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IRCT20251222068409N1 IRCT 2026-01-14 Tehran University of Medical Sciences Physiotherapy for upper trapezius trigger points Comparison of muscle energy technique plus static stretching versus static stretching alone in office workers with upper trapezius trigger points 2026-01-23 anticipated 50 Recruiting https://irct.ir/trial/88257 interventional Randomization: Randomized, Blinding: Single blinded, Placebo: Not used, Assignment: Parallel, Purpose: Treatment, Randomization description: The patients will randomly assign into Muscle Energy Technique plus static stretching group and only static stretching group. Randomization will be performed using simple method with sealed, randomly filled envelopes describing the treatment groups. At first step, name of each intervention will be written on 25 papers(equal to sample size of each group) and these papers will be put in sealed envelops. Then, the envelops will be blended and at first treatment session, the therapist will take one of these envelops randomly and start the treatment according the group which has been determined in the envelop, Blinding description: This study is a single-blinded randomized controlled trial. Due to the nature of the physiotherapy interventions, blinding of the therapist and participants is not possible. However, the outcome assessor is blinded to group allocation. All assessments are performed by an independent assessor who is not involved in treatment and is unaware of the intervention received by participants. Randomization and allocation concealment are performed to minimize assessment bias. 3 Upper Trapezius Trigger Points. Intervention 1: Intervention group: Participants receive muscle energy technique (MET) combined with static stretching for the upper trapezius muscle, delivered by a qualified physiotherapist according a standardized protocol. Patients will be positioned in supine lying with the head supported. The cervical spine will be passively positioned in lateral flexion to place the upper trapezius fibers on the involved side in a lengthened position. Then the muscle will be brought to a comfortable resistance barrier and the therapist will instruct the patient to perform an isometric contraction of the upper trapezius while the therapist provides a precisely matched counterforce. At the end of the 5-second isometric contraction, the patient will be instructed to be relax completely. A relaxation phase of approximately 3 seconds will be allowed, coordinated with slow exhalation. This contraction–relaxation–repositioning cycle constitutes one MET repetition. The procedure will be repeated four times in each treatment session for the involved upper trapezius muscle. The technique will be applied unilaterally, only on the side where active myofascial trigger point(s) are clinically identified. Intervention 2: Control group: Participants receive static stretching exercises for the upper trapezius muscle only, delivered by a qualified physiotherapist. Stretching of the upper trapezius muscle will be carried out as a therapist-supervised exercise. Patients will be positioned in sitting on a chair with a backrest, without armrests. The subject will be instructed to slowly move the head and neck into contralateral side flexion (i.e., side-bending away from the involved shoulder) until a mild to moderate, non-painful stretching sensation is felt over the superior shoulder and lateral neck region. The ipsilateral shoulder will be encouraged to remain relaxed and depressed, either by verbal cueing or gentle manual contact, to enhance the stretch on the upper trapezius fibers. In accordance with the original intervention plan, active stretching will be performed slowly, with 5 repetitions per treatment session. Each repetition will be held at the point of a comfortable stretch (not pain) for 10 seconds, during which the patient will be encouraged to breathe slowly and avoid any compensatory trunk or shoulder movements. After each 10-second stretch, the head and neck will be returned to the neutral position and the muscle will be allowed to relax for 10 seconds before initiating the next repetition. This pattern—10-second stretch followed by 10-second relaxation—will be repeated for all 5 repetitions in each session. Undecided - It is not yet known if there will be a plan to make this available Justification or reason for indecision in sharing IPD is There is no further information.
public kadhim hashim saud
Al-Jamaeeh Street, Karbala, Hindi, Iraq
Karbala Iraq 1234567890 +964 771 443 5044 kazemhashem987@gmail.com self funded scientific Noureddin Nakhostin Ansari
Piche Shemiran, Enghelab Ave.,Tehran
Tehran Iran (Islamic Republic of) 1148965111 +98 21 7753 5132 nakhostin@tums.ac.ir Tehran University of Medical Sciences Iraq Iraq - Adults 18–45 years, both sexes.- - Clinically confirmed active, unilateral myofascial trigger point in the upper trapezius (the most active and most tender point). - Currently employed in office/desk-based work (≥ 20 h/week for ≥ 6 months), typically ≥ 4–6 h/day of sitting or computer use. - Neck pain >3 based on Numerical Pain Rating Scale. 18 years 45 years Both - Diagnosed fibromyalgia - Facial neuralgia - Coagulation alteration - Cancer - History of cervical or shoulder surgery - History of deep vein thrombosis - History of myopathy - History of infiltration at upper trapezius trigger point - Patients with simultaneous Trigger Points in other body regions. M95 Other disorders of the musculoskeletal system and connective tissue Rehabilitation Rehabilitation Intervention group: Participants receive muscle energy technique (MET) combined with static stretching for the upper trapezius muscle, delivered by a qualified physiotherapist according a standardized protocol. Patients will be positioned in supine lying with the head supported. The cervical spine will be passively positioned in lateral flexion to place the upper trapezius fibers on the involved side in a lengthened position. Then the muscle will be brought to a comfortable resistance barrier and the therapist will instruct the patient to perform an isometric contraction of the upper trapezius while the therapist provides a precisely matched counterforce. At the end of the 5-second isometric contraction, the patient will be instructed to be relax completely. A relaxation phase of approximately 3 seconds will be allowed, coordinated with slow exhalation. This contraction–relaxation–repositioning cycle constitutes one MET repetition. The procedure will be repeated four times in each treatment session for the involved upper trapezius muscle. The technique will be applied unilaterally, only