction materials ensure that the stabilizers will both guide the feet when walking and provide support during long periods of standing.

Unlike other stabilizing technologies, which use rigid materials to force the feet into a theoretical “ideal” position and may result in muscle atrophy and abnormal nerve proprioception, Foot Levelers’ allow controlled, supported movement for the dynamic human body.

Treatment of Fibromyalgia

What is Fibromyalgia?
Fibromyalgia (FM) is a chronic pain illness characterized by widespread musculoskeletal aches, pain, and stiffness, soft tissue tenderness, general fatigue, and sleep disturbances. The most common sites of pain include the neck, back, shoulders, pelvic girdle, and hands, but any body part can be affected. Fibromyalgia patients experience a range of symptoms of varying intensities that wax and wane over time.

Who is affected?
It is estimated that approximately 5-7% of the U.S. population has FM. Although a higher percentage of women of all ages and races are affected, although it does strike men and children.

What are the symptoms?
FM is characterized by the presence of multiple tender points and a constellation of symptoms.

Pain:
The pain of FM is profound, widespread and chronic. It migrates to all parts of the body and varies in intensity. FM pain has been described as deep muscular aching, throbbing, twitching, stabbing and shooting pain. Neurological complaints such as numbness, tingling and burning are often present and add to the discomfort of the patient. The severity of the pain and stiffness is often worse in the morning. Aggravating factors that affect pain include cold/humid weather, non-restorative sleep, physical and mental fatigue, excessive physical activity, physical inactivity, anxiety and stress.

Fatigue:
The fatigue of FM is much more than being tired. It is an exhaustion that leaves one feeling drained of energy which interferes with even the simplest daily activities.

Sleep Problems:
Many fibromyalgia patients have an associated sleep disorder that prevents them from getting deep, restful, restorative sleep.

Other Symptoms:
Additional symptoms may include: irritable bowel and bladder, headaches and migraines, impaired memory and concentration, skin sensitivities and rashes, dry eyes and mouth, anxiety, depression, ringing in the ears, dizziness vision problems, neurological symptoms, and impaired coordination.

How is it diagnosed?
Currently there are no laboratory tests available for diagnosing fibromyalgia. Doctors must rely on patient histories, self-reported symptoms, a physical examination and an accurate manual tender point examination. This exam is based on the standardized ACR criteria. Proper implementation of the exam determines the presence of multiple tender points at characteristic locations.

To receive a diagnosis of FM, the patient must meet the following diagnostic criteria:

• Widespread pain in all four quadrants of the body for a minimum duration of three months
• Tenderness or pain in at least 11 of the 18 specified tender points when pressure is applied (see figure)

What causes FM?
While the underlying cause or causes of FM still remain a mystery, most researchers agree that FM is a disorder of central processing with neuroendocrine/neurotransmitter dysregulation. Medical researchers have just begun to untangle the truths about this life-altering disease.

Recent studies show that genetic factors may predispose individuals to a genetic susceptibility to FM. For some, the onset of FM is slow; however, in a large percentage of patients the onset is triggered by an illness

or injury that causes trauma to the body. These events may act to incite an undetected physiological problem already present.

How is FM treated?
One of the most important factors in improving the symptoms of FM is for the patient to recognize that lifestyle adaptation can bring about recognizable improvement in function and quality of life. Becoming educated about FM gives the patient more potential for improvement.

An empathetic physician who is knowledgeable about the diagnosis and treatment of FM and who will listen to and work with the patient is an important component of treatment. Medical intervention may be only part of a potential treatment program. Alternative treatments such as nutrition, relaxation techniques and exercise play an important role in FM treatment as well. Each patient should, with the input of a doctor, establish a multifaceted and individualized approach that works for them.

This can include: physical therapy, therapeutic massage, acupressure, the application of heat or cold, acupuncture, yoga, relaxation exercises, breathing techniques, herbs, nutritional supplements, MUA, and chiropractic manipulation.

The symptoms of FM can vary in severity and often wax and wane, but most patients do tend to improve over time.

