3. MUA School.com
“The only true security in life comes from knowing that
you can improve yourself every single day.”

4. MUA School.com
“The only true security in life comes from knowing that
you can improve yourself every single day.”

5. We need everyone mobilizing NOW.
Calls to legislators must be made on Wed since bill A-4416,
which will reverse Bedford, is going to the floor on Thurs!
In response to Assemblyman Caraballo introducing legislation
A-4416, we now have a significant opportunity to reverse the
negative impact of the Bedford decision and restore the
extraspinal care that so many of our patients depend upon.
Assembly bill A-4416 “Provides that the practice of
chiropractic includes diagnosis and adjustment of the
articulations of the spinal column and other joints...”
The bill is specifically designed to help chiropractic patients by
restoring the chiropractor's ability to perform extraspinal
manipulations and care that was provided prior to the Bedford
decision.
Bedford V.S Riello
This legislation was voted
out of committee on
Monday, June 18th. The
bill is going to the floor
of the FULL ASSEMBLY FOR A VOTE ON
THURSDAY JUNE 21, and we need to 2.5678 | 908.722.5677 - fax
spring into action fast. www.anjc.info

6. We need everyone mobilizing NOW.
Calls to legislators must be made on Wed since bill A-4416,
which will reverse Bedford, is going to the floor on Thurs!
In response to Assemblyman Caraballo introducing legislation
A-4416, we now have a significant opportunity to reverse the
negative impact of the Bedford decision and restore the
extraspinal care that so many of our patients depend upon.
Assembly bill A-4416 “Provides that the practice of
chiropractic includes diagnosis and adjustment of the
articulations of the spinal column and other joints...”
The bill is specifically designed to help chiropractic patients by
restoring the chiropractor's ability to perform extraspinal
manipulations and care that was provided prior to the Bedford
decision.
Bedford V.S Riello
This legislation was voted
out of committee on
Monday, June 18th. The
bill is going to the floor
of the FULL ASSEMBLY FOR A VOTE ON
THURSDAY JUNE 21, and we need to 2.5678 | 908.722.5677 - fax
spring into action fast. www.anjc.info

7. You and your patients need to call directly from your
1 office to your legislators. If you call, do not mention
you're a doctor. A-4166 will allow chiropractors to again
do what they have been doing for over 80 years...treat
other joints outside the spine.
2 Ask the Legislator (by telling their aide) to support
A-4166 and its Senate companion bill when it's voted on
Thursday.
3 Be nice and cordial.
To find out which legislator to call in your district simply click:
http://www.njleg.state.nj.us/districts/districtnumbers.asp
Thank you. Thank you. Thank you.
All the best.
Sigmund Miller, DC, FICC
Executive Director
Here’s what we need you to
3121 Route 22 East, Suite 302,
Branchburg, NJ 08876
do all day Wednesday...
Association of New Jersey Chiropractors
quot;You deserve this kind of service.You've earned this type of respect.quot;

8. You and your patients need to call directly from your
1 office to your legislators. If you call, do not mention
you're a doctor. A-4166 will allow chiropractors to again
do what they have been doing for over 80 years...treat
other joints outside the spine.
2 Ask the Legislator (by telling their aide) to support
A-4166 and its Senate companion bill when it's voted on
Thursday.
3 Be nice and cordial.
To find out which legislator to call in your district simply click:
http://www.njleg.state.nj.us/districts/districtnumbers.asp
Thank you. Thank you. Thank you.
All the best.
Sigmund Miller, DC, FICC
Executive Director
Here’s what we need you to
3121 Route 22 East, Suite 302,
Branchburg, NJ 08876
do all day Wednesday...
Association of New Jersey Chiropractors
quot;You deserve this kind of service.You've earned this type of respect.quot;

9. MUA School .com
With Dr. Jason Tirado

10. MUA School .com
With Dr. Jason Tirado

11. Do We Belong?
Should Chiropractors be performing MUA?

12. What’s in it for you?

13. MUA WORKS

14. MUA WORKS

15. Manual medicine is as old as medicine itself
5-6000 years ago in ancient India and parts of eastern Mediterranean spinal
manipulation was used for various conditions
Greece first documents were found of the practice of
spinal manipulation.
Hippocrates in his book On Joints, described techniques of spinal manipulation to
improve posture and misalignment