on the side where active myofascial trigger point(s) are clinically identified. Control group: Participants receive static stretching exercises for the upper trapezius muscle only, delivered by a qualified physiotherapist. Stretching of the upper trapezius muscle will be carried out as a therapist-supervised exercise. Patients will be positioned in sitting on a chair with a backrest, without armrests. The subject will be instructed to slowly move the head and neck into contralateral side flexion (i.e., side-bending away from the involved shoulder) until a mild to moderate, non-painful stretching sensation is felt over the superior shoulder and lateral neck region. The ipsilateral shoulder will be encouraged to remain relaxed and depressed, either by verbal cueing or gentle manual contact, to enhance the stretch on the upper trapezius fibers. In accordance with the original intervention plan, active stretching will be performed slowly, with 5 repetitions per treatment session. Each repetition will be held at the point of a comfortable stretch (not pain) for 10 seconds, during which the patient will be encouraged to breathe slowly and avoid any compensatory trunk or shoulder movements. After each 10-second stretch, the head and neck will be returned to the neutral position and the muscle will be allowed to relax for 10 seconds before initiating the next repetition. This pattern—10-second stretch followed by 10-second relaxation—will be repeated for all 5 repetitions in each session. Numeric pain rating scale. Timepoint: Primary outcome will be measured at baseline (before intervention), immediately after completion of the 2-week intervention period, and at one-week follow-up after the end of the intervention. Method of measurement: The Numeric Pain Rating Scale (NPRS) is a unidimensional tool used to assess pain intensity. Patients rate their pain on an 11-point scale ranging from 0 (“no pain”) to 10 (“worst imaginable pain”) by marking or drawing a tick on the number that best represents their current pain level. This scale is widely used in both clinical and research settings due to its simplicity, reliability, and validity. A change of 2 points or approximately 30% reduction is typically considered clinically significant. Neck Proprioception–Joint Position Sense (JPS). Timepoint: Primary outcome will be measured at baseline (before intervention), immediately after completion of the 2-week intervention period, and at one-week follow-up after the end of the intervention. Method of measurement: Joint Position Sense was evaluated using the cervicocephalic relocation test. A laser pointer was securely attached to the center of the participant’s forehead, and the subject was seated exactly 90 cm away from a fixed target on the wall. With eyes closed, the participant actively moved the head into contralateral lateral flexion, then attempted to return to the neutral starting position. The discrepancy between the initial reference point and the returned point was measured in centimeters, representing the repositioning error and serving as an indicator of cervical proprioceptive accuracy (27, 36). Contralateral lateral flexion was selected because the upper trapezius is most involved in side-bending movements. Active trigger points in this muscle primarily impair proprioception when the muscle is placed under stretch. Thus, contralateral flexion provides the most sensitive and specific direction to detect joint position sense errors associated with upper trapezius trigger points. Neck Active Range of Motion. Timepoint: Neck Active Range of Motion will be measured at baseline (before intervention), immediately after completion of the 2-week intervention period, and at one-week follow-up after the end of the intervention. Method of measurement: Active cervical range of motion (AROM) will be assessed for contralateral lateral flexion, flexion, and extension using a Universal goniometer. All measurements will follow the standardized protocol described by Farooq et al. (2016) Participants will be seated upright in a standardized position, with the trunk stabilized against the backrest of a wooden chair, hips and knees at 90°, feet flat on the floor, and arms folded across the chest to minimize thoracic compensation. The head will be positioned in neutral alignment before each measurement For contralateral lateral flexion, the axis of the goniometer will be placed over the spinous process of C7, the stationary arm aligned vertically along the thoracic spine (perpendicular to the floor), and the moving arm aligned with the midline of the head toward the external occipital protuberance. Participants will actively bend the neck away from the symptomatic upper trapezius side until their end range of motion. For flexion and extension, the axis of the goniometer will be placed over the external auditory meatus, the stationary arm aligned vertically (perpendicular to the ground), and the moving arm aligned with the base of the nares. Participants will actively flex or extend the cervical spine to their comfortable end range. Each participant will perform three trials for each direction. A brief familiarization will be provided before taking measurements, consistent with PJMS protocol. Scapular elevation, thoracic movement, or trunk lean will be avoided through verbal cues and standardized positioning. A rest interval of 10–15 seconds will be provided between trials to minimize fatigue. The mean value (in degrees) of the three trials will be used as the final outcome. Universal goniometry was selected due to its excellent inter- and intra-rater reliability for measuring active cervical ROM in clinical setting. Functional rating scale. Timepoint: Secondary outcome will be measured at baseline (before intervention), immediately after completion of the 2-week intervention period, and at one-week follow-up after the end of the intervention. Method of measurement: The Functional Rating Index (FRI) is a self-reported questionnaire developed to evaluate the functional impact of spinal conditions, especially those involving the neck and lower back. It consists of 10 items addressing pain and functional activities such as work, sleep, and recreation. Each item is scored from 0 to 4, and the total score is converted into a percentage, with higher scores indicating greater disability. The Arabic FRI has shown strong validity, reliability, and responsiveness in musculoskeletal populations. Tehran University of Medical Sciences Approved 2025-12-10 School of Nursing and Midwifery & Rehabilitation - Tehran University of Medical Sciences Mirkhani st.(East Nosrat), Tohid Sq. Tehran Tehran Tehran Iran (Islamic Republic of)