Comparative Effectiveness of Cervical Mobilization vs. Therapeutic Ultrasound in the Treatment of Whiplash-Associated Disorders in Pain, Mobility, Muscle Function, and Neurophysiological Responses

Abstract

Background: Whiplash-Associated Disorders (WADs) are among the most prevalent post-traumatic musculoskeletal conditions, characterized by pain, restricted mobility, muscle dysfunction, and altered neurophysiologic control. Despite widespread use of cervical mobilization and therapeutic ultrasound, limited comparative evidence exists regarding their differential effectiveness across multidimensional outcomes. Objective: To compare the efficacy of cervical mobilization and therapeutic ultrasound in improving pain intensity, cervical mobility, muscle strength, and neurophysiological responses among patients with acute WADs. Methods: A randomized controlled clinical trial was conducted involving 60 participants (30 per group) diagnosed with acute WAD Grades I–II. The cervical mobilization group received graded passive oscillatory movements, while the ultrasound group received continuous 1 MHz ultrasound at 1.5 W/cm². Both interventions were applied three times weekly for four weeks. Outcomes included pain (VAS), cervical range of motion (CROM), muscle strength (MMT), and surface electromyography (sEMG) activity. Data were analyzed using t-tests and repeated-measures ANOVA with α = 0.05. Results: Both interventions significantly improved all outcomes (p < 0.05). Cervical mobilization yielded greater pain reduction (VAS −4.9 ± 1.2) and CROM gains (~30–35%), while ultrasound produced superior EMG normalization (~20% amplitude reduction). Conclusion: Cervical mobilization and therapeutic ultrasound are both effective for acute WAD rehabilitation, with mobilization favoring rapid analgesia and mobility recovery and ultrasound optimizing neuromuscular modulation.