This study aimed to compare the efficacy of MFR plus HPPT-US versus stretching plus HPPT-US on pain intensity, cervical range of motion (ROM), muscle length (ML), and neck disability in athletes with active upper trapezius MTrPs. Methods: A randomized clinical trial was conducted on 60 male athletes diagnosed with active upper trapezius MTrPs. Participants were randomly assigned to Group A (MFR + HPPT-US) or Group B (stretching + HPPT-US). Interventions were administered over two weeks. Outcome measures including Visual Analog Scale (VAS), ROM, ML, and Neck Disability Index (NDI) were recorded at baseline, week 1, week 2, and one-week follow-up. Between-group comparisons were analyzed using independent t-tests, and effect sizes were calculated using Cohen's d. For all statistical analyses, the level of significance alpha was set at 95% (p < .05).

Neck pain caused by active myofascial trigger points (MTrPs) in the upper trapezius is a significant concern for athletes, often leading to decreased mobility, persistent discomfort, and compromised performance. Research indicates that these hyperirritable muscle knots contribute not only to localized pain but also to referred discomfort and motor dysfunction, creating a cycle of chronic impairment (Simons et al., 1999). The underlying mechanisms involve both peripheral factors-such as inflammation and nerve sensitization-and central nervous system adaptations that amplify pain perception (Fernández-de-las-Peñas & Dommerholt, 2018). The resulting limitations extend beyond physical symptoms, affecting training consistency, competition readiness, and long-term athletic careers (Hoy et al., 2014; Elabd et al., 2024).

Athletic Susceptibility to MTrPs Athletes engaged in repetitive or high-load movements are particularly vulnerable to upper trapezius MTrPs. Sports like swimming, tennis, and weightlifting, which demand sustained shoulder and neck exertion, frequently lead to muscle overuse and microtrauma (Page, 2012). Similarly, disciplines requiring prolonged static postures, such as cycling or wrestling, place continuous strain on the cervical musculature, increasing the likelihood of trigger point development (Wiewelhove et al., 2019). Without effective intervention, these issues can evolve into chronic pain syndromes, further hindering athletic output.

Current Therapeutic Approaches

Management of MTrPs typically involves a multimodal approach, including:

Stretching Techniques - Both static and dynamic methods aim to restore muscle pliability and enhance joint mobility (Behm et al., 2021).

Myofascial Release (MFR) - Hands-on or instrument-assisted techniques target fascial tightness, improving tissue flexibility and reducing stiffness (Cheatham et al., 2015).

High-Power-Pain-Threshold (HPPT) Ultrasound - This modality may accelerate healing by increasing blood circulation and breaking down adhesions within affected muscle fibers (Watson, 2008).

While these treatments are commonly used, the optimal combination remains unclear. Some studies suggest that integrating MFR with HPPT ultrasound could offer synergistic benefits by simultaneously addressing soft tissue restrictions and enhancing cellular repair (Robertson et al., 2016). However, direct comparisons between MFR-based and stretching-focused approaches, particularly in athletes, are lacking.

Study Objective and Expected Outcomes This investigation seeks to determine whether MFR combined with HPPT ultrasound outperforms stretching combined with HPPT ultrasound in alleviating neck pain and restoring function in athletes with active MTrPs. Key measures include pain reduction, cervical mobility, strength recovery, and sport-specific functionality.

Given MFR's ability to directly manipulate fascial restrictions and improve neuromuscular coordination, it is anticipated that this approach will yield greater clinical benefits than stretching alone. The findings could influence rehabilitation protocols, offering athletes more effective strategies to manage myofascial pain and expedite return to peak performance.

Broader Implications By clarifying the most effective treatment combination, this research has the potential to refine sports medicine practices, reducing reliance on temporary pain relief and promoting long-term musculoskeletal health. Enhanced intervention strategies may also decrease the economic burden associated with prolonged athlete downtime, benefiting both individuals and sports organizations.

Ultimately, this study aims to advance evidence-based care for myofascial pain, ensuring athletes receive targeted, efficient therapies that support sustained competitive success.

Inclusion Criteria:

• Male athletes
• Aged between 20-40 years
• Active MTrPs in the upper trapezius, confirmed via Travell and Simons' (1999) criteria (palpable taut band, spot tenderness, referred pain, and local twitch response);
• Chronic pain lasting 2-3 months; and
• Willingness to provide informed consent.

Exclusion Criteria:

• Fibromyalgia (per American College of Rheumatology criteria; Wolfe et al., 1990);
• Recent MTrP injections or physical therapy (within 1 year);
• Acute trauma or systemic conditions (e.g., inflammatory diseases); and
• Neurological deficits.
• Non-willingness to participation or showed non-cooperation.

Male