Manipulation Under Anesthesia

317 Pages·2005·42.88 MB·English

by  Werner Mang

Manipulation Under Anesthesia
Concepts in Theory and Application
Manipulation Under Anesthesia
Concepts in Theory and Application
Edited by
Robert C. Gordon, D.C., DAAPM
Cornerstone Professional Education, Inc.
Boca Raton London New York Singapore
A CRC title, part of the Taylor & Francis imprint, a member of the
Taylor & Francis Group, the academic division of T&F Informa plc.
T&FLOC_B_Master Page 1 Friday, March 18, 2005 1:23 PM
Published in 2005 by
CRC Press
Taylor & Francis Group
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Boca Raton, FL 33487-2742
© 2005 by Taylor & Francis Group
CRC Press is an imprint of Taylor & Francis Group
No claim to original U.S. Government works
Printed in the United States of America on acid-free paper
10 9 8 7 6 5 4 3 2 1
International Standard Book Number-10: 0-8493-1700-2 (Hardcover)
International Standard Book Number-13: 978-0-8493-1700-2 (Hardcover)
Library of Congress Card Number 2004054511
The publisher and the authors assume no responsibility for the consequences of the use of the materials contained in this
book. Some of the content represents an emerging area of study. No guarantees have been made or implied that the same
results will be achieved with the MUA technique. As new information becomes available, changes in treatment and in the
use of drugs may be necessary. The publisher and editor disclaim any liability, loss, injury, or damage incurred as a
consequence, directly or indirectly, of the use and application of any of the contents of this volume.
No part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or
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Library of Congress Cataloging-in-Publication Data
Manipulation under anesthesia / edited by Robert C. Gordon.
p. cm.
ISBN 0-8493-1700-2
1. Manipulation (Therapeutics). 2. Anesthesia. I. Gordon, Robert C.
RM724.M345 2004
615.5'3—dc22 2004054511
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Taylor & Francis Group and the CRC Press Web site at
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Dedication
I dedicate this textbook to the love of my life, my partner, and my best
friend, my wife Yvonne. Yvonne has been with me since we were high
school sweethearts, and today after years of ups and downs, good times
and bad times, she still remains the mainstay in my life. I could not
fathom completing a work of this magnitude without having her by my
side. She has been my confidant, my editor, my comrade, and my
partner in this effort, and if my name is on the book as the editor, her
name will always be the core of my inspiration.
Preface
Manipulation in various forms has been performed for hundreds of years. Adjustive procedures
specific to chiropractic and osteopathic practitioners have been used and practiced for more than
100 years. From the time these procedures were first used, they carried with them an aura of both
allure and mystique. Scientific validation was not a prominent focus by many of the early practi-
tioners, and techniques were passed on from one practitioner to another. The use of these manual
techniques provided positive results for patients, and practitioners were not concerned with using
controlled studies to prove the results. Some have referred to this as a period of anecdotal results
— “Stories of improvement with no actual proof.” Sadly this was the way manual practitioners
approached their techniques and how they looked at the concerns of the scientific community.
Today, as more research is conducted, and as more knowledge of manual therapy becomes available,
the scientific community is starting to recognize that those practitioners who were scorned and
scoffed at for so many years really did have something to offer.
Even so, we still see educated men and women using pragmatic discourse in their denial of the
thousands of cases that have been and are daily being positively affected by the use of manual therapy.
ADVANCED MANUAL THERAPY
With the advent of more research and more specific types of manual therapy, a technique that has
been used for more than 70 years by osteopathic, orthopedic, and chiropractic practitioners is being
revisited with regularity. This technique is using manual/manipulative therapy while the patient is
under the influence of anesthesia or, to use a more updated vernacular, medication-assisted manip-
ulation. Today this technique is referred to as the fibrosis release procedure using medication-
assisted manipulation under IV sedation.
This text is written at a time when manipulation under anesthesia (MUA) is controversial but
being practiced with regularity. Third-party payors believed that if they labeled it as experimental,
it would go away, even though there are some 70 years of documented proof of its efficacy.
Our greatest challenge today is to prove the efficacy of MUA beyond all reasonable doubt. Our
challenges will still be present, but the argument of being experimental will not survive the scrutiny
of the scientific community because there will no longer be a platform for unrealistic dialogue.