16. Manual medicine is as old as medicine itself
5-6000 years ago in ancient India and parts of eastern Mediterranean spinal
manipulation was used for various conditions
Greece first documents were found of the practice of
spinal manipulation.
Hippocrates in his book On Joints, described techniques of spinal manipulation to
improve posture and misalignment
History of Manual Manipulation

17. PLEASE DOCUMENT VOCABULARY
USED IN REFERENCES

19. Hippocrates influence lasted for over 2000 years with his
teachings spread back to the east
Over 2000 years

20. Hippocrates influence lasted for over 2000 years with his
teachings spread back to the east
Manipulative therapy spread to the West with Ambroise
Pare, Friar Thomas Moulton (the complete bone setter)
Over 2000 years
Manipulative Therapy

21. Hippocrates influence lasted for over 2000 years with his
teachings spread back to the east
Manipulative therapy spread to the West with Ambroise
Pare, Friar Thomas Moulton (the complete bone setter)
Johannis Scultetus who spoke about manipulation in
“The surgeons store house...”
Over 2000 years
Manipulative Therapy
Johannis Scultetus

22. Hippocrates influence lasted for over 2000 years with his
teachings spread back to the east
Manipulative therapy spread to the West with Ambroise
Pare, Friar Thomas Moulton (the complete bone setter)
Johannis Scultetus who spoke about manipulation in
“The surgeons store house...”
By mid 19th century James Paget Lancet that “doctors would do
well to observe bone-setters and learn from them...”
Over 2000 years
Manipulative Therapy
Johannis Scultetus
Mid 19th Century

23. Hippocrates influence lasted for over 2000 years with his
teachings spread back to the east
Manipulative therapy spread to the West with Ambroise
Pare, Friar Thomas Moulton (the complete bone setter)
Johannis Scultetus who spoke about manipulation in
“The surgeons store house...”
By mid 19th century James Paget Lancet that “doctors would do
well to observe bone-setters and learn from them...”
Over 2000 years
Manipulative Therapy
Johannis Scultetus
Mid 19th Century

25. Late 19th century Daniel David Palmer founded
chiropractic D.C.and Andrew Still founded osteopathy D.O.
Late 19th Century

26. Late 19th century Daniel David Palmer founded
chiropractic D.C.and Andrew Still founded osteopathy D.O.
Both emphasized the treatment of musculoskeletal lesions
and organic diseases through spinal manipulative therapy.
Late 19th Century
Both emphasized

27. Late 19th century Daniel David Palmer founded
chiropractic D.C.and Andrew Still founded osteopathy D.O.
Both emphasized the treatment of musculoskeletal lesions
and organic diseases through spinal manipulative therapy.
These two were the fathers of the two disciplines
chiropractic and osteopathy
Late 19th Century
Both emphasized
Two Disciplines

29. MUA is recorded this far back
1911

30. MUA is recorded this far back
Recorded Studies: Piersol’s International Medical Clinic. Using 200
cases with 94-97% recovery rate from low back dysfunctions.
1911
1938

31. MUA is recorded this far back
Recorded Studies: Piersol’s International Medical Clinic. Using 200
cases with 94-97% recovery rate from low back dysfunctions.
JAOA’S First recorded Studies with Siehl, D.O.
1911
1938
1955

32. MUA is recorded this far back
Recorded Studies: Piersol’s International Medical Clinic. Using 200
cases with 94-97% recovery rate from low back dysfunctions.
JAOA’S First recorded Studies with Siehl, D.O.
JAOA Clybourne, H. “I have had the opportunity to use MUA on a
sufficiently large number of cases to realize its scope, effectiveness
and limitations”
1911
1938
1955
1948

33. MUA is recorded this far back
Recorded Studies: Piersol’s International Medical Clinic. Using 200
cases with 94-97% recovery rate from low back dysfunctions.
JAOA’S First recorded Studies with Siehl, D.O.
JAOA Clybourne, H. “I have had the opportunity to use MUA on a
sufficiently large number of cases to realize its scope, effectiveness
and limitations”
1911
1938
1955
1948

35. 1955 - 63

36. JAOA 1955-63 Siehl - Mensor reported that patients responded to
MUA with “sufficiently high results to warrant its use.
1955 - 63

