Pain Management Manipulation under Anesthesia

By Michael Dorausch, D.C.

I received a fax at my chiropractic office today with a headline that read Pain Management Manipulation under Anesthesia. There’s nothing unusual about the office receiving faxes, we get several a day. This one caught my attention than I thought it was pretty funny (you may think it’s pretty sad).

Some event is going on in Texas, regarding training for Manipulation under Anesthesia, also known as MUA. On the fax it states that “MUA is one of the most exciting chiropractic physical medicine procedures being performed today..” What in hojimeny is chiropractic physical medicine? Is this stuff being taught at colleges? I’ve heard of physical medicine, and I am familiar with the term chiropractic medicine, but I’d never heard the terms combined. I guess this is what you could call long tail use of words.

A sentence later in the fax says that MUA expands the primary role of the chiropractic physician in chronic pain management and physical medicine. I knew I’d be seeing that term somewhere. I’m wondering if what they really meant to say was a chiropractor can be making lots more money making believe they are a medical doctor, instead of practicing chiropractic.

Interesting that this is a 34 hour course, which is made up of 18 hours lecture, 12 hours clinical proctorship, and four hours of literature review. Wow, after one weekend you could be a certified manipulator. It’s a good thing the people having their bones jerked around are under anesthesia, be sure to show them your weekend course certificate when they come to, that should get some laughs. Research shows laughter is good for healing.

Let me ask you, if this was something that was really a benefit to patients, shouldn’t that be listed? The fax includes 10 reasons to incorporate MUA, and only one mentions anything about offering pain relief for patients. The rest of the advantages listed include: increased medical referrals, two hour a day practice, no overhead expenses, see only six patients per week, increase your income by four or five figures per week, obtain outpatient surgery center privileges and secure hospital privileges.

All of this great stuff is being provided by some Manual Medicine Academy and I don’t believe there’s any affiliation to any chiropractic group, organization, or college. Sounds like a lot of fun (kidding) but I’ll be busy that weekend in October.

15 thoughts on “Pain Management Manipulation under Anesthesia”

  1. This profession is headed toward and so many think anything for a buck. Its not about the patient its how can the Doc make more money. Its Sad

  2. I have to tell you I saw this sardonic post regarding the the MUA procedure and I just thought some might like to know how the MUA procedure helped me. Heck, it has literally given me my life back.
    I have some of my family members suffer terrible declines after spinal surgeries with cadaver discs, etc and never regain anywhere near to the range of motion they had before surgery.
    MUA is a BLESSING and a true breakthrough. I saw what happened to my aunt with spinal sugery but Imagine I avoided surgery and the nerve damage that would have happened and got 90% of my range of motion and flexibility back with a non invasive procedure and only mild discomfort that felt like the day after a tough workout at the gym.
    I don’t know how much the Dr’s make at it, but my Dr. is fantastic you can tell he got into this field to help people, to see them have the highest possible quality of life. He deserves every penny I am so glad he was able to offer MUA I wasn’t going under the knife I would have just took the wheelchair if it came to that but the MUA gave me my life back. I am virtualy pain free for 8 months.
    I don’t think Dr. Dourach knows a lot about MUA. I was consious during it all they just numbed the area and it is very gentle but they are able to stretch and adjust more than they could on me normally and I was very comfortable. Anyway that is my story I am so thankful for chiropractic and I am more thankful that chiropractors now thanks to MUA can do so much more to help patients like me.
    All the best!

  3. Yes MUA is affiliated with Chiropractic Colleges. Texas Chiropractic College and Bridgeport University to mention a couple.
    MUA has been a blessing for many of my patients. I have personally been performing MUAs since 1992, and I can tell you this procedure works and works well.

  4. Is MUA ok for someone with mild osteoporosis of the neck? I’m 60 with severe range of motion of the neck.

  5. Kathleen, Yes MUA can be performed on someone with mild osteoporosis. I would suggest you find a physician in your area that does MUA to get more specific information.

  6. Any clues on how to get insurance to pay for MUA of the spine? My insurance company says it is investigational, it is United HealthCare.

  7. MUA is not experimental or investigational. It has been around for 60 years and paid for by Medicare. Medicare has become the gold standard for medicine. If medicare recognizes it then it would generally not be considered experimenta or investigational. Unfortunately because health insurance is private they have the right to deny any procedure they want to. You as a client of that company can argue for it. Consult your MUA doctor to find out the procudure codes under medicare (use those terms to ask the doctor, he/she will know what you are talking about) and send a letter to United telling them this is a procedure recognized by medicare.

