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When patients are under the influence of anesthesia, pain, spasm, and muscle guarding or muscle tension is greatly reduced. Manual therapy such as stretching, joint mobilization, and connective tissue release can be done with much less force. Without anesthesia, it can be difficult to overcome muscle resistance from patient apprehension or from uncontrolled muscle spasm.
The theory behind this treatment is that manipulation and mobilizations when properly done can break up fibrous adhesions without causing inflammation that leads to more scar tissue formation. Manipulation can be done after injection of a numbing agent. This is usually lidocaine combined with a steroid. With this type of injection, manual therapy can address both the inflammatory and restrictive factors.
Patients must qualify for this treatment in one of two ways. First, they must be approved by the anesthesiologist. Health problems such as bleeding disorders or heart disease can prevent the use of anesthesia.
Secondly, they must have nonspecific mechanical chronic low back pain. That means there's no infection, tumor or fracture causing the problem. There's just something about the way the spine is positioned or moves that is causing the pain. Often there is one or more spinal segments that are hypomobile. Hypomobile means the joint doesn't move or has less motion than needed for normal movement.
Usually, other less expensive and less invasive forms of treatment are used first before trying medicine-assisted manipulation (MAM). A physical therapist works with the patient to restore normal joint motion and movement in general. Hands-on techniques can be used to stretch muscles and break adhesions in the connective tissue.
If you have hypermobile joints (excessive motion), then you aren't a good candidate for MAM. Likewise, the presence of tumors, osteoporosis, or spinal stenosis (narrowing of the spinal canal) will exclude you from this treatment.
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