Why MUA? FREQUENTLY ASKED QUESTIONS

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1 Manipulation Under Anesthesia Including Clinical Proctorship Patients Provided Montvale, NJ August 13-16, 2015 Cornerstone Professional Education, Inc. Presents The two foremost experts in the MUA procedure:, Dr. Robert Gordon and Dr. Donald T. Alosio, Jr. team up to present to the modern Healthcare community, an MUA program featuring the most comprehensive and up to date information as well as the most effective, cutting edge MUA techniques available anywhere in the world! Dr. Robert C. Gordon, D.C., FRCCM, FABCS, DAAPM is often referred to as the nation s leading MUA advocate, supporting MUA and its practitioners through years of research, teaching, consulting and perfecting the MUA technique. He is an advisor to the newly formed national organization, American Association of MUA Providers and is an active member of the American Academy of Pain Management. Dr. Gordon literally wrote the book on the MUA procedure entitled: Manipulation Under Anesthesia: Concepts in Theory and Application which is widely renowned as the benchmark text on the subject of MUA. Dr. Donald T. Alosio, Jr., D.C., FABCS, FRCCM has instructed over 1000 physicians in the art and application of the MUA procedure, including chiropractors, orthopedic surgeons, neurologists and pain management specialists, including such high profile practitioners as the N.Y. Yankees chiropractor Dr. Louis Bisogni and WWF World Champion Dr. Shawn Stipich. Dr. Alosio began his practice in 1984 and presently teaches, directs and builds MUA programs through MUA Educators, Inc., including multiple locations in Florida, Georgia, Arizona, Pennsylvania, Texas, New York and New Jersey. Do not miss out on this rare opportunity to learn and master the MUA technique under the tutelage of the world s two leading experts on the Manipulation Under Anesthesia procedure!

2 The course will take place at Advanced Center for Special Surgery (Montvale Surgical Center) 6 Chestnut Ridge Rd Montvale, NJ (procedures and workshops) and qualifies for the required American Association of MUA Providers (AAMUAP) 36 Hours of fellowship study in Manipulation Under Anesthesia for receiving a certificate of completion. Manipulation Under Anesthesia (MUA) is by far one of the most exciting non-invasive pain management procedures being performed today for the treatment of chronic and recurrent spine and extremity pain, fibroblastic proliferative changes, chronic muscle spasms, failed back syndromes, herniated discs and unresolving headaches. MUA expands the primary role of the M.D., D.O. and D.C., as well as other chronic pain management (PM) and PM&R practitioners to relieve the pain of patients with articular and neurological syndromes and restore maximum function, and is within nationally published practice guidelines and parameters of care. CEUs and certificates Provided by Southern California University of Health Sciences Why MUA? Effective pain relief for chronic patients Increase patient referrals Increase interdisciplinary networking Create new practice parameters No overhead expenses Develop new community reputation Create alternate revenue streams Participate in pain management groups Obtain outpatient surgery center privileges or secure hospital privileges Completing these procedures in Hospital/ASCs guarantees you a whole new aspect of practice and new patient treatment modality. CALL NOW! For registration and information: Fax Class size is limited! FREQUENTLY ASKED QUESTIONS Where do my MUA patients come from? 1. 80% from your own practice 2. 5%-10% from referrals by D.C.s 3. 5%-10% from M.D., D.O., P.T. referrals Hospitals and ambulatory surgery centers (ASC) have been acute care facilities. Now they are treating the chronic pain patient with Pain Management, Physical Medicine, Manual Medicine, Manipulative Medicine, and a host of other alternative health care practice techniques. With all the recent changes in the health care delivery system, a new window of opportunity has opened and a new exciting level of practice for the physician is now here. With the skills that are learned in this fellowship training program you will have an additional "practice tool" to offer your patients that is still conservative, but offers more intensive Manual Physical Therapy to

