Doctors who perform spinal manipulation under anesthesia (MUA) typically recommend post-procedure care. The goals of this care are to:

  • Manage general muscle soreness that may accompany the procedure.
  • Reduce the risk of excessive scar tissue (fibrous adhesions) reforming around the spine.
  • Continue gains in range of motion and movement. After spinal MUA, it is common for patients to have some fear of pushing past the point where pain was previously felt. So it is important to help patients with proprioceptive positioning (sense of one’s own body position) and overcoming the fear of causing pain to return.

See Scar Tissue and Pain After Back Surgery

Post-procedure care starts the same day as the spinal MUA and goes through different phases, typically finishing in about 6 weeks.

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Post-Procedure Care: Immediately After

Post-procedure treatments are typically started the same day the spinal MUA is completed. These treatments are usually done in the doctor’s office and may include:

  • Cold packs. Applying ice or a cold pack can help reduce inflammation, swelling, and pain. Care must be taken to check the skin periodically to avoid tissue damage. Cold pack applications are typically limited to 10 or 20 minutes at a time on the skin.
  • See Ice Packs for Back Pain Relief

  • Massage. Massaging the soft tissues may be encouraged as part of the post-procedure care to improve circulation, as well as continue loosening and relaxing the muscles and joints. Sometimes cold therapy is combined with massage, known as ice massage.
  • See Massage Therapy for Lower Back Pain

  • Electrotherapy. Typically using a battery-powered device that is connected to adhesive electrodes placed on the skin, an electrotherapy unit sends electrical pulses to the problem area and may help reduce pain. The most common type of electrotherapy is transcutaneous electrical nerve stimulation (TENS).
  • See Transcutaneous Electrical Nerve Stimulators (TENS)

  • Ultrasound. Utilizing sound waves that are beyond the range of human hearing, ultrasound therapy may send gentle vibrations into the skin and other soft tissues with the goal of increasing blood flow and potentially reducing pain.

After the spinal MUA procedure, the patient needs a friend or relative to drive him or her home to rest. After having anesthesia, such as propofol, it is typically recommended to avoid driving for 24 hours.8

Post-Procedure Care: First Week

After the spinal MUA procedure or series of procedures on consecutive days are over, follow-up care usually continues with regular returns to the office over the next 7 to 10 days for:1

  • Spinal manipulation and/or mobilization without anesthesia
  • The same or similar stretching and soft tissue procedures that had been done during spinal MUA

See Spinal Manipulation: High-Velocity Low-Amplitude (HVLA)

It should be noted that deep muscle stretching (massage, active release technique, instrument-assisted soft tissue mobilization, and other methods) are important during this period.

Other pain relief treatments may also be provided in office, such as heat and/or cold therapy, TENS, and/or ultrasound.

See Chiropractic Services Beyond Adjustments

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Post-Procedure Care: Second Week and Beyond

About a week after spinal MUA, the patient is ready to transition to an active physical rehabilitation program that typically lasts 4 to 6 weeks. A medical professional, such as the doctor who performed the spinal MUA or a physical therapist, can design a physical therapy program to meet the patient’s specific needs for:

  • Continuing to improve and/or maintain spinal flexibility and range of motion
  • Strengthening muscles that support the spine

See Manual Physical Therapy for Pain Relief

The types of exercises, stretches, and frequency recommended are dependent upon the patient’s unique situation, level of function, and desired goals. Physical therapy may require some sessions at a clinic, at least initially while learning the correct techniques. After the patient understands how to do the exercises, he or she can typically perform them at home.

See Specific Manual Physical Therapy Techniques

In some situations, the doctor may recommend continuing manual manipulation to reduce the risk of the neck and/or back pain from worsening again.

References:

  1. L Summerlin-Grady, Austin PN, Gabaldon DA. Safe driving after propofol sedation. J Perianesth Nurs. 2017; 32(5):464-71.

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