Comparison of the Effectiveness of Exercise, Dry Needling and Interfascial Block Treatments in the Treatment of Myofascial Pain Syndrome

The study will include patients who present to the Physical Medicine and Rehabilitation outpatient clinic between July 2025 and May 2026 with clinical symptoms consistent with myofascial pain syndrome in the trapezius muscle. Patients referred to our injection clinic (treatment room) for routine myofascial stretching exercises, dry needling, and interfascial block treatments will be included if they meet the inclusion and exclusion criteria specified below. Demographic data such as age, gender, height, and weight will be recorded. At the initial assessment, patients' VAS (Visual Analog Scale), range of motion in the neck, neck disability scale, pressure pain threshold (PPT) measurements with an algometer, central sensitization scale, and Short Form 12 (SF-12) results will be noted. A total of 78 patients will be included in the study and randomly divided into three groups: Group 1 (Exercise group), Group 2 (Exercise + dry needling group), and Group 3 (Exercise + interfascial block group). Randomization will be done using a sealed envelope method. Group 1 will perform cervical ROM and trapezius facial stretching exercises. Group 2 will perform cervical ROM, trapezius facial stretching exercises, and dry needling of the relevant fascia using Hua Long brand 0.25x25 mm disposable sterile steel acupuncture needles under ultrasound guidance. Group 3 will perform cervical ROM and trapezius facial stretching exercises, and interfascial application of a mixture of 1 cc of 2% lidocaine and 4 cc of 0.9% saline under ultrasound guidance. Patients will receive a total of 3 treatment sessions, once a week for 3 weeks. All evaluation parameters will be performed before treatment, 30 minutes after the last session, and 12 weeks after the start of treatment. Within-group and between-group differences will be examined statistically.

Inclusion criteria

• Myofascial pain in the upper trapezius muscle that has lasted for at least 3 months
• VAS score of 4 or higher for the current pain
• Clinically diagnosed with myofascial pain in the trapezius muscle
• Ages 18 to 55
• Patients who can follow verbal instructions and have no cognitive deficits

Exclusion criteria

• Having received interventional injections in the neck and shoulder area within the last 3 months
• Having received physical therapy within the last 3 months
• Having received regular nonsteroidal anti-inflammatory and myorelaxant treatment within the last month
• History of surgery on the affected side (neck or shoulder)
• Chronic inflammatory disease
• Acute infection
• History of malignancy
• Coagulation disorders
• Pregnancy
• Liver and kidney pathologies
• Drug allergy