Active Trapezius Trigger Point PainNCT07002593
Myofascial Release vs. Stretching With Ultrasound for Trapezius Trigger Points in Athletes: A Randomized Clinical Trial
A study testing Myofascial release (MFR), Muscle Stretching and High-powered pulsed therapeutic ultrasound (HPPT-US) in people with Active Trapezius Trigger Point Pain, run by King Saud University at 1 site in Saudi Arabia.
Trial summary
This study aimed to compare the efficacy of MFR plus HPPT-US versus stretching plus HPPT-US on pain intensity, cervical range of motion (ROM), muscle length (ML), and neck disability in athletes with active upper trapezius MTrPs. Read more about this study
- Who is it for?
- Ages 20 to 40 years, men only
- Conditions the study is for
- Active Trapezius Trigger Point Pain
- What is being tested?
- Myofascial release (MFR), Muscle Stretching and High-powered pulsed therapeutic ultrasound (HPPT-US)
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 54 participants
- Where
- 1 siteSaudi Arabia
- Study dates
- 7 Aug 2022to 27 Apr 2023
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 20 to 40 years
- Men only
- No healthy volunteers
- Adult
Who may be able to join
- Male athletes
- Aged between 20-40 years
- Active MTrPs in the upper trapezius, confirmed via Travell and Simons' (1999) criteria (palpable taut band, spot tenderness, referred pain, and local twitch response);
- Chronic pain lasting 2-3 months; and
- Willingness to provide informed consent.
Who cannot join
- Fibromyalgia (per American College of Rheumatology criteria; Wolfe et al., 1990);
- Recent MTrP injections or physical therapy (within 1 year);
- Acute trauma or systemic conditions (e.g., inflammatory diseases); and
- Neurological deficits.
- Non-willingness to participation or showed non-cooperation.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Comparative Efficacy of Myofascial Release Versus Stretching Combined With High-Powered Pulsed Therapeutic Ultrasound in Athletes With Active Trapezius Trigger Points: A Randomized Comparative Trial
This study aimed to compare the efficacy of MFR plus HPPT-US versus stretching plus HPPT-US on pain intensity, cervical range of motion (ROM), muscle length (ML), and neck disability in athletes with active upper trapezius MTrPs. Methods: A randomized clinical trial was conducted on 60 male athletes diagnosed with active upper trapezius MTrPs. Participants were randomly assigned to Group A (MFR + HPPT-US) or Group B (stretching + HPPT-US). Interventions were administered over two weeks. Outcome measures including Visual Analog Scale (VAS), ROM, ML, and Neck Disability Index (NDI) were recorded at baseline, week 1, week 2, and one-week follow-up. Between-group comparisons were analyzed using independent t-tests, and effect sizes were calculated using Cohen's d. For all statistical analyses, the level of significance alpha was set at 95% (p < .05).
Read the detailed description
Neck pain caused by active myofascial trigger points (MTrPs) in the upper trapezius is a significant concern for athletes, often leading to decreased mobility, persistent discomfort, and compromised performance. Research indicates that these hyperirritable muscle knots contribute not only to localized pain but also to referred discomfort and motor dysfunction, creating a cycle of chronic impairment (Simons et al., 1999). The underlying mechanisms involve both peripheral factors-such as inflammation and nerve sensitization-and central nervous system adaptations that amplify pain perception (Fernández-de-las-Peñas \& Dommerholt, 2018). The resulting limitations extend beyond physical symptoms, affecting training consistency, competition readiness, and long-term athletic careers (Hoy et al., 2014; Elabd et al., 2024).
Athletic Susceptibility to MTrPs Athletes engaged in repetitive or high-load movements are particularly vulnerable to upper trapezius MTrPs. Sports like swimming, tennis, and weightlifting, which demand sustained shoulder and neck exertion, frequently lead to muscle overuse and microtrauma (Page, 2012). Similarly, disciplines requiring prolonged static postures, such as cycling or wrestling, place continuous strain on the cervical musculature, increasing the likelihood of trigger point development (Wiewelhove et al., 2019). Without effective intervention, these issues can evolve into chronic pain syndromes, further hindering athletic output.
