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NCT Number: NCT07571655

Comparative Effect of Active Release Technique and Myofascial Release in Cervical Myofascial Syndrome

The aim of this randomized controlled trial is to find the comparative effect of Active Release Technique and Myofascial release, each combined with eye exercises, on asthenopia, sleep quality, stress, pain and functional disability in patients with CMPS. A total of 44 participants will be randomized into two groups, ART + eye exercises and MFR+ eye exercises with interventions provided 3 days per week for 4 weeks. Outcomes will be assessed at baseline, 2 weeks and then after 4 weeks.

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Key information

Conditions

Cervical Myofascial Pain Syndrome Asthenopia Eye Diseases Neurologic Manifestations Pain Pathological Conditions, Signs and Symptoms Signs and Symptoms

Age range

18 year–40 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Railway General Hospital, Rawalpindi

Rawalpindi, Punjab Province, 46600, Pakistan

Location contact

IQRA iFTIKHAR, MS-OMPT*

SUB_INVESTIGATOR

IQRA, MS-OMPT*

CONTACT

IFTIKHAR

KINZA ANWAR, MS-OMPT

CONTACT

[email protected]

+92-3239735427

About this study

A musculoskeletal condition known as myofascial pain is characterized by discomfort in the region of a muscle and the fascia, the connective tissue that surrounds it. In addition to having several trigger sites, the pain may be local or widespread. Trigger points are very sensitive muscle foci that radiate pain to the surrounding area and hurts to touch. In particular, the rhomboids, trapezius, levator scapulae, supraspinatus, and infraspinatus often affected muscles in the cervical area. Acute or chronic pain is possible, and it is most likely brought on by overuse, altered posture, or muscular injury. Cervical myofascial pain is highly prevalent globally. A 2021 study by Kamran Ezzati found that 88.9% of Iranian participants had at least one neck trigger point. Similarly, a 2024 study by Sahib Rehman et al in Pakistan reported high prevalence of Myofascial Trigger Points in cervical radiculopathy patients, with mean scores of MTrPs.

Cervical myofascial pain or neck muscle pain is often caused by poor posture or prolonged use of electronic devices, leading to muscle knots or trigger points. A component of myofascial pain is the emotional stress we carry which contributes to muscle tension (in the form of, increased activation of the "fight or flight" response) releasing stress hormones like cortisol that increase muscle tension. As a health care profession, we know that physical injuries like whiplash cause damage to the structures of the neck and may also alter how certain structures respond post injury (inflammation and stiffness). There are many other conditions, such as degenerative disc disease, osteoarthritis, and fibromyalgia, both predispose the patient to altered spinal posture. As a result, muscle may function differently resulting in myofascial pain Cervical myofascial pain can be managed with orthopedic manual techniques like Active Tissue Release (ATR) and Myofascial Release (MFR). ATR, developed by Dr. Michael Leahy, combines pressure with movement to break down adhesions, improve circulation, and reduce trigger point activity. It helps restore muscle balance and relieve postural strain. MFR, popularized by John F. Barnes, uses gentle sustained pressure to release fascial restrictions, improve blood flow, and reduce nervous system overactivity. Both techniques enhance mobility, reduce pain, and promote better posture and function in the neck.

Combining these interventions with eye exercises targets both neuromuscular and visual dysfunction, offering a holistic approach to improving sleep quality, reducing stress, and alleviating cervical pain. The study addresses a gap in evidence by directly comparing ART and MFR with integrated eye exercises, potentially guiding physiotherapists and clinicians toward the most effective treatment strategy for CMPS.

Who can participate

Healthy volunteers accepted: No

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

Inclusion criteria

  • • Both genders
  • Age between 18 and 40 years
  • Neck pain since last month with NPRS >3
  • Cervical Myofascial pain (Presence of one or more trigger point in neck/ shoulder muscles particularly (upper trapezius, SCM and levator)
  • PSQI score > 5
  • Subjects with ASQ-17 score > 13

Exclusion criteria

  • • Subjects with a history of cervical trauma or surgery
  • Subjects with a history of substance abuse
  • Subjects with use of sleep medications
  • Subjects with psychological disturbance (stress, depression or anxiety)
  • Visual impairment or ophthalmologic disease other than asthenopia

Treatment and study plan

Myofascial Release + Eye exercises

Other
  • MFR applied with forearm/ulnar border of palm, gliding towards neck base/upper scapula, Sustained gentle pressure is maintained, held until a release (softening/yield) of fascial tissue is felt; the pressure is gradually increased as tolerance allows.
  • 3-4 glides × 90 seconds each, according to tolerance.
  • Frequency: 3 days/week for 4 weeks.
  • Followed by the same Eye Exercises as in experimental group

Active Release Technique + Eye exercises

Other

ART applied to cervical region (upper trapezius, Levator scapula and SCM) deep tension stretch with thumb over the tender areas , repeated 3-5 times.

