Case 1- A 38-year-old female presented with initial complaints of headaches, neck, midback, and low back pain resulting from a roll-over motor vehicle accident in January 1988.

She sustained a compression fracture of the L1 vertebral body, with findings of small disc bulges in the cervical and lumbar spine and a reversal of her cervical curve. She was initially hospitalized for 1 week and continued her treatment with medications, physical therapy, an chiropractic manipulative therapy for approximately 1 year. In 1992, another patient advised her of the procedure of manipulation under anesthesia, at which time she sought treatment at the office. The treatment had not worked since the accident, was on total disability, and was using alcohol for pain relief. Examination prior to MUA included a pain level of 9 (on a 0-10 scale) with greatest pain being in the cervical spine (leading to headaches) and in the area of L1 compression fracture. Straight leg raise (SLR) caused pain in her low back bilaterally and down her right leg at 30 , and at 45 on the left side. Bragard's sign was positive on the right. Cervical and lumbar motions were decreased at least 50% in all directions and 70% in flexion with pain on all movements. Her paraspinal muscles were light and tender to touch from T8 to S1. She had referred pain down both arms and legs, worse on the right. She underwent 3 consecutive days of MUA in May 1992. to the cervical, thoracic, and lumbar spine and also received physical therapy three times per week in the form or interferential electrical stimulation, ultrasound, heat, and massage. She reported great relief from the pain at the end of the three trials of MUA. One month post-MUA her pain level (0-10) was 1 and her headaches had resolved. SLR was 85 bilaterally without referred symptoms. Lumbar range of motion (ROM) was within 90% of normal and cervical ROM was normal. She claimed no referred pain and had normal sensation. Six months post-MUA, SLR was 80 . Pain and stiffness had slightly increased to2/20 in the cervical and a 3/10 in the lumbar spine region. This was significant improvement in her pain and functional level from her-MUA procedure condition. At 1 year post-procedure she reported that pain reached a maximum of 4/10 in the region of the L1 compression fracture when doing activities of bending, lifting, and twisting.