Current Therapeutic Approaches
Management of MTrPs typically involves a multimodal approach, including:
Stretching Techniques - Both static and dynamic methods aim to restore muscle pliability and enhance joint mobility (Behm et al., 2021).
Myofascial Release (MFR) - Hands-on or instrument-assisted techniques target fascial tightness, improving tissue flexibility and reducing stiffness (Cheatham et al., 2015).
High-Power-Pain-Threshold (HPPT) Ultrasound - This modality may accelerate healing by increasing blood circulation and breaking down adhesions within affected muscle fibers (Watson, 2008).
While these treatments are commonly used, the optimal combination remains unclear. Some studies suggest that integrating MFR with HPPT ultrasound could offer synergistic benefits by simultaneously addressing soft tissue restrictions and enhancing cellular repair (Robertson et al., 2016). However, direct comparisons between MFR-based and stretching-focused approaches, particularly in athletes, are lacking.
Study Objective and Expected Outcomes This investigation seeks to determine whether MFR combined with HPPT ultrasound outperforms stretching combined with HPPT ultrasound in alleviating neck pain and restoring function in athletes with active MTrPs. Key measures include pain reduction, cervical mobility, strength recovery, and sport-specific functionality.
Given MFR's ability to directly manipulate fascial restrictions and improve neuromuscular coordination, it is anticipated that this approach will yield greater clinical benefits than stretching alone. The findings could influence rehabilitation protocols, offering athletes more effective strategies to manage myofascial pain and expedite return to peak performance.
Broader Implications By clarifying the most effective treatment combination, this research has the potential to refine sports medicine practices, reducing reliance on temporary pain relief and promoting long-term musculoskeletal health. Enhanced intervention strategies may also decrease the economic burden associated with prolonged athlete downtime, benefiting both individuals and sports organizations.
Ultimately, this study aims to advance evidence-based care for myofascial pain, ensuring athletes receive targeted, efficient therapies that support sustained competitive success.
- Conditions
- Active Trapezius Trigger Point Pain
- Being tested
- Myofascial release (MFR), Muscle Stretching, High-powered pulsed therapeutic ultrasound (HPPT-US)
- Keywords
- Myofascial Pain Syndromes, Ultrasonic Therapy, Athletes, Trigger Points, Range of Motion
- Medical subject headings
- Myofascial Pain Syndromes
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Myofascial release (MFR)Other
A 10-minute manual myofascial release (MFR) technique targeting active upper trapezius trigger points (MTrPs), applying sustained pressure until tissue release was achieved.
Muscle StretchingOther
Three 30-second static muscle stretches were performed for the upper trapezius by placing neck side flexion with contralateral rotation.
High-powered pulsed therapeutic ultrasound (HPPT-US)Other
A 5-minute high-powered pulsed therapeutic ultrasound (HPPT) was delivered subcutaneously with specific parameters of 1.5 W/cm², 1 MHz, and pulsed mode.
| Study group | Role | What they receive |
|---|---|---|
| MFR Group | Experimental | MFR Group received a 10-minute manual myofascial release (MFR) technique followed by a 5-minute session of high-powered pulsed therapeutic ultrasound (HPPT-US). It was performed three times per week for two weeks. Receives: Other: Myofascial release (MFR); Other: High-powered pulsed therapeutic ultrasound (HPPT-US) |
| Stretching Group | Active comparator | Stretching Group received three 30-second static stretches for the upper trapezius, involving neck side flexion with contralateral rotation, followed by a 5-minute session of HPPT ultrasound. It was performed three times per week for two weeks. Receives: Other: Muscle Stretching; Other: High-powered pulsed therapeutic ultrasound (HPPT-US) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Pain intensity
Pain intensity was assessed using the visual analog scale (VAS), an imaginary line with either end marked with 0 or 10, indicating no pain or extremely unbearable pain, respectively.