MUA has indeed been a part of the growth of our health care delivery system. It is part of our
heritage now, and it is up to those who wish to study its effectiveness to continue to develop more
research into its clinical validity. It is our hope that the material contained in this text will help
start your discovery of this wonderful form of therapy. We also hope that it will instill in you a
desire to continue your study so that future practitioners will have the benefit of your study to
perpetuate the procedure known as manipulation under anesthesia.
This book focuses on all of the aspects of the MUA technique. It presents the scientific basis
of the procedure; provides information on patient selection criteria; documents outcomes from
patient procedures; and examines policies, protocols, and standards by which the procedure should
be incorporated in treatment facilities. It also provides step-by-step guidelines of the generic
procedure and policies for documenting results; addresses the “pain management” aspect of MUA;
and discusses the overall use of the procedure from pre-MUA through post-MUA rehabilitation. It
is my hope that this book will provide the tools needed to investigate this procedure so that it can
become an acceptable addition to mainstream health care delivery.
Acknowledgments
The book that you are about to read has been in the works for the past 4 years and in the mind of
the MUA practitioner for the past 70 years. My father used to say that “there is no limit to the
good a man can do if he doesn’t care who gets the credit.”
The men and women who have put their hearts and souls into making MUA the technique that
it is today and what it will become in the future is why this book is being written. I have had the
privilege of meeting some wonderful people in the field of manipulation under anesthesia. To say
the least, they are some of the hardest working people that I can ever remember meeting in my
lifetime. To make this book work, I had to have the advice, understanding, caring, concern, and
love of many people. This book is a culmination of 15 years of my life dedicated to the MUA
field, and it is a tribute to the many folks who have been a part of those years by helping to make
MUA what it is today.
Of special acknowledgment are my contributing authors. It is through their hard, tireless, and
sometimes frustrating efforts that we have this complete written work that I envisioned so many
years ago which would support the doctors who are involved in and who perform MUA every day
in the course of their practices. I’d like to thank all of the people who in last minute desperation
helped complete sections of this text. Drs. Ed Cremata and Sarb Dhesi from California worked
diligently every day for the rights of the practitioner to continue to use this wonderful technique
and helped with pictures and comments in the formation of several sections of the book. The
National University of Health Sciences stayed with me and has sponsored my course since 1994;
I thank them for their support and confidence in this procedure. Drs. Bill Waln, Dana Lawrence,
and Jonathan Soltz, the postgraduate deans at National, have played a great part in helping me to
grant MUA certification to doctors over the years. I’d like to thank the Forest Surgery Center in
Paramus, NJ, for allowing me to take the procedure pictures in their operative suite. A special
thank you is in order to the doctors who took the time to help me show the proper techniques for
this procedure in picture form, Dr. Don Alosio and Dr. Anthony Riotto. Many people have been
responsible for making this book a reality, but three people had an initial vision that my syllabus
used in teaching the course could become a book: my wife, who is my partner, and Dan Hovland
and Chris Sepulveda from Shark Creative, who through the years have helped me with a great
deal of the media production that I have made available in my course for this procedure. Finally
I’d like to thank Barbara Norwitz and Erica Dery from CRC Press, who saw potential in a syllabus
used in a class setting that would become the book that you are going to read. It takes special
people to see the vision of a completed book, and although I have resisted them in many phases
of the completion of this text, it is their hard work and dedication to this material that made this
come together.
Editor
Robert C. Gordon, DC, FRCCM, ABCS, DAAPM , is a postgraduate faculty member of the
National University of Health Sciences. He holds active licenses to practice chiropractic in Florida
and New Jersey. Dr. Gordon earned his undergraduate degrees from Florida State University in
physical education, recreational science, and sports medicine and was involved in the masters
program in exercise physiology.
Since graduating from the National College of Chiropractic in 1975, Dr. Gordon has specialized
in the fields of sports medicine and industrial chiropractic, and it is within these fields that he
pursued his early interest and training at the Texas College of Chiropractic in the science of
manipulation under anesthesia (MUA). Most of the early research for his work in MUA was
completed at the Southeastern University of Health Sciences (which is now Nova Southeastern
University), an osteopathic college in South Florida.