37. JAOA 1955-63 Siehl - Mensor reported that patients responded to
MUA with “sufficiently high results to warrant its use.
1955 - 63
1986

38. JAOA 1955-63 Siehl - Mensor reported that patients responded to
MUA with “sufficiently high results to warrant its use.
Modern Manual Therapy 1986 Krumhausi, Norwacek, and Grieve “Any
patient suffering from intractable spinal pain who is considering
surgery without MUA has only taken advantage of half of what is
available to them” (case study using Siehl guidelines.
1955 - 63
1986

39. JAOA 1955-63 Siehl - Mensor reported that patients responded to
MUA with “sufficiently high results to warrant its use.
Modern Manual Therapy 1986 Krumhausi, Norwacek, and Grieve “Any
patient suffering from intractable spinal pain who is considering
surgery without MUA has only taken advantage of half of what is
available to them” (case study using Siehl guidelines.
1955 - 63
1986
1992

40. JAOA 1955-63 Siehl - Mensor reported that patients responded to
MUA with “sufficiently high results to warrant its use.
Modern Manual Therapy 1986 Krumhausi, Norwacek, and Grieve “Any
patient suffering from intractable spinal pain who is considering
surgery without MUA has only taken advantage of half of what is
available to them” (case study using Siehl guidelines.
JAOA 1992 Greenman, P.E., D.“MUA is an old widely recognized
procedure in musculoskeletal medicine. It is used for treating
chronic MS conditions with significant biomechanical
dysfunction unresponsive to conservative therapy”
1955 - 63
1986
1992

42. MUA is supported by the literature to be safe and effective
procedure for certain types of spinal pain when performed
by and experienced operator
Advances In Chiropractic 1996 Francis Beckett D.C.
1996

43. MUA is supported by the literature to be safe and effective
procedure for certain types of spinal pain when performed
by and experienced operator
Advances In Chiropractic 1996 Francis Beckett D.C.
MUA is a conservative treatment modality which is both safe
and efficacious in the treatment of both acute and chronic
spinal pain disorders in appropriate selected patients.
Journal Neuro and Ortho Med and Surgery
Spring 1998; West, D, D.C.; Matthews, R., M.D.; Kent, M.D.
1996
1998

45. On 171 patients who experienced constant intractable pain from
several months to 18 years duration and who underwent MUA. All of
the patients had failed at previous interventions. Results reported that
post MUA 25% had no pain at all and were “cured”, 50% were “much
improved”, with pain markedly reduced and ADL’s essentially
unaffected; 20% were “better” but pain continued to
interfere with ADL; and finally 5% had minimal or no
relief.
Reported by: Krumhansl and Nowacek

46. On 171 patients who experienced constant intractable pain from
several months to 18 years duration and who underwent MUA. All of
the patients had failed at previous interventions. Results reported that
post MUA 25% had no pain at all and were “cured”, 50% were “much
improved”, with pain markedly reduced and ADL’s essentially
unaffected; 20% were “better” but pain continued to
interfere with ADL; and finally 5% had minimal or no
relief.
Reported by: Krumhansl and Nowacek
On a study of 177 patients which 68.6% of the patients who
were out of work were able to return to unrestricted work
activities after a series of three consecutive MUA
procedures at 6 months post MUA, 58.4% of the MUA
patients receiving medication prior to the procedure required no
prescription medication post- procedure, and 60.1% of patients
with lumbar pain had the pain resolved after a series of MUA
procedures.
Reported by: West et al

47. On 171 patients who experienced constant intractable pain from
several months to 18 years duration and who underwent MUA. All of
the patients had failed at previous interventions. Results reported that
post MUA 25% had no pain at all and were “cured”, 50% were “much
improved”, with pain markedly reduced and ADL’s essentially
unaffected; 20% were “better” but pain continued to
interfere with ADL; and finally 5% had minimal or no
relief.
Reported by: Krumhansl and Nowacek
On a study of 177 patients which 68.6% of the patients who
were out of work were able to return to unrestricted work
activities after a series of three consecutive MUA
procedures at 6 months post MUA, 58.4% of the MUA
patients receiving medication prior to the procedure required no
prescription medication post- procedure, and 60.1% of patients
with lumbar pain had the pain resolved after a series of MUA
procedures.
Reported by: West et al

