Emmett Technique Versus Bowen Technique for Upper Trapezius Myofascial Pain Syndrome

This research is a randomized clinical trial designed to compare the effects of the Emmett Technique and Bowen Therapy on pain intensity, cervical range of motion, and functional disability in patients with upper trapezius myofascial pain syndrome (MPS). Upper trapezius MPS is characterized by the presence of myofascial trigger points within taut skeletal muscle bands and may present with localized or referred pain, muscle stiffness, restricted cervical movement, weakness, and reduced functional performance.

The rationale for conducting this study is that although both the Emmett Technique and Bowen Therapy are increasingly used as manual therapy approaches, there is limited evidence directly comparing their effectiveness. Existing research has largely investigated these techniques independently, creating a gap regarding which intervention may provide superior improvement in pain, range of motion, and functional ability in patients with upper trapezius MPS. The primary objective is therefore to evaluate their relative efficacy in this patient population.

The study includes a total sample of 46 participants, with the sample size calculated using G*Power with an additional 5% attrition rate. A non-probability purposive convenient sampling strategy is used for recruitment. Eligible participants include both males and females aged 18-45 years with a clinical diagnosis of upper trapezius MPS according to Travell and Simons' criteria, including features such as a taut band, hypersensitive trigger point, referred pain pattern, restricted range of motion, and reproduction of pain on probing. Participants are also required to have pain lasting more than three months, an NPRS score of 3-10, and an NDI score between 20 and 35.

Following recruitment, participants are randomized into two groups. Group A consists of 23 participants receiving the Emmett Technique, while Group B consists of 23 participants receiving Bowen Therapy. Both groups additionally receive the same standardized physiotherapy protocol.

In the Emmett Technique group, mild pressure is applied to specific EMMETT points for approximately 5-20 seconds and repeated three times at each point. The first application is used to evaluate the tissue, the second is intended to produce the therapeutic response, and the third reassesses the tissue response. In the Bowen Therapy group, gentle cross-fibre rolling movements are performed over the fascia, tendons, muscles, and ligaments of the upper trapezius and cervical region using light pressure, with approximately two-minute pauses between sets of Bowen movements. Each intervention session lasts approximately 20 minutes, and both groups receive 12 treatment sessions over four weeks, at three sessions per week.

Both groups also receive a standardized physiotherapy protocol, consisting of TENS, hot pack application, strengthening and stretching exercises, and ischemic compression release. The exercise component includes isometric strengthening and stretching of the upper trapezius, supraspinatus, and pectoral muscles.

The primary clinical outcomes are assessed before and after treatment using three measurement tools. The Numerical Pain Rating Scale (NPRS) assesses pain intensity on a 0-10 scale; the Neck Disability Index (NDI) evaluates the impact of neck symptoms on functional activities; and a Universal Goniometer measures cervical range of motion, including flexion, extension, right and left lateral flexion, and right and left rotation.

For statistical analysis, the study uses IBM SPSS version 26.0. The Shapiro-Wilk test is used to assess normality. According to the methodology, the data are considered normally distributed; therefore, paired-sample t-tests are planned for within-group pre- versus post-treatment comparisons, while independent-samples t-tests are used to compare outcomes between the two intervention groups.

Overall, the study is intended to determine whether the Emmett Technique or Bowen Therapy provides greater clinical benefits when combined with standardized physiotherapy for upper trapezius myofascial pain syndrome. By comparing changes in pain, cervical mobility, and neck-related functional disability, the research aims to provide evidence that may assist physiotherapists in selecting a more effective manual therapy approach for this patient population.

Inclusion criteria

• Participants including both male and female
• Age: 18-45 years
• Clinical diagnosis of upper trapezius myofascial pain syndrome according to -----Travell and Simons' criteria, including:

Taut band Hypersensitive trigger point Referral pain pattern Restricted range of motion

• Reproduction of pain upon probing
• Pain duration surpassing 3 months
• NPRS score: 3-10

Exclusion criteria

• Cervical trauma or surgical history
• Cervical radiculopathy and/or other neurological conditions
• Psychiatric disorders, malignancies, rheumatologic conditions, or systemic illnesses
• Fibromyalgia
• Recent dry needling, trigger-point injection treatments, or other invasive procedures
• Pregnancy