Dr. Gordon has been actively teaching and researching MUA since 1992 and has been involved
in compiling information on the subject since 1985. His interest in the industrial field led him to
receive his training as an authorized trainer for the Occupational Safety and Health Administration
(OSHA) in 2001, and it is in the sports medicine and industrial fields that Dr. Gordon has used the
MUA procedure to bring recovery to many injured employees and athletes over the years. Dr.
Gordon holds many awards from his years in the chiropractic field, including Chiropractor of the
Year from the Broward Chiropractic Society and the KUDO award from the Florida Chiropractic
Association for his work as the state chairman for scoliosis.
Dr. Gordon is the executive director of the National Academy of MUA Physicians and is an
active member of the American Academy of Pain Management. He was an active member of the
American Chiropractic Association for many years, as well as an active member of the Florida
Chiropractic Association, and he held many offices in the Broward County Chiropractic Society,
including president. He is currently active with the North Carolina Chiropractic Association as an
associate member and lectures on manipulation under anesthesia regularly for many organizations
and universities, including the American Academy of Pain Management. He is a consultant for the
MUA procedure for many hospitals and ambulatory surgical centers throughout the U.S. and has
taught more than 1600 doctors of chiropractic and osteopathy.
Dr. Gordon was recently inducted into the Royal College of Physicians and Surgeons (U.S.)
and is vice chairman of the newly formed Royal College of Chiropractic Medicine (FRCCM) of
the United States. Dr. Gordon will also assume the position of Professor of Chiropractic Medicine
at the American International University. Through the Royal College of Chiropractic Medicine, the
American Board of Chiropractic Specialists (ABCS) has been formed, which recognizes board
certification in MUA, neurobiomechanics, and hospital emergency room procedures.
Contributors
David Basch, MD Matt Miller, PA-C
Fellow, American Board of Orthopedic Lancaster, Pennsylvania
Surgeons
Diplomate, American Board of Orthopedics Anthony B. Morovati, DC
Sparta, New Jersey Glendale, California
Ramona Carter, MD Lawrence Petracco, DC
Department of Family Medicine Jersey City, New Jersey
University of Texas Medical Branch at
Galveston Anthony Rogers, MD
Galveston, Texas Fellow, American Board of Anesthesia
Fellow, American Board of Pain Medicine
Robert S. Francis, DC, PhD Lake Worth, Florida
Associate Professor
Course Director Postgraduate Studies B. H. Rubin, DC, DABCO
Texas Chiropractic College Hampton, Virginia
Pasadena, Texas
Fred E. Russo, DC
James Giordano, PhD Tallahassee, Florida
Director of Clinical Research
Professor of Pathology Thomas Schultea, PhD
Texas Chiropractic College Professor of Pathology
Pasadena, Texas Texas Chiropractic College
Pasadena, Texas
Timothy S. Kersch, DC
Vista, California Dan West, DC
East Earl, Pennsylvania
Robert Mathews, MD, PhD, FACS, FICS,
FRCS (US)
Pain Intervention, American International
University
Royal College of Physicians and Surgeons (US)
Fellow, American College of Surgeons
Fellow, American International College of
Surgeons
American Academy of Orthopedic Surgeons
Lancaster, Pennsylvania
Contents
PART I
Chapter 1 An Historical Perspective on Manipulation Under Anesthesia...................................3
Robert S. Francis
Chapter 2 The Scientific Basis of Manipulation Under Anesthesia.............................................9
Robert C. Gordon, Robert S. Francis, and Anthony B. Morovati
Chapter 3 Mechanisms of Spinal Pain and Pain Modulation.....................................................41
James Giordano and Thomas Schultea
Chapter 4 The Core of the MUA Procedure: Tissue Injury Repair Sequence and
Fibrous Release with Manipulation...........................................................................59
Robert C. Gordon
Chapter 5 Manipulative Energy..................................................................................................71
Timothy S. Kersch
Chapter 6 Indications and Contraindications for MUA.............................................................97
Robert C. Gordon
Chapter 7 MUA Principles and Practices.................................................................................105
Robert C. Gordon
Chapter 8 Support for MUA: Evidence-Based Research and Literature Review....................113
Robert C. Gordon
Chapter 9 Evaluation of the MUA Patient................................................................................123
Robert C. Gordon
Chapter 10 Anesthesia.................................................................................................................137
Anthony Rogers and Robert C. Gordon