When asked about MUA and it's effect on TOS, Dr. Gordon says:
“In my experience in the 31 years that I have been in practice I feel that I have actually experienced maybe 100 true TOS cases. And more recently I have experienced more of these cases because I have been referred upper extremity..neck ..and mid back pain patients that were actually experiencing TOS. MUA is a technique that relaxes the whole body and gives the trained practitioner time to stretch and mobilize the neuromusculoskeletal system in a way that has never been able to be performed in the past. Sure many tried to do something similar to what we do now...but in the end...the treatments were a mimick of many other types of compression reduction therapies. By the use of relaxation techniques and stretching that is able to be acccomplished during manipulation under anesthesia...we feel we are able to refine the decompression necessary to reduce the inflammatory response in the neurological components as well as the vascular components of TOS. During cervical traction for instances...the muscles are so relaxed, (even though they are not flaccid) that it is possible to alter the underlying elastic quality of the muscle and stretch the muscles gently into eventual full arthrokenic sequence of elongation. Now this takes more than one procedure...and certainly takes follow-up concentrated post care. But it is possible to make these changes...and in the process greatly decompress the component elements that cause the continuous "tension" on the structures that traverse the clavicle and the first rib. This type of treatment also has a lasting effect, if the patient will follow the post care... that will help control the return of TOS as has been experienced in the past by many TOS patients. Articular movement is also very important in treating TOS and obviously in reducing the compression on these elements that cause the pain. But I truely feel that it is the specific stretching that we are able to accomplish with the patient not responding with immediate secondary muscle contraction...that makes it possible to improve and even eliminate TOS. I hope this gives a little insight into what we try to do with this technique.”
Dr. Gordon says on his website "Spinal manipulation under anesthesia is a procedure that primarily originated with the osteopathic profession and has been utilized for the treatment of spinal pain since the 1930’s. Documentation regarding the success and value of manipulation under anesthesia has been recorded in the osteopathic literature since 1948 when Clybourne reported in the Journal of American Osteopath Association a success rate of 80-90% which has been maintained to this day. In the last two decades the emphasis regarding manipulation in osteopathic education has greatly decreased. Therefore, the osteopaths that had been adequately trained in manipulation are coming to close of their career or have retired. Because of the need for continuance of this procedure, the focus for the performance of spinal manipulation under anesthesia has now shifted to chiropractic and their expertise in spinal manipulative skills.
Spinal manipulation under anesthesia is a procedure that is intended for patients that suffer from sometimes acute, but mostly chronic musculoskeletal disorders in conjunction with biomechanical aberrancies. These individual have also been unresponsive to previous conservative therapy.
Etiology of their pain can be a disc bulge/herniation, chronic sprain/strain, failed back surgery, myofacial pain syndromes in conjunction with those listed below. The procedure is extremely beneficial; for the patient that has muscle spasm accompanied with pain and terminal joint range of motion loss. These types of patients typically respond well to manipulation/physical therapy/exercise, but their relief may only be temporary (days to weeks). To ensure good result results with a procedure of this type, one of the most important considerations is patient selection. The indications being adhered for this procedure are as follows.
1. Bulging protruded, prolapsed or herniated discs without free fragment and are not surgical candidates.
2. Frozen or fixated articulation from adhesion formation.
3. Failed low back surgery
4. Compression syndromes with or without radiculopathies causes from adhesion formation, but not associated with oseteophytic entrapment.
5. Restricted motion, which causes pain and apprehension from the patient but manipulation, is the therapy of choice.
6. unresponsive to manipulation and adjustment when they are the therapy of choice
7. Unresponsive pain, which interferes with the function of daily life and sleep patterns, but f which fall within the parameters for manipulative treatment.
8. unresponsive muscle contracture which is preventing normal daily activates and function
9. Post-traumatic syndrome injuries from deceleration/acceleration types of injuries which result in painful exacerbation of chronic fixations.
10. Chronic recurrent neuromusculoskeletal dysfunction syndromes syndrome, which result in a regular periodic treatment series that are always exacerbation of the same condition.
11. Neuromusculoskeletal condition that re not surgical candidates but have reached MMI, especially with occupational injuries.
[Many candidates for] Mua have been relatively unresponsive to other conservative methods of treatments and not much more is available through the traditional health care delivery system
As with any procedure, there are no guarantees of success. However, if the protocol is adhered to, the likelihood of a positive outcome is increased. It is also extremely imperative that the physician providing the manipulation is properly trained and proficient in providing manipulation while the patient is under anesthesia.
Professional differences of opinions regarding MANIPULATION UNDER ANESTHESIA are common. Once an adequate explanation of the procedure and clinical rationale for performing the procedure is understood, MUA is generally well accepted within the chiropractic and medical communities. This is truly a multi-disciplinary approach for the treatment of spinal pain."