49. The clinical efficacy of MUA performed of MUA performed in a
series of three consecutive procedures. The average
Numeric Pain Scale scores in the MUA group decreased by 50%,
and the average Rolan Morris Questionnaire scores
decreased by 51% compared to the control group.
Demonstrated by: Palmieri et al

50. The clinical efficacy of MUA performed of MUA performed in a
series of three consecutive procedures. The average
Numeric Pain Scale scores in the MUA group decreased by 50%,
and the average Rolan Morris Questionnaire scores
decreased by 51% compared to the control group.
Demonstrated by: Palmieri et al

52. 1984

53. 1984 Samuel Turek, orthopedic surgeon, reported in his textbook,
Orthopedics: Principles and Their Application, that “good to
excellent results” can be expected with lumbar herniated
nucleus pulposus with MUA.
1984

54. 1984 Samuel Turek, orthopedic surgeon, reported in his textbook,
Orthopedics: Principles and Their Application, that “good to
excellent results” can be expected with lumbar herniated
nucleus pulposus with MUA.
Kohlbeck and Haldeman reported that, although much of the
literature in the 70 years that MUA has been in use relates to
clinical observation and is considered somewhat anecdotal, there
is sufficient evidence to warrant further controlled trials.
Reported by: Mercy
1984

55. 1984 Samuel Turek, orthopedic surgeon, reported in his textbook,
Orthopedics: Principles and Their Application, that “good to
excellent results” can be expected with lumbar herniated
nucleus pulposus with MUA.
Kohlbeck and Haldeman reported that, although much of the
literature in the 70 years that MUA has been in use relates to
clinical observation and is considered somewhat anecdotal, there
is sufficient evidence to warrant further controlled trials.
Reported by: Mercy
1984

57. MUA appears to offer some patients increased
improvement in low back pain and disability when
compared to usual chiropractic care. “Further
investigation of these apparent benefits in randomized clinical trials
is warranted
Reported by: Kohlbeck et al

58. MUA appears to offer some patients increased
improvement in low back pain and disability when
compared to usual chiropractic care. “Further
investigation of these apparent benefits in randomized clinical trials
is warranted
Reported by: Kohlbeck et al

59. In stark contrast to what is said by insurance
companies there is an abundance of clinical info
available suggesting that MUA is not experimental all
showing positive clinical outcomes.
Important to note that there has been no clinical
trial that demonstrates MUA to be ineffective in an
appropriately selected patient population.
How do you perform a double blind study with
MUA?
HOW CAN MUA BE EXPERIMENTAL?

60. 00:06:00
The number of minutes a colonscopy should take.
- New England Journal of Medicine

61. $500-$1500.00
..the average insurance reimbursement for this procedure...

62. After 70 years can it still be considered
experimental...*
Does MUA fit both the chiropractic model and the
medical model
How does the MUA procedure fit into the
chiropractic regime of natural healing
BUT IS MUA NEW?

63. Twilight sedation places pt in a position to be
nonapprehensive to treatment
Manipulation and stretching is completed without
resistance
Fibrotic adhesions are altered better for more
productive movement rather than correcting
subluxation...
WHAT MAKES MUA DIFFERENT FROM
CONSERVATIVE CHIRO THERAPY

64. Rapid results which are seen after the first
procedure
Patient response is extremely positive overall
Treatment protocols are regimented
Results are long lasting
Patients can return to work faster and less
dependent on further medication
WHY CHOOSE MUA OVER OTHER TREATMENTS

65. MUA has been a growing specialty in chiropractic
for the past 4-6 years
There has been a resurgence in the procedure over
the past 4-6 years.
The procedure, once performed by DO’s and
orthopods was completed in one day now is
completed in a series of 3 days under safer
conditions
THE CHIROPRACTIC MUA MUA TREATMENT
MODEL VS MEDICAL MODEL

66. Extended or prolonged conservative care is not
working
The pt. may be a borderline surgical candidate and
MUA could be a deciding procedure
MUA is proven to return pts. to work faster with
more productivity
MUA is more cost effective than prolonged
conservative care
WHY USE MUA