For physiotherapists treating patients post-traffic accident, the acute phase of whiplash-associated disorders presents a distinct challenge. Pain levels are often high, guarding is significant, and the window to prevent centralization or chronicity is narrow. While standard care protocols exist, the specific timing and efficacy of manual therapy in these acute stages have been subjects of ongoing debate. A significant 2026 Randomized Controlled Trial (RCT) published in the Journal of Integrative Medicine provides compelling evidence regarding the utility of mobilization-focused manual therapy for hospitalized patients with traffic accident-induced neck pain.
Investigating Manual Therapy as an Adjunct Intervention
The study, led by Choi et al., sought to evaluate the safety and effectiveness of manual therapy when added to a standard regimen of Integrative Korean Medicine Treatment (IKMT). The trial was a single-center, assessor-blinded RCT involving 120 inpatients suffering from acute neck pain following traffic accidents. The study design was robust, allocating participants into two groups: a control group receiving only IKMT and an intervention group receiving IKMT plus four sessions of mobilization-focused manual therapy.
For clinicians, the distinction of “mobilization-focused” is vital. Unlike high-velocity low-amplitude (HVLA) thrust techniques which may be contraindicated or poorly tolerated in acute whiplash scenarios, mobilization focuses on restoring range of motion and reducing pain through graded, passive movements. This approach aligns well with current best practices for acute cervical injury management.
Rapid Pain Reduction in the Acute Phase
The primary outcome measure was the change in the Numeric Rating Scale (NRS) for neck pain by day 5 of hospitalization. The results demonstrated a statistically significant advantage for the manual therapy group. By day 5, the intervention group showed a greater improvement in NRS scores (0.97 points lower) and Visual Analogue Scale (VAS) scores compared to the control group.
Perhaps more interesting for the clinician is the data regarding the “Area Under the Curve” (AUC) of cumulative pain values. The intervention group displayed a smaller AUC, indicating that the total burden of pain experienced by the patient over the first five days was significantly lower. In the context of acute trauma, reducing the cumulative pain experience is critical for improving patient comfort, reducing anxiety, and potentially facilitating earlier active rehabilitation.
Long-Term Outcomes and Clinical Takeaway
It is important to note the study’s findings regarding long-term follow-up. At the 12-week mark, there were no significant differences in outcomes between the two groups. This suggests that while manual therapy acts as a powerful accelerator for early recovery, the long-term prognosis may converge with natural history or standard care outcomes.
However, this does not diminish the value of the intervention. For the acute traffic accident patient, the first week is often the most debilitating. By utilizing mobilization-focused manual therapy, physiotherapists can significantly reduce early-stage pain intensity. This acceleration of symptom relief helps build therapeutic alliance, improves patient satisfaction, and may help mitigate the fear-avoidance behaviors that often take root in the first week of injury.
References
Choi, S. W., Kim, K. H., Yoon, J. Y., Lee, S. W., Park, J. W., Hong, H. W., Kyeong, D. H., Kim, M. K., Kim, S. N., Kim, C. Y., Lee, Y. J., Lee, J. H., Kim, J. Y., & Ha, I. H. (2026). Effectiveness and safety of manual therapy for inpatients with traffic accident-induced acute neck pain: A randomized controlled trial. Journal of Integrative Medicine, 24(1), 81–89.
