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Completed

NCT Number: NCT07695402

Combined Therapy and Jones Technique for Upper Trapezius Myofascial Trigger Points

Myofascial trigger points in the upper trapezius muscle are a common cause of neck pain and may negatively affect pressure pain threshold, upper limb function, sleep quality, and quality of life. This randomized, sham-controlled clinical trial aimed to compare the effects of the Jones Technique, combined therapy (therapeutic ultrasound plus transcutaneous electrical nerve stimulation [TENS]), their combination, and a sham intervention in women with active upper trapezius myofascial trigger points. The primary outcome was pressure pain threshold. Secondary outcomes included pain intensity, upper limb disability, sleep quality, quality of life, physical activity level, and participant satisfaction.

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Key information

Conditions

Myofascial Trigger Points Myofascial Pain Syndrome - Neck Neck Pain Musculoskeletal

Age range

18 year–40 year

Sex eligibility

Female

Study type

Interventional

Phase

Not applicable

Primary location

Physical Therapy Teaching Clinic, Universidade do Vale do Rio dos Sinos (UNISINOS)

São Leopoldo, Rio Grande do Sul, Brazil

About this study

Myofascial trigger points (MTrPs) in the upper trapezius muscle are frequently associated with neck pain, reduced pressure pain threshold, and impaired upper limb function. Several conservative interventions have been proposed for the treatment of MTrPs; however, evidence comparing manual therapy and combined electrotherapy remains limited.

This single-center, randomized, sham-controlled, parallel-group clinical trial evaluated the effects of the Jones Technique and combined therapy (therapeutic ultrasound plus transcutaneous electrical nerve stimulation [TENS]) in women aged 18 to 40 years presenting with active myofascial trigger points in the upper trapezius muscle.

Participants were randomly allocated (1:1:1:1) into four groups: (1) Jones Technique; (2) combined therapy; (3) combined therapy plus Jones Technique; and (4) sham control. Randomization was performed using block randomization stratified by age. Participants underwent a single treatment session.

Baseline assessments included demographic data, pain intensity measured using the Visual Analog Scale (VAS), pressure pain threshold measured with a pressure algometer, upper limb disability (DASH), sleep quality (Pittsburgh Sleep Quality Index), quality of life (SF-36), and physical activity level (IPAQ). Immediately after the intervention, pain intensity, pressure pain threshold, and participant satisfaction were reassessed.

The primary outcome was pressure pain threshold. Secondary outcomes included pain intensity, upper limb disability, sleep quality, quality of life, physical activity level, and participant satisfaction.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Female participants aged 18 to 40 years.
  • Presence of active myofascial trigger points in the upper trapezius muscle for no longer than 12 weeks.
  • Neck pain lasting less than 3 months.
  • Pain intensity of at least 3 cm on the 10-cm Visual Analog Scale (VAS).
  • Ability to understand the study procedures and provide written informed consent.

Exclusion criteria

  • Presence of a cardiac pacemaker or other contraindications to electrotherapy.
  • Pregnancy.
  • Uncontrolled cardiovascular disease.
  • Psychiatric disorders that could interfere with study participation.
  • Thrombosis or coagulation disorders.
  • History of tumors or neoplasms.
  • Physical therapy or myofascial treatment within the previous 3 weeks.
  • Treatment for myofascial trigger points within the previous 3 months.
  • Current use of analgesic medications.
  • Cervical musculoskeletal disorders (e.g., cervical osteoarthritis or other cervical lesions).
  • History of cervical trauma or surgery.
  • Cervical spondylosis or spondylolisthesis with radiculopathy.
  • Fibromyalgia or other systemic rheumatic diseases.
  • Other musculoskeletal disorders that could interfere with the study outcomes.

Treatment and study plan

Jones technique

Procedure

Manual therapy technique applied to active myofascial trigger points of the upper trapezius muscle. Participants were positioned in prone lying, and sustained pressure with positional release was applied to each trigger point for 90 seconds. Five trigger points were treated during a single treatment session.

Combined Therapy (Therapeutic Ultrasound + TENS)

Device

Combined therapy consisting of pulsed therapeutic ultrasound (1 MHz, 20% duty cycle, 1.0 W/cm²) delivered simultaneously with transcutaneous electrical nerve stimulation (TENS; biphasic asymmetric waveform, 200 μs pulse duration, 100 Hz). Treatment was applied to five active upper trapezius myofascial trigger points during a single 10-minute session.

Combined Therapy + Jones Technique

Combination Product

Participants received the Jones Technique followed immediately by combined therapy (therapeutic ultrasound plus transcutaneous electrical nerve stimulation [TENS]) during a single treatment session.

sham intervention

Procedure

Participants underwent sham treatment consisting of inactive combined therapy with the device turned off and a simulated Jones Technique performed without therapeutic pressure.

Primary outcomes

  1. Pressure Pain Threshold (PPT)

    Time frame: Baseline and immediately after the intervention (single treatment session)

    Pressure pain threshold assessed using a pressure algometer at five active myofascial trigger points in the upper trapezius muscle. The pressure pain threshold is recorded in kg/cm². Higher values indicate greater pressure tolerance and therefore a better outcome.

  2. Pain Intensity

    Time frame: Baseline and immediately after the intervention

    Pain intensity assessed using the Visual Analog Scale for Pain (VAS). Scores range from 0 to 10 cm, where 0 indicates no pain and 10 indicates the worst pain imaginable. Higher scores indicate worse pain.

Secondary outcomes

  1. Upper Limb Disability

    Time frame: Baseline

    Upper limb disability assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Scores range from 0 to 100, where 0 indicates no disability and 100 indicates the most severe disability. Higher scores indicate worse upper limb function.

  2. Sleep Quality

    Time frame: Baseline

    Sleep quality assessed using the Pittsburgh Sleep Quality Index (PSQI). Total scores range from 0 to 21, where higher scores indicate poorer sleep quality.

  3. Quality of life

    Time frame: Baseline

    Quality of life assessed using the 36-Item Short Form Health Survey (SF-36). Scores for each domain range from 0 to 100, where higher scores indicate better health-related quality of life.

  4. Physical Activity Level

    Time frame: Baseline

    Physical activity level assessed using the International Physical Activity Questionnaire (IPAQ). Participants are classified into low, moderate, or high physical activity levels based on the questionnaire scoring protocol. Higher physical activity classification indicates a better outcome.

  5. Participant Satisfaction

    Time frame: Immediately after the intervention

    Participant satisfaction assessed immediately after treatment using a 7-point Likert scale. Scores range from 1 (strongly disagree/very dissatisfied) to 7 (strongly agree/very satisfied). Higher scores indicate greater participant satisfaction.

Sponsors and collaborators

Lead sponsor

Isabel de Almeida Paz

Other

Registry information

Official study title

Clinical Effects of Combined Therapy, Jones Technique, and Their Combination in Women With Upper Trapezius Myofascial Trigger Points: A Four-Arm Randomized Controlled Trial

Important dates

Study start
2024
Primary completion
2024
Study completion
2024
First posted
Jul 10, 2026
Registry last updated
Jul 14, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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