References:
National Fibromyalgia Association: http://www.fmaware.org/
The Mayo Clinic: http://www.mayoclinic.com/health/fibromyalgia/DS00079
The National Institute for Health: http://www.nlm.nih.gov/medlineplus/fibromyalgia.html

Treatment of Fibromyalgia

What is Fibromyalgia?
Fibromyalgia (FM) is a chronic pain illness characterized by widespread musculoskeletal aches, pain, and stiffness, soft tissue tenderness, general fatigue, and sleep disturbances. The most common sites of pain include the neck, back, shoulders, pelvic girdle, and hands, but any body part can be affected. Fibromyalgia patients experience a range of symptoms of varying intensities that wax and wane over time.

Who is affected?
It is estimated that approximately 5-7% of the U.S. population has FM. Although a higher percentage of women of all ages and races are affected, although it does strike men and children.

What are the symptoms?
FM is characterized by the presence of multiple tender points and a constellation of symptoms.

Pain:
The pain of FM is profound, widespread and chronic. It migrates to all parts of the body and varies in intensity. FM pain has been described as deep muscular aching, throbbing, twitching, stabbing and shooting pain. Neurological complaints such as numbness, tingling and burning are often present and add to the discomfort of the patient. The severity of the pain and stiffness is often worse in the morning. Aggravating factors that affect pain include cold/humid weather, non-restorative sleep, physical and mental fatigue, excessive physical activity, physical inactivity, anxiety and stress.

Fatigue:
The fatigue of FM is much more than being tired. It is an exhaustion that leaves one feeling drained of energy which interferes with even the simplest daily activities.

Sleep Problems:
Many fibromyalgia patients have an associated sleep disorder that prevents them from getting deep, restful, restorative sleep.

Other Symptoms:
Additional symptoms may include: irritable bowel and bladder, headaches and migraines, impaired memory and concentration, skin sensitivities and rashes, dry eyes and mouth, anxiety, depression, ringing in the ears, dizziness vision problems, neurological symptoms, and impaired coordination.

How is it diagnosed?
Currently there are no laboratory tests available for diagnosing fibromyalgia. Doctors must rely on patient histories, self-reported symptoms, a physical examination and an accurate manual tender point examination. This exam is based on the standardized ACR criteria. Proper implementation of the exam determines the presence of multiple tender points at characteristic locations.

To receive a diagnosis of FM, the patient must meet the following diagnostic criteria:

• Widespread pain in all four quadrants of the body for a minimum duration of three months
• Tenderness or pain in at least 11 of the 18 specified tender points when pressure is applied (see figure)

What causes FM?
While the underlying cause or causes of FM still remain a mystery, most researchers agree that FM is a disorder of central processing with neuroendocrine/neurotransmitter dysregulation. Medical researchers have just begun to untangle the truths about this life-altering disease.

Recent studies show that genetic factors may predispose individuals to a genetic susceptibility to FM. For some, the onset of FM is slow; however, in a large percentage of patients the onset is triggered by an illness

or injury that causes trauma to the body. These events may act to incite an undetected physiological problem already present.

How is FM treated?
One of the most important factors in improving the symptoms of FM is for the patient to recognize that lifestyle adaptation can bring about recognizable improvement in function and quality of life. Becoming educated about FM gives the patient more potential for improvement.

An empathetic physician who is knowledgeable about the diagnosis and treatment of FM and who will listen to and work with the patient is an important component of treatment. Medical intervention may be only part of a potential treatment program. Alternative treatments such as nutrition, relaxation techniques and exercise play an important role in FM treatment as well. Each patient should, with the input of a doctor, establish a multifaceted and individualized approach that works for them.

This can include: physical therapy, therapeutic massage, acupressure, the application of heat or cold, acupuncture, yoga, relaxation exercises, breathing techniques, herbs, nutritional supplements, MUA, and chiropractic manipulation.

The symptoms of FM can vary in severity and often wax and wane, but most patients do tend to improve over time.

