Group A ( study group )will receive high intensity laser ,TENs , ultrasound therapy , and isometric exercise.

Group B ( study group) will receive ischemic compression ,TENs and ultrasound therapy and isometric exercise.

Group C (control group ) will receive TENs and ultrasound therapy and isometric exercise only.

effect of high intensity laser versus ischemic compression on myofascial trigger points in the upper trapezius

All the cervical active movements will be measured by cervical range of motion device (CROM) especially in cervical flexion ,extension and medial and lateral rotation.one tester will document the results.

cervical range of motion (cROM) will be measured by using Electronic CROM Goniometer in all ranges.

Cervical pain will be measured by Cervical range of motion device (CROM) .The patient will actively perform cervical movements in flexion ,extension and medial and lateral rotation then one tester will document the results as VAS will be used to measure pain levels .The VAS is a 10_cm line divided into 10 equal sections , with 10 expressing "unbearable pain " and 0 indicating no pain .each patient will be asked to point on this line to their level of neck pain .as pain level decreases ,the patient state improves. Pain will be assessed before and after treatment.

Pressure pain threshold (PPT) ,measured by Algometer is defined as the point at which painless stimulation such as pressure turns into a painful sensation,so that we will measure PPT for each patient before and after treatment by one tester as pressure Algometry is a method that objectively describes PPT