Measured: Once a week for 3 weeks (baseline, week 1 and 2 post-intervention, and follow up at week 3 after one-week completion of intervention.
Cervical range of motion
Cervical range of motion (ROM) was assessed with a universal goniometer for flexion, extension, right and left lateral flexion, and rotation.
Measured: Once a week for 3 weeks (baseline, week 1 and 2 post-intervention, and follow up at week 3 after one-week completion of intervention.
Functional disability
Neck disability was quantified using the Neck Disability Index (NDI), a 10-item questionnaire with established reliability. The minimum and maximum scores are 0 and 50, indicating no disability to severe disability, respectively.
Measured: Once a week for 3 weeks (baseline, week 1 and 2 post-intervention, and follow up at week 3 after one-week completion of intervention.
Upper trapezius muscle length
Upper trapezius muscle length was measured using a vernier calliper with the participants seated in a standardized position. The distance between the mastoid process (posterior to the ear) and the acromioclavicular joint (distal end of the clavicle) was considered.
Measured: Once a week for 3 weeks (baseline, week 1 and 2 post-intervention, and follow-up at week 3 after one-week completion of intervention).
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted3 Jun 2025
- Study start7 Aug 2022
- Primary completion17 Jan 2023
- Study completion27 Apr 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Active Trapezius Trigger Point PainStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Participant, Outcomes assessor
- Enrolment
- 54 participants (actual)
Sponsor and investigators
- Lead sponsor
- King Saud University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, AMIR IQBAL, King Saud University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07002593
- Sponsor's protocol ID
- RRC-2022-07
- Status last verified
- Jul 2025
- First submitted
- 25 May 2025
- Last updated
- 1 Aug 2025
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
Khan N, Ghai T, Kashyap R, Bhat P, Ahmad F, Iqbal A, Alghadir T, Alghadir F, Anwer S, Alghadir AH. Comparative efficacy of myofascial release versus stretching combined with high-powered pulsed therapeutic ultrasound in amateur overhead athletes with active trapezius trigger point pain: a randomized clinical trial. BMC Sports Sci Med Rehabil. 2025 Dec 17;18(1):89. doi: 10.1186/s13102-025-01474-y.
PubMed 41402896
Study at a glance
From the registry record, last updated by the sponsor on 1 Aug 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparative Efficacy of Myofascial Release Versus Stretching Combined With High-Powered Pulsed Therapeutic Ultrasound in Athletes With Active Trapezius Trigger Points: A Randomized Comparative Trial
- ClinicalTrials.gov ID
- NCT07002593
- Acronym / sponsor ID
- RRC-2022-07
- Conditions
- Active Trapezius Trigger Point Pain
- Keywords
- Myofascial Pain Syndromes, Ultrasonic Therapy, Athletes, Trigger Points, Range of Motion
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 54 participants (actual)
- Lead sponsor
- King Saud UniversityUniversity, hospital or other
- Study start
- 7 Aug 2022 (actual)
- Primary completion
- 17 Jan 2023 (actual)
- Study completion
- 27 Apr 2023 (actual)
- First posted
- 3 Jun 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study aimed to compare the efficacy of MFR plus HPPT-US versus stretching plus HPPT-US on pain intensity, cervical range of motion (ROM), muscle length (ML), and neck disability in athletes with active upper trapezius MTrPs. Methods: A randomized clinical trial was conducted on 60 male athletes diagnosed with active upper trapezius MTrPs. Participants were randomly assigned to Group A (MFR + HPPT-US) or Group B (stretching + HPPT-US). Interventions were administered over two weeks. Outcome measures including Visual Analog Scale (VAS), ROM, ML, and Neck Disability Index (NDI) were recorded at baseline, week 1, week 2, and one-week follow-up. Between-group comparisons were analyzed using independent t-tests, and effect sizes were calculated using Cohen's d. For all statistical analyses, the level of significance alpha was set at 95% (p < .05).