References:
National Fibromyalgia Association: http://www.fmaware.org/
The Mayo Clinic: http://www.mayoclinic.com/health/fibromyalgia/DS00079
The National Institute for Health: http://www.nlm.nih.gov/medlineplus/fibromyalgia.html

Treatment of Fibromyalgia

What is Fibromyalgia?
Fibromyalgia (FM) is a chronic pain illness characterized by widespread musculoskeletal aches, pain, and stiffness, soft tissue tenderness, general fatigue, and sleep disturbances. The most common sites of pain include the neck, back, shoulders, pelvic girdle, and hands, but any body part can be affected. Fibromyalgia patients experience a range of symptoms of varying intensities that wax and wane over time.

Who is affected?
It is estimated that approximately 5-7% of the U.S. population has FM. Although a higher percentage of women of all ages and races are affected, although it does strike men and children.

What are the symptoms?
FM is characterized by the presence of multiple tender points and a constellation of symptoms.

Pain:
The pain of FM is profound, widespread and chronic. It migrates to all parts of the body and varies in intensity. FM pain has been described as deep muscular aching, throbbing, twitching, stabbing and shooting pain. Neurological complaints such as numbness, tingling and burning are often present and add to the discomfort of the patient. The severity of the pain and stiffness is often worse in the morning. Aggravating factors that affect pain include cold/humid weather, non-restorative sleep, physical and mental fatigue, excessive physical activity, physical inactivity, anxiety and stress.

Fatigue:
The fatigue of FM is much more than being tired. It is an exhaustion that leaves one feeling drained of energy which interferes with even the simplest daily activities.

Sleep Problems:
Many fibromyalgia patients have an associated sleep disorder that prevents them from getting deep, restful, restorative sleep.

Other Symptoms:
Additional symptoms may include: irritable bowel and bladder, headaches and migraines, impaired memory and concentration, skin sensitivities and rashes, dry eyes and mouth, anxiety, depression, ringing in the ears, dizziness vision problems, neurological symptoms, and impaired coordination.

How is it diagnosed?
Currently there are no laboratory tests available for diagnosing fibromyalgia. Doctors must rely on patient histories, self-reported symptoms, a physical examination and an accurate manual tender point examination. This exam is based on the standardized ACR criteria. Proper implementation of the exam determines the presence of multiple tender points at characteristic locations.

To receive a diagnosis of FM, the patient must meet the following diagnostic criteria:

• Widespread pain in all four quadrants of the body for a minimum duration of three months
• Tenderness or pain in at least 11 of the 18 specified tender points when pressure is applied (see figure)

What causes FM?
While the underlying cause or causes of FM still remain a mystery, most researchers agree that FM is a disorder of central processing with neuroendocrine/neurotransmitter dysregulation. Medical researchers have just begun to untangle the truths about this life-altering disease.

Recent studies show that genetic factors may predispose individuals to a genetic susceptibility to FM. For some, the onset of FM is slow; however, in a large percentage of patients the onset is triggered by an illness

or injury that causes trauma to the body. These events may act to incite an undetected physiological problem already present.

How is FM treated?
One of the most important factors in improving the symptoms of FM is for the patient to recognize that lifestyle adaptation can bring about recognizable improvement in function and quality of life. Becoming educated about FM gives the patient more potential for improvement.

An empathetic physician who is knowledgeable about the diagnosis and treatment of FM and who will listen to and work with the patient is an important component of treatment. Medical intervention may be only part of a potential treatment program. Alternative treatments such as nutrition, relaxation techniques and exercise play an important role in FM treatment as well. Each patient should, with the input of a doctor, establish a multifaceted and individualized approach that works for them.

This can include: physical therapy, therapeutic massage, acupressure, the application of heat or cold, acupuncture, yoga, relaxation exercises, breathing techniques, herbs, nutritional supplements, MUA, and chiropractic manipulation.

The symptoms of FM can vary in severity and often wax and wane, but most patients do tend to improve over time.

References:
National Fibromyalgia Association: http://www.fmaware.org/
The Mayo Clinic: http://www.mayoclinic.com/health/fibromyalgia/DS00079
The National Institute for Health: http://www.nlm.nih.gov/medlineplus/fibromyalgia.html