Combined Therapy and Jones Technique for Upper Trapezius Myofascial Trigger Points

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

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.

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.

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.