What is manipulation under anesthesia (MUA)?

Manipulation under anesthesia, also referred to herein as MUA, is a type of non-invasive treatment performed by certain chiropractors who are trying to relieve a patient of chronic pain. In general, MUA is only offered to select candidates who tried other forms of care to no avail. Manipulation under anesthesia focuses on breaking up internal scar tissue that is left over from an injury or operation. This results in restoring movement and reducing painful symptoms. The treatment is most commonly used in the shoulders, neck, back and joints. 

When a patient is being treated with chiropractic care while sedated, they won’t be completely asleep. Rather, they will be in a state of “twilight”. This is similar to the state in which a patient undergoing a colonoscopy might be in. The sedation will let the chiropractor adjust the patients’ bones and joints, as well as stretch and align the muscles. At the same time the patient is so relaxed that they won’t resist the treatment. Manipulation under anesthesia involves less force than other chiropractic procedures. It is often less painful and very effective. 

The treatment is usually performed by a trained doctor who works in the chiropractic field, as well as osteopathy or orthopedics. It is a subspecialty and available in select clinics only. 

Why Choose MUA?

A majority of patients using chiropractic treatment will notice a decrease in their symptoms after a few sessions. They will respond well to the standard manipulation and rehabilitation. For these people MUA may not be necessary. That being said, a small number of people will find that their standard care is not doing enough. They might have relief for a few weeks only to experience a flare up of their symptoms. When this is true, a chiropractor might discuss manipulation under anesthesia. The benefits of MUA include:

MUA is cost effective

It is less invasive

It is safer than surgery

Insurance policies often cover MUA

Workers’ compensation usually covers MUA

Are You a Candidate for MUA?

Before you decide that you should undergo manipulation under anesthesia, it is important you talk with a chiropractor. Only a chiropractor, or other select medical professionals, can make a decision about MUA and whether it is right for you. A chiropractor may need to review your symptoms, medical history, and any previous chiropractic records. You may also need to undergo:

A physical exam

A neurological exam


A CT scan

X rays



Blood test 

Pregnancy test

Nerve conduction velocity test

If you have been diagnosed with the following, a chiropractor might talk to you about undergoing manipulation under anesthesia. 

Chronic disc pain

Acute muscle spasms

Chronic strains

Failed back operation

Fibrous adhesions 

Loss of motion

Chronic pain

Pinched nerves


The treatment is generally not suited to:

Pregnant women

People with cancer

Acute inflammatory gout

Inflammatory arthritis

Bone fractures

Severe obesity

Severe osteoporosis

A compressed spinal cord

Bone diseases

There are patients who may or may not be a candidate, but be unable to relate to any of the above. It is certainly possible that patients taking certain medications will not be able to undergo MUA. Only a doctor or chiropractor can help you to decide if you are a candidate.