Workers' Compensation

Edward Cremata, D.C. on Manipulation Under Anesthesia: A Safe, Effective, and Cost-Effective Procedure for Suitable Candidates

“Manipulation Under Anesthesia (MUA) is a generic term that describes a procedure or set of procedures designed to improve lost ranges of motion due to infiltration of fibrotic and scar tissue. Fibrosis deposition is part of the normal healing process, but can lead to scarring and motion restrictions in articulations and soft tissues if the healing takes place in an environment where full motion is inhibited,” explains Edward Cremata, D.C. “MUA procedures do not inherently repair a pathology, for example, a surgery to repair a torn shoulder tendon, but rather reduce or eliminate a potential barrier for patient improvement, such as fibrosis proliferation with resultant range of motion losses. MUA is not a procedure provided merely as a pain relief option, but rather as a corrective measure to help normalize articular and soft tissue motion restrictions in those patients in whom motion restrictions are a significant contributing cause of a patient's pain, impairment, or disability.”

“As an example, orthopedic surgeons commonly perform MUA of the knee after replacement or when a post-surgical infection causes the knee to heal with fibrosis that inhibits normal motion. When patients develop a frozen shoulder syndrome (adhesive capsulitis), MUA is performed to release the adhesions within the shoulder capsule and surrounding soft tissues, when pain or a patient's protective responses disallow the return of normal motion using typical in-office procedures such as passive mobilization or exercise,” states the author, who is the president of the National Academy of Manipulation Under Anesthesia. “If the patient is sent to a chiropractor or physical therapist for post-procedure rehabilitation, this assures that these newly-obtained ranges of motion are maintained while the joint heals. These shoulder and knee MUA procedures are highly effective and considered very safe by the overwhelming majority of doctors knowledgeable about the procedures. The concept of mechanical dysfunction of articulations as a cause of pain is not foreign to any orthopedist, osteopath, or chiropractor.”

“The controversy over MUA typically surrounds the performance of these same procedures for the spine. The controversy over spinal MUA has been fueled by opinions that have circulated regarding spinal FRP-MUA procedures – some justified, but most based on ignorance and mistruths. The issues commonly raised regarding FRP-MUA procedures for the spine include safety, efficacy, legality, abuse, and cost-effectiveness,” explains the author, who addresses each of these issues within this article.


Edward Cremata, DC has been in private practice in Fremont, California for 28 years. He is a continuing education instructor for both the California Division of Workers' Compensation and Life Chiropractic College West. He is currently the president of the National Academy of Manipulation Under Anesthesia and is a fellow of both the Royal College of Physicians and the Academy of Forensic and Industrial Chiropractic Consultants. He has been a Qualified Medical Evaluator since the inception of the California program. He has published in peer reviewed journals including JMPT. He can be reached at, Website:

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