Detailed description
Neck pain caused by active myofascial trigger points (MTrPs) in the upper trapezius is a significant concern for athletes, often leading to decreased mobility, persistent discomfort, and compromised performance. Research indicates that these hyperirritable muscle knots contribute not only to localized pain but also to referred discomfort and motor dysfunction, creating a cycle of chronic impairment (Simons et al., 1999). The underlying mechanisms involve both peripheral factors-such as inflammation and nerve sensitization-and central nervous system adaptations that amplify pain perception (Fernández-de-las-Peñas \& Dommerholt, 2018). The resulting limitations extend beyond physical symptoms, affecting training consistency, competition readiness, and long-term athletic careers (Hoy et al., 2014; Elabd et al., 2024).
Athletic Susceptibility to MTrPs Athletes engaged in repetitive or high-load movements are particularly vulnerable to upper trapezius MTrPs. Sports like swimming, tennis, and weightlifting, which demand sustained shoulder and neck exertion, frequently lead to muscle overuse and microtrauma (Page, 2012). Similarly, disciplines requiring prolonged static postures, such as cycling or wrestling, place continuous strain on the cervical musculature, increasing the likelihood of trigger point development (Wiewelhove et al., 2019). Without effective intervention, these issues can evolve into chronic pain syndromes, further hindering athletic output.
Current Therapeutic Approaches
Management of MTrPs typically involves a multimodal approach, including:
Stretching Techniques - Both static and dynamic methods aim to restore muscle pliability and enhance joint mobility (Behm et al., 2021).
Myofascial Release (MFR) - Hands-on or instrument-assisted techniques target fascial tightness, improving tissue flexibility and reducing stiffness (Cheatham et al., 2015).
High-Power-Pain-Threshold (HPPT) Ultrasound - This modality may accelerate healing by increasing blood circulation and breaking down adhesions within affected muscle fibers (Watson, 2008).
While these treatments are commonly used, the optimal combination remains unclear. Some studies suggest that integrating MFR with HPPT ultrasound could offer synergistic benefits by simultaneously addressing soft tissue restrictions and enhancing cellular repair (Robertson et al., 2016). However, direct comparisons between MFR-based and stretching-focused approaches, particularly in athletes, are lacking.
Study Objective and Expected Outcomes This investigation seeks to determine whether MFR combined with HPPT ultrasound outperforms stretching combined with HPPT ultrasound in alleviating neck pain and restoring function in athletes with active MTrPs. Key measures include pain reduction, cervical mobility, strength recovery, and sport-specific functionality.
Given MFR's ability to directly manipulate fascial restrictions and improve neuromuscular coordination, it is anticipated that this approach will yield greater clinical benefits than stretching alone. The findings could influence rehabilitation protocols, offering athletes more effective strategies to manage myofascial pain and expedite return to peak performance.
Broader Implications By clarifying the most effective treatment combination, this research has the potential to refine sports medicine practices, reducing reliance on temporary pain relief and promoting long-term musculoskeletal health. Enhanced intervention strategies may also decrease the economic burden associated with prolonged athlete downtime, benefiting both individuals and sports organizations.
Ultimately, this study aims to advance evidence-based care for myofascial pain, ensuring athletes receive targeted, efficient therapies that support sustained competitive success.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| MFR Group | Experimental | Other: Myofascial release (MFR), Other: High-powered pulsed therapeutic ultrasound (HPPT-US)MFR Group received a 10-minute manual myofascial release (MFR) technique followed by a 5-minute session of high-powered pulsed therapeutic ultrasound (HPPT-US). It was performed three times per week for two weeks. |
| Stretching Group | Active comparator | Other: Muscle Stretching, Other: High-powered pulsed therapeutic ultrasound (HPPT-US)Stretching Group received three 30-second static stretches for the upper trapezius, involving neck side flexion with contralateral rotation, followed by a 5-minute session of HPPT ultrasound. It was performed three times per week for two weeks. |
Who may qualify
- Ages
- 20 to 40 years
- Sex
- Male only
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (5 listed)
- Male athletes
- Aged between 20-40 years
- Active MTrPs in the upper trapezius, confirmed via Travell and Simons' (1999) criteria (palpable taut band, spot tenderness, referred pain, and local twitch response);
- Chronic pain lasting 2-3 months; and
- Willingness to provide informed consent.
