To determine the effect of Muscle Energy Technique plus static stretching, and static stretching alone, on neck pain, Range Of Motion, proprioception, and function in office workers with upper trapezius trigger points.
Design
A concealed, randomized, single-blinded, controlled clinical trial (third phase) with a parallel group design of 50 patients, enrolled between January to July 2026
Settings and conduct
A single blind clinical trial will be conducted on the office workers with neck pain associated with upper Trapezius trigger points in Physiotherapy clinic of Imam Hassan hospital of Karbala in Iraq.
The patients randomly assigned in muscle energy technique plus static stretching or static stretching alone and will receive 6 sessions treatments.
A blind assessor who is not aware to the patients group, will evaluate the patients before and after treatment and after one week follow-up.
Participants/Inclusion and exclusion criteria
The inclusion criteria for this study are:
- Adults with Active, unilateral myofascial trigger point in the upper trapezius.
- Neck pain more than 3 based on Numerical Pain Rating Scale.
- Currently employed in office/desk-based work.
The exclusion criteria for this study are:
- History of diseases that cause pain without muscular origin.
- History of infiltration at upper trapezius trigger point.
Intervention groups
The control group will include patients with neck pain associated with upper trapezius trigger points who will receive static stretching.
The intervention group will include patients with neck pain associated with upper trapezius trigger points who will receive muscle energy technique plus static stretching.
Main outcome variables
Pain intensity; neck range of motion; Joint position sense; and functional disability.
General information
Reason for update
Acronym
IRCT registration information
IRCT registration number:IRCT20251222068409N1
Registration date:2026-01-14, 1404/10/24
Registration timing:prospective
Last update:2026-01-14, 1404/10/24
Update count:0
Registration date
2026-01-14, 1404/10/24
Registrant information
Name
Kadhim Saud
Name of organization / entity
Country
Iran (Islamic Republic of)
Phone
+98 939 462 1855
Email address
kazemhashem987@gmail.com
Recruitment status
recruiting
Funding source
Expected recruitment start date
2026-01-23, 1404/11/03
Expected recruitment end date
2026-07-23, 1405/05/01
Actual recruitment start date
empty
Actual recruitment end date
empty
Trial completion date
empty
Scientific title
Comparison of muscle energy technique plus static stretching versus static stretching alone in office workers with upper trapezius trigger points
Public title
Physiotherapy for upper trapezius trigger points
Purpose
Treatment
Inclusion/Exclusion criteria
Inclusion criteria:
- Adults 18–45 years, both sexes.-
- Clinically confirmed active, unilateral myofascial trigger point in the upper trapezius (the most active and most tender point).
- Currently employed in office/desk-based work (≥ 20 h/week for ≥ 6 months), typically ≥ 4–6 h/day of sitting or computer use.
- Neck pain >3 based on Numerical Pain Rating Scale.
Exclusion criteria:
- Diagnosed fibromyalgia
- Facial neuralgia
- Coagulation alteration
- Cancer
- History of cervical or shoulder surgery
- History of deep vein thrombosis
- History of myopathy
- History of infiltration at upper trapezius trigger point
- Patients with simultaneous Trigger Points in other body regions.
Age
From 18 years old to 45 years old
Gender
Both
Phase
3
Groups that have been masked
Outcome assessor
Sample size
Target sample size:
50
Randomization (investigator's opinion)
Randomized
Randomization description
The patients will randomly assign into Muscle Energy Technique plus static stretching group and only static stretching group. Randomization will be performed using simple method with sealed, randomly filled envelopes describing the treatment groups.
At first step, name of each intervention will be written on 25 papers(equal to sample size of each group) and these papers will be put in sealed envelops. Then, the envelops will be blended and at first treatment session, the therapist will take one of these envelops randomly and start the treatment according the group which has been determined in the envelop.
Blinding (investigator's opinion)
Single blinded
Blinding description
This study is a single-blinded randomized controlled trial. Due to the nature of the physiotherapy interventions, blinding of the therapist and participants is not possible. However, the outcome assessor is blinded to group allocation. All assessments are performed by an independent assessor who is not involved in treatment and is unaware of the intervention received by participants. Randomization and allocation concealment are performed to minimize assessment bias.
Placebo
Not used
Assignment
Parallel
Other design features
Secondary Ids
empty
Ethics committees
1
Ethics committee
Name of ethics committee
School of Nursing and Midwifery & Rehabilitation - Tehran University of Medical Sciences
Street address
Mirkhani st.(East Nosrat), Tohid Sq. Tehran
City
Tehran
Province
Tehran
Postal code
1419733171
Approval date
2025-12-10, 1404/09/19
Ethics committee reference number
IR.TUMS.FNM.REC.1404.193
Health conditions studied
1
Description of health condition studied
Upper Trapezius Trigger Points
ICD-10 code
M95
ICD-10 code description
Other disorders of the musculoskeletal system and connective tissue
Primary outcomes
1
Description
Numeric pain rating scale
Timepoint
Primary outcome will be measured at baseline (before intervention), immediately after completion of the 2-week intervention period, and at one-week follow-up after the end of the intervention
Method of measurement
The Numeric Pain Rating Scale (NPRS) is a unidimensional tool used to assess pain intensity. Patients rate their pain on an 11-point scale ranging from 0 (“no pain”) to 10 (“worst imaginable pain”) by marking or drawing a tick on the number that best represents their current pain level. This scale is widely used in both clinical and research settings due to its simplicity, reliability, and validity. A change of 2 points or approximately 30% reduction is typically considered clinically significant.
2
Description
Neck Proprioception–Joint Position Sense (JPS)
Timepoint
Primary outcome will be measured at baseline (before intervention), immediately after completion of the 2-week intervention period, and at one-week follow-up after the end of the intervention
Method of measurement
Joint Position Sense was evaluated using the cervicocephalic relocation test. A laser pointer was securely attached to the center of the participant’s forehead, and the subject was seated exactly 90 cm away from a fixed target on the wall. With eyes closed, the participant actively moved the head into contralateral lateral flexion, then attempted to return to the neutral starting position. The discrepancy between the initial reference point and the returned point was measured in centimeters, representing the repositioning error and serving as an indicator of cervical proprioceptive accuracy (27, 36). Contralateral lateral flexion was selected because the upper trapezius is most involved in side-bending movements. Active trigger points in this muscle primarily impair proprioception when the muscle is placed under stretch. Thus, contralateral flexion provides the most sensitive and specific direction to detect joint position sense errors associated with upper trapezius