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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Jones Technique | Experimental | Participants received a single session of the Jones Technique for the treatment of active myofascial trigger points in the upper trapezius muscle. |
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| Combined Therapy | Experimental | Participants received a single session of combined therapy consisting of therapeutic ultrasound combined with transcutaneous electrical nerve stimulation (TENS) applied to active myofascial trigger points in the upper trapezius muscle. |
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| Combined Therapy + Jones Technique | Experimental | Participants received the Jones Technique followed immediately by combined therapy (therapeutic ultrasound plus transcutaneous electrical nerve stimulation [TENS]) during a single treatment session. |
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| Sham Control | Sham Comparator | Participants underwent all study assessments and received sham treatment consisting of inactive combined therapy (device turned off) and a simulated Jones Technique without therapeutic pressure. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Jones Technique | Procedure | Manual therapy technique applied to active myofascial trigger points of the upper trapezius muscle. Participants were positioned in prone lying, and sustained pressure with positional release was applied to each trigger point for 90 seconds. Five trigger points were treated during a single treatment session. |
| Measure | Description | Time Frame |
|---|---|---|
| Pressure Pain Threshold (PPT) | Pressure pain threshold measured with a pressure algometer at five active myofascial trigger points in the upper trapezius muscle. Three measurements were obtained at each assessment | Baseline and immediately after the intervention (single treatment session) |
| Pain Intensity | Pain intensity measured using a 10-cm Visual Analog Scale (VAS). | Baseline and immediately after the intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Upper Limb Disability | Upper limb disability assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. | Baseline |
| Sleep Quality | Sleep quality assessed using the Pittsburgh Sleep Quality Index (PSQI). |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Physical Therapy Teaching Clinic, Universidade do Vale do Rio dos Sinos (UNISINOS) | São Leopoldo | Rio Grande do Sul | Brazil |
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| Combined Therapy (Therapeutic Ultrasound + TENS) | Device | Combined therapy consisting of pulsed therapeutic ultrasound (1 MHz, 20% duty cycle, 1.0 W/cm²) delivered simultaneously with transcutaneous electrical nerve stimulation (TENS; biphasic asymmetric waveform, 200 μs pulse duration, 100 Hz). Treatment was applied to five active upper trapezius myofascial trigger points during a single 10-minute session. |
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| Combined Therapy + Jones Technique | Combination Product | Participants received the Jones Technique followed immediately by combined therapy (therapeutic ultrasound plus transcutaneous electrical nerve stimulation [TENS]) during a single treatment session. |
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| Sham Intervention | Procedure | Participants underwent sham treatment consisting of inactive combined therapy with the device turned off and a simulated Jones Technique performed without therapeutic pressure. |
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| Baseline |
| Quality of life | Quality of life assessed using the 36-Item Short Form Health Survey (SF-36). | Baseline |
| Physical Activity Level | Physical activity level assessed using the International Physical Activity Questionnaire (IPAQ). | Baseline |
| Participant Satisfaction | Participant satisfaction assessed immediately after treatment using a Likert scale. | Immediately after the intervention |
| ID | Term |
|---|---|
| D014464 | Ultrasonic Therapy |
| D004561 | Transcutaneous Electric Nerve Stimulation |
| D011616 | Psychotherapy, Multiple |
| ID | Term |
|---|---|
| D003972 | Diathermy |
| D006979 | Hyperthermia, Induced |
| D013812 | Therapeutics |
| D004599 | Electric Stimulation Therapy |
| D026741 | Physical Therapy Modalities |
| D012046 | Rehabilitation |
| D000698 | Analgesia |
| D000760 | Anesthesia and Analgesia |
| D011613 | Psychotherapy |
| D004191 | Behavioral Disciplines and Activities |
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