Frequency: 3 days/week for 4 weeks Followed by Eye exercises (3 days/week for 4 weeks)

  • Trataka (focusing on one point) = 30s/ 3 times
  • Eye ball movements = 10 reps/ 2sets i. Sideways ii. Up and down iii. Two ways diagonal movement iv. Clockwise and anticlockwise rotational movements
  • Eye blinking and opening = 10 reps/ 2sets
  • Palming = 30s/1 time

Primary outcomes

  1. : Neck Disability Index (NDI)

    Time frame: Baseline, 2 weeks and 4 weeks (one-month follow-up)

    The Neck impairment Index (NDI) is a self-report questionnaire designed to measure the self-rated impairment of patients with neck pain and to establish how neck pain impacts a patient's everyday life. A vertical scale from 0 to 5 is used to rate the questions; After scoring, 0-4 points (0-8%) indicate no disability, 5-14 points (10-28%) indicate mild disability, 15-24 points (30-48%) indicate moderate disability, 25-34 points (50-64%) indicate severe disability, and 35-50 points (70-100%) indicate complete disability

  2. Numeric Pain Rating Scale NPRS

    Time frame: Baseline, 2 weeks and 4 weeks (one-month follow-up)

    The numeric pain rating scale (NPRS) is a tool used to assess pain intensity, where patients rate their pain on a scale of 0 to 10, with 0 representing no pain and 10 representing the worst possible pain.

  3. Pittsburgh Sleep Quality Index (PSQI)

    Time frame: Baseline, 2 weeks and 4 weeks (one-month follow-up)

    The Pittsburgh Sleep Quality Index (PSQI) is a standardized questionnaire used to assess sleep quality and disturbances over a one-month period. It consists of 19 self-rated questions grouped into seven components: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction. a global score ranging from 0 to 21. A global PSQI score greater than 5 indicates poor sleep quality, while a score of 5 or below reflects good sleep quality.

  4. ASQ-17 (Asthenopia Survey Questionnaire)

    Time frame: Baseline, 2 weeks and 4 weeks (one-month follow-up)

    The ASQ-17 (Asthenopia Survey Questionnaire) is a self-administered questionnaire that measures asthenopia (or eye strain) and associated symptoms. The ASQ-17 covers 7 items of eye strain symptoms, 6 items of visual symptoms and 4 items of systemic and psychological symptoms with a maximum total score of 51 and an optimal cut-off threshold value of 12.5, indicating the presence of asthenopia.

  5. Perceived Stress Scale (PSS)

    Time frame: Baseline, 2 weeks and 4 weeks (one-month follow-up)

    The Perceived Stress Scale (PSS) is a widely used psychological instrument designed to measure the degree to which individuals perceive their lives as stressful. The scale typically includes 10 items (PSS-10), yielding a total score ranging from 0 to 40. Scoring involves reversing the scores for positively worded items (items 4, 5, 7, and 8), then summing all item scores. Interpretation of scores is generally categorized as follows: 0-13 indicates low stress, 14-26 suggests moderate stress, and 27-40 reflects high perceived stress. Higher scores indicate greater levels of perceived stress.

Study contacts

Contact information is provided by the study sponsor or research team.

KINZA ANWAR, MS-OMPT

CONTACT

[email protected]

+92-3239735427

Sponsors and collaborators

Lead sponsor

Riphah International University

Other

Registry information

Official study title

Comparative Effect of Active Release Technique and Myofascial Release to Improve Asthenopia, Sleep and Stress in Patients With Cervical Myofascial Pain Syndrome

Important dates

Study start
2026
Primary completion
2027
Study completion
2027
First posted
May 6, 2026
Registry last updated
Jun 3, 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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