Manipulation Under Anesthesia for Spinal Pain

Spinal manipulation under anesthesia (MUA) is a non-invasive procedure that may be recommended to relieve chronic neck and back pain when other treatments have not worked. The procedure involves sedating the patient and performing spinal stretches and maneuvers that would otherwise be too painful due to muscle spasms and/or excessive scar tissue.

See Chronic Pain As a Disease: Why Does It Still Hurt?

While MUA is not as well-known as regular manual manipulation, it has been around for decades in various forms. This article focuses on MUA for spinal pain ranging anywhere from the neck down to the lower back.

See Understanding Spinal Manipulation


The Theory Behind Manipulation Under Anesthesia

For spinal pain that becomes particularly stubborn, especially with chronically tight muscle spasms, it is speculated that one of the causes may be excess scar tissue that has formed in or near joints from past injuries and/or surgeries. Also called fibrous adhesions, these scar tissues may cause chronic inflammation for nearby structures, such as nerves or muscles, and may make joints stiff and painful to move.

See Scar Tissue and Pain After Back Surgery

If spinal joints are too painful to move for physical therapy or manual manipulation treatments, a doctor may recommend manipulation under anesthesia. With anesthesia, the natural guarding mechanisms of the muscles relax, which enables doctors to put the joints through ranges of motion that would otherwise not be achievable with the patient awake. These manipulations performed under anesthesia are intended to break up or stretch the excess scar tissues so that they cause less resistance and inflammation.

How Spinal MUA Is Performed

To stretch out the scar tissue (fibrous adhesions) around the spine and surrounding tissue, spinal MUA uses a combination of manipulations typically performed by chiropractors or osteopaths, including specific short-lever spinal manipulations, articular and postural maneuvers, and passive stretches. However, the specifics of the procedure can vary significantly from clinic to clinic because the industry has not yet established formal standards for the procedure.1,2

Spinal MUA is performed in a hospital or surgery center by licensed doctors with specialized training and certification for the procedure. A team approach with multiple doctors and assistants is required to have a safe and successful outcome.

The manipulation procedures can be offered under various types of anesthetics:

  • General anesthesia with the patient completely unconscious for the entire procedure
  • Mild sedation with the patient awake for the procedure but not feeling pain nor likely to remember the procedure
  • Local anesthetic with the injection going into and numbing one specific location, such as the one or two most painful joints, allowing the patient to remain alert for the procedure

One session of spinal MUA generally takes less than an hour. Sometimes the procedure can be as short as 10 or 15 minutes but repeated on consecutive days in order to achieve a similar level of pain relief with less soreness from the procedure itself.

Who Performs Spinal MUA

The medical team performing spinal MUA typically includes:

  • Lead chiropractor or other doctor who performs the manipulation
  • Co-attending doctor who is a first assistant and also certified in manipulation under anesthesia
  • Anesthesiologist in charge of administering the anesthesia and monitoring the patient
  • Nurses and other assistants who may help throughout the procedure

Variations of the medical team’s size and expertise can vary from clinic to clinic. For example, some teams might be led by a physiatrist or orthopedic surgeon, rather than a chiropractor.

See Specialists Who Treat Back Pain

Symptoms Treated by Spinal MUA

Typically, spinal MUA is performed for chronic back and/or neck pain that involves tissue inflammation, muscle tenderness or spasm, and/or reduced range of motion. It may also be performed in certain cases where an entrapped nerve causes pain to radiate from the spine down into an arm or leg, or up into the head. Sometimes spinal MUA is performed for nonspecific spinal pain where the exact cause is unknown.

See Understanding Chronic Pain

While many patients and medical professionals have reported pain relief from spinal MUA, the procedure’s effectiveness has yet to be scientifically proven and further research is ongoing.


Spinal MUA Risks

Spinal manipulation under anesthesia’s risks can range from mild to life-threatening. While relatively rare, some of the more serious risks can include adverse reaction to anesthesia, worsening of an existing spinal condition, new injury during the procedure, stroke, paralysis, and others.3,4

To reduce the procedure’s risks, a thorough patient history and physical exam must be performed. In addition, most doctors require 6+ weeks of manipulation and physical therapy, x-rays, MRI of the injured areas, and EKG/ECG to rule a patient in or out as a candidate for spinal MUA.

See Chiropractic Diagnosis


  • 1.Gordon R, Cremata E, Hawk C. Guidelines for the practice and performance of manipulation under anesthesia. Chiropr Man Therap. 2014;22(1):7.
  • 2.Digiorgi D. Spinal manipulation under anesthesia: a narrative review of the literature and commentary. Chiropr Man Therap. 2013;21(1):14
  • 3.Hepner DL, MC Castells. Anaphylaxis during the perioperative period. Anesthesia & Analgesia. 2003; 97(5): 1381-95.
  • 4.Nielsen SM, Tarp S, Christensen R, Bliddal H, Klokker L, Henriksen M. The risk associated with spinal manipulation: an overview of reviews. Syst Rev. 2017;6(1):64.