3 allow for potential complete recovery (as has been shown with thousands of procedures throughout the United States and abroad). * * The course is an Evidence based course and supportive literature is given as part of the course. MANIPULATION UNDER ANESTHESIA COURSE REGISTRATION FORM Please print clearly: Class Date August 13-16, 2015 City Montvale, NJ License # State Name: Degrees: Address: City: State: Zip: E:mail: Office Phone: Fax. Phone: Classroom Clinical Proctorship Thursday, 8 a.m. to 5 p.m. Friday, 1 p.m. to 5 p.m. Friday 7 a.m. to 12 p.m. Saturday, 1 p.m. to 5 p.m. Saturday, 7 a.m. to 12 p.m. Sunday, 1 p.m. to 3 p.m. Sunday, 7 a.m. to 12 p.m. MUA Certificate of Completion including Clinical Proctorship (Patients Provided) NEW DOCTOR REGISTRATIONS $ Refresher Doctor (previous certificate of completion) $ **CEUs (36) and certificates Provided by Southern California University of Health Sciences PHYSICIAN S NAME : LICENSE #: COST 1. $ TOTAL $ No Door Registrations PAYMENT (Must be received with registration): DATE RECEIVED Credit Card: [ ] AMEX [ ] VISA [ ] MasterCard Card No. Print Cardholder name Expiration Date *** SIGNATURE REQUIRED *** Cornerstone Profession Edu, Inc. reserves the right to alter the course material, presentation, instructor(s), sponsors, content, location, time(s) and dates. No refunds will be given; tuition will be applied to future classes. Enrollees will be responsible for their own travel, lodging, meals, and related expenses when enrolled or rescheduling for a class. Please fax completed Registration form to: Enclose Copies of Licensure and Declaration of your Malpractice Policy Fax Registration to: Course Location Cornerstone Professional Edu Advanced Center for Special Surgery Montvale SC Fax 6 Chestnut Ridge Rd

4 Dr. Gordon Montvale, NJ Dr. Alosio CLASS SIZE IS LIMITED! MANIPULATION UNDER ANESTHESIA PRESENTED BY CORNERSTONE PROFESSIONAL EDUCATION, INC. August 13-16, 2015 Montvale, NJ Manipulation under anesthesia (MUA) is by far one of the most exciting non-invasive pain management multidisciplinary procedures being performed today for the treatment of chronic and recurrent spine and extremity pain, fibroblastic proliferative changes, chronic muscle spasms, failed back syndromes, herniated discs, unresolving headaches and is within nationally published practice guidelines and parameters of care. This 36-hour course includes 24 hours of didactic lecture and 12 hours of clinical proctorship. Upon successful completion of this course, you will receive your CERTIFICATE OF TRAINING IN MUA, 36 CEUs and certificates Provided by Southern California University of Health Sciences (SCU) and an application for staff privileges at the Surgery Center or assistance with an ASC facility closer to your practice. Upon completing this comprehensive training course, you will receive your Certificate. This is contingent upon passing a written examination and performing the clinical proctorship. WE WILL PROVIDE THE PATIENTS FOR YOUR PROCTORSHIP AND THE MUA PROCEDURE WILL BE PERFORMED DURING THIS COURSE. This comprehensive program provides you the complete MUA certificate of training including clinical proctorship all in the same course. You do not have to go home and try to figure the rest of it out by yourself, since we are available to help you establish MUA hospital / ambulatory surgery center privileges in your area offering your new non-invasive pain management service. Why Manipulation Under Anesthesia Manipulative treatment of the spine and joints is the art, science and philosophy of the nonoperative restoration of the functions of the joints, bones, muscles, tendons and ligament. The role of the physician is to relieve suffering due to segmental dyskinesia. So, why Manipulation Under Anesthesia? This procedure is utilized for variety of reasons and conditions. A brief summary is that certain patients will not respond favorably or satisfactorily to conservative chiropractic or manual therapy procedures due to a diversity of reasons - many of these patients make excellent candidates for Manipulation Under Anesthesia. The technique is designed to stretch or alter intramuscular and periarticular adhesions that form around the articular facets of the spine and joints which can be caused by time, trauma or by

5 herniated or bulging discs. These adhesions are what tend to lock the joints in a state of fixation or create dyskinesia, preventing normal movement and causing pain. The paraspinal muscles spasm causing splinting or guarding at the adhesion site, which make the traditional therapies less effective. By placing the patient under anesthesia, a mild relaxation of the affected muscles is achieved (but still lets the patient's body respond to various stimuli) allowing the physician to directly influence adhesions by temporarily diminishing the guarding influence of the postural musculature. Since the adhesions are aneurovascular, there is generally no bleeding or pain following the procedure. The benefits of this procedure are numerous including a return to normal joint movement, the structural integrity of the joints is reestablished, a reduction or elimination of symptomatic pain levels is achieved and an increased range of motion develops. Choosing the Manipulation Under Anesthesia Patient Choosing the Manipulation Under Anesthesia patient is the most crucial part of the procedure. The candidate should have received conservative clinical care for a minimum period of six to eight weeks and have demonstrated minimal improvement or no relief of their symptoms and / or objective physical findings. It is imperative that certain strict documentation and guidelines are followed (including the indications and contraindications for MUA) before a patient should be considered for this procedure. The overall objective of manipulation is to relieve the patient s pain and disability with a minimum amount of expense and loss of time from his / her work and other activities. In instances of chronic pain when the patient has received regular therapeutic treatments over the appropriate period of time to produce results and the patient has demonstrated no improvement either symptomatically or in range of articular motion, Manipulation Under Anesthesia may be a desirable alternative. Indications for Performing Manipulation Under Anesthesia The following are indications for manipulative procedures under anesthesia, when manipulation is the therapy of choice: 1. Failure to respond to conservative chiropractic or manual therapy care in the office setting after a minimum of six to eight weeks of continuous conservative care. 2. Chronic or Recurrent pain. 3. Pain so severe that narcotic analgesic is of little benefit. 4. Chronic Myositis peripheral, muscular, fibrotic adhesion formation (adhesions and scar tissues will begin to develop 6-12 hours after an initial injury). 5. Chronic Fibrositis - peripheral, can be muscular or articular: related to fibrotic adhesion buildup over short or long periods of time (i.e.--facet joint encapsulation or encapsulitis with associated restriction of motion). 6. Nerve Entrapment - peripheral (i.e. -- facet syndrome or inflammation or disc pathology). 7. Disc Pathology - Disc protrusions, bulging discs, protrusions (spontaneous or from traumatic origin) documented by CT, MRI or Myelography. 8. Traumatically induced restriction of range of motion -(i.e. torticollis). 9. Chronic production arthritis - spondylosis, spondyloarthritis, and spondyloarthrosis. 10. Lumbarization associated with acute / chronic pain - peripheral in nature, causing muscle splinting, fibrotic adhesions, and / or chronic spasm. 11. Sacralization associated with acute / chronic pain - peripheral causing chronic muscle splinting contracture, spasm fibrotic adhesion formation (relating to degenerative changes). 12. Chronic disc changes - associated with fibrotic adhesions due to degenerative changes. 13. Traumatic torticollis - peripheral in nature, causing severe muscle splinting and / or contracture,

6 vertebral subluxation due to trauma (intractable pain from hyperflexion / hyperextension injury). 14. Failed spinal surgery. 15. Headaches - non-organic origin. Contraindications for Manipulation Under Anesthesia 1. Infectious bone disease. 2. Acute Fractures. 3. Acute Inflammatory arthritis (i.e. -- gout or rheumatoid). 4. Tuberculosis of the bone. 5. Gonorrheal spinal arthritis. 6. Osteoporosis - advanced or indicated diagnostically. 7. Direct Manipulation of old compression fractures (however, you can manipulate above or below the fracture site). 8. Uncontrolled diabetic neuropathy. 9. Syphilitic articular or periarticular lesions. 10. Evidence of cord or caudal compression by tumor or disc herniations. 11. Widespread staphylococcal or streptococcal infection. 12. Respiratory infections. 13. Metastatic bone disease. 14. Any forms of malignancy or metastasis. 15. Prior history of stroke. 16. Infection of the joint or disc area or space 17. Osteogenesis imperfecta. 18. Vertebral artery syndrome. 19. Abdominal aortic aneurysm. 20. Clotting disorders. 21. Pregnancy.