Key exclusion criteria (5 listed)
- Fibromyalgia (per American College of Rheumatology criteria; Wolfe et al., 1990);
- Recent MTrP injections or physical therapy (within 1 year);
- Acute trauma or systemic conditions (e.g., inflammatory diseases); and
- Neurological deficits.
- Non-willingness to participation or showed non-cooperation.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Myofascial release (MFR)A 10-minute manual myofascial release (MFR) technique targeting active upper trapezius trigger points (MTrPs), applying sustained pressure until tissue release was achieved. | Other | MFR Group |
| Muscle StretchingThree 30-second static muscle stretches were performed for the upper trapezius by placing neck side flexion with contralateral rotation. | Other | Stretching Group |
| High-powered pulsed therapeutic ultrasound (HPPT-US)A 5-minute high-powered pulsed therapeutic ultrasound (HPPT) was delivered subcutaneously with specific parameters of 1.5 W/cm², 1 MHz, and pulsed mode. | Other | MFR Group, Stretching Group |
Primary outcome
Pain intensity
Time frame: Once a week for 3 weeks (baseline, week 1 and 2 post-intervention, and follow up at week 3 after one-week completion of intervention.
Pain intensity was assessed using the visual analog scale (VAS), an imaginary line with either end marked with 0 or 10, indicating no pain or extremely unbearable pain, respectively.
Cervical range of motion
Time frame: Once a week for 3 weeks (baseline, week 1 and 2 post-intervention, and follow up at week 3 after one-week completion of intervention.
Cervical range of motion (ROM) was assessed with a universal goniometer for flexion, extension, right and left lateral flexion, and rotation.
Functional disability
Time frame: Once a week for 3 weeks (baseline, week 1 and 2 post-intervention, and follow up at week 3 after one-week completion of intervention.
Neck disability was quantified using the Neck Disability Index (NDI), a 10-item questionnaire with established reliability. The minimum and maximum scores are 0 and 50, indicating no disability to severe disability, respectively.
Upper trapezius muscle length
Time frame: Once a week for 3 weeks (baseline, week 1 and 2 post-intervention, and follow-up at week 3 after one-week completion of intervention).
Upper trapezius muscle length was measured using a vernier calliper with the participants seated in a standardized position. The distance between the mastoid process (posterior to the ear) and the acromioclavicular joint (distal end of the clavicle) was considered.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 1 Aug 2025.
- Derived from this study: PubMed 41402896Khan N, Ghai T, Kashyap R, Bhat P, Ahmad F, Iqbal A, Alghadir T, Alghadir F, Anwer S, Alghadir AH. Comparative efficacy of myofascial release versus stretching combined with high-powered pulsed therapeutic ultrasound in amateur overhead athletes with active trapezius trigger point pain: a randomized clinical trial. BMC Sports Sci Med Rehabil. 2025 Dec 17;18(1):89. doi: 10.1186/s13102-025-01474-y.
- Controlled intervention to compare the efficacies of manual pressure release and the muscle energy technique for treating mechanical neck pain due to upper trapezius trigger pointsLink provided by the sponsor.
Related trials for Active Trapezius Trigger Point Pain
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Myofascial release (MFR), Muscle Stretching and High-powered pulsed therapeutic ultrasound (HPPT-US) in people with Active Trapezius Trigger Point Pain, run by King Saud University at 1 site in Saudi Arabia.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 1 Aug 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Saudi Arabia. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Pain intensity (time frame: Once a week for 3 weeks (baseline, week 1 and 2 post-intervention, and follow up at week 3 after one-week completion of intervention.). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07002593, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 1 Aug 2025.