International MUA Academy of Physicians
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About Dr. Rob Francis and Manipulation Under Anesthesia

Dr. Rob Francis maintains a hospital-based multidisciplinary practice for chronic pain patients. He practices with anesthesiologists and pain management specialists Houston, Texas where he holds hospital medical staff privileges at area hospitals and ambulatory surgical centers. Dr. Francis is certified in Manipulation Under Anesthesia, commonly called MUA. This is an out-patient procedure designed to treat chronic pain conditions of the musculoskeletal system.

Dr. Francis was the first doctor in the United States certified in Manipulation Under Anesthesia. He was first trained in Manipulation Under Anesthesia by board certified orthopedic surgeons who performed MUAs on post surgical patients to alleviate chronic post surgical pain.

Towards an effort to ensure quality training in MUA for physicians and treatment with MUA for patients, Dr. Francis pioneered the development of the MUA procedure over the last two decades. There are numerous research studies demonstrating the clinical efficacy of MUA. It has been well documented in the peer reviewed medical literature for many years as a clinically and cost effective method to treat chronic musculoskeletal pain conditions.

During the 1980's, while Dean of Clinical Sciences and Director of Institutional Research at TCC, Dr. Francis developed the first accredited certification course for doctors in Manipulation Under Anesthesia. In addition to his faculty appointment at University of texas Medical School as Clinical Assistant Professor of Family Medicine, Dr. Francis also serves on the post graduate faculty at the University of Bridgeport and continues to teach and certify physicians in Manipulation Under Anesthesia at hospitals and outpatient surgery centers around the country and in Europe. He is also a Visiting Professor at St. George’s University School of Medicine.


Manipulation Under Anesthesia (MUA) is an outpatient procedure that effectively treats chronic neck, back and extremity pain and dysfunction. Most candidates for MUA have already had an adequate trial of conservative care including medications, injections, in-office manipulations, rehabilitation, physical therapy, and some have even been considered for surgical intervention. These individuals have mechanical dysfunction of the joints and scar tissue build up in the supporting soft tissues of the spine resulting in joint and muscle dysfunction, chronic stiffness and pain. Many patients with herniated discs have avoided surgery by undergoing a series of MUA procedures. Numerous patients who have already undergone surgery develop scar tissue and are referred to Dr. Francis by their surgeons and treating physicians for the MUA procedure.


MUA is performed in a hospital or ambulatory out patient surgical center in an out patient surgical setting with board certified anesthesiologists supervising and providing the anesthesia. Patients receive a sedative and then experience a twilight anesthesia much the same as when they are peacefully sleeping. This allows the doctor to gently manipulate the joints and soft tissues that have become chronically tight and inflexible resulting in pain and dysfunction. The procedure takes less than an hour and is usually performed first thing in the morning for three consecutive days for maximum results. The patient then may come in for follow up office visits for a brief period of continued physical medicine interventions to maintain the flexibility and increased range of motion accomplished with the MUAs.

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