    To Dr. Dorausch, I felt the same way you did when I first learned about MUA and I will agree with you that the marketing of the procedure does give the appearance of a snake oil sales man. However when you take the class you learn some really good techniques that you can use in your office. The reason the course is only a few hours is because we (chiropractors) have a fairly limited role in the procedure as a matter of fact after certification our mal prac rates do not increase at all. The procedure is a lot of deep stretching following the stretch you adjust. The adjustments are no more robust then what you would perform at your office. That fact that insurance pays for it great, why not make a lot of money for a service that really helps people.

    You should really take the course before you comment on something you haven’t experienced. You may be surprised.

  8. I am really surprised at Michael Dorausch, DC I have worked with Chiropractors for many years and I have learned so much. I have never met or read any Chiropractor being so negative. Chiropractors are there to give hope and to help people in pain. I pushed the Doctor that I worked for to go through the MUA class not just for the learning experience but, I wanted him to have rights at our ER. After it was all done and said he is certified and is making alot of people happy and able to function again. I no longer work for him… I now work for the surgery center that performs the MUAs. That is how much i believe in it. So again Dr. Michael please do your homework before you try and step on toes of other Doctors and patients that have or are going to do the procedure or the class. ITS WONDERFUL AND IT IS EFFECTIVE.

  9. Carol…
    If you have United Health Care they say it is experimental but, They will pay for the procedure. I do all the billing for the MUAs and as long as you have the information to back up why you want the procedure done then you as a client of United Health Care need to have the right to have it done. As David said its not experimental. Been around for over 60 years and Medicare recognizes it. Good Luck

  10. I was wondering if any of the D.C.’s who posted would be able to comment on the different trainings available for MUA. I have looked out there and there seems to be debate about whether all courses are accepted or recognized.

  11. I would like to find a Chiropractor who performs MUA and accepts Medicare and GHI as full payment in the N.Y.C. area


    Presented By


    Co-Sponsored By

    of Manual and Physical Medicine


    College of Chiropractic

    Fort Lauderdale, Florida May 22-24th 2008

    Universal Surgical Center
    Nicci D’Skyy
    [email protected]/

    For registration and information:

    Class size is limited!

  13. I am near retirement after having practiced Chiropractic Medicine for over 30 years. I was an appointed member of the Florida Board of Chiropractic Medicine when we were asked to determine the protocols for MUA in Florida. We, the board, worked on this for months. We came up with a very thorough document defining safe protocols. At the beginning of the Board of Chiropractic meeting, (over six years ago) where we were to adopt the protocols, our board attorney made some very convincing recommendations: 1. There was no need for the Board of Chiropractic to adopt the protocols. 2. There were already standards of practice for MUA in place within the medical practice act. This may sound confusing but our board attorney explained: A chiropractor can take courses to familuarize himself and correctly administer the adjustment. The Anesthesiologist can administer the medications. The procedure must be conducted in the appropriate medical setting, which is controlled by the medical authority, not the chiropractic authority. ie surgery center, hospital or private medical office with all the required skilled backups. We as The Florida Board of Chiropractic Medicine
    decided that no move was necessary. Adopting medical protocols was not within the scope of our Practice Act. The document we do diligently work on was made available to anyone who wanted to use it as a guideline.

  14. I can see the DC who wrote this obviously doenst believe in MUA but thank god for the ones who do!!! I am a mother of 4, and after two surgery I could only get 50% of range of motion in my arm. I have 95% after my MUA. I dont think the doctors are taught in a few hours but building on what they are taught in school.
    I am thankful to my doctor and surgery center for MUA’s and suggest any patient to get a doctor who believes in them for their opinion since I know first hand it can give you your life back
    D Smith

  15. Proper manipulation/adjustment of a patient requires their willing surrender of guarding reflexes, which is generally accomplished by establishing rapport and developing trust, or the application of massage or ultra sound. However, extensive fibrosis/scar tissue, or degenerative joints (arthritis), as well as other pain generators or anxiety may leave the patient in a state of hyper-vigilance that makes it difficult or impossible to achieve the desired effect. While I have never performed MUA, I have referred patients for pain management prior to treatment, and the combination of Vicodin and Valium renders the patient unguarded and highly cooperative, if still conscious. In any event, skillful performance improves outcomes.

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