J Manipulative Physiol Ther. 1995 Oct; 18(8): 537-46.

MUJA: manipulation under joint anesthesia/analgesia: a treatment approach for recalcitrant low back pain of synovial joint origin.

Dreyfuss P, Michaelsen M, Horne M.

Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, USA.

OBJECTIVE: These four cases show how application of manipulation under joint anesthesia/analgesia (MUJA) may benefit the patient with low back pain (LBP) of synovial joint origin when prior treatment options fail. We propose that MUJA should be considered as a treatment option for those with recalcitrant synovial joint-mediated LBP. CLINICAL FEATURES: We report four cases of patients with LBP successfully treated by this protocol. These four patients were neurologically normal and suffered from lumbar zygapophyseal joint and/or sacroiliac joint mediated pain diagnosed by fluoroscopically guided, contrast enhanced, intra-articular anesthetic injections. There were various radiographic findings. INTERVENTION AND OUTCOMES: All four individuals were treated with manipulation after facilitatory intra-articular anesthetic/corticosteroid injections into lumbar zygapophyseal and/or sacroiliac joints. Some also required physical therapy interventions to resolve their LBP. CONCLUSIONS: Anecdotal success with MUJA is enticing; MUJA appears to be a viable alternative for those patients in whom traditional treatment options for LBP of synovial joint origin have failed. However, prospective, quality research is required before MUJA can be formally validated or not in the treatment of documented lumbar zygapophyseal joint and/or sacroiliac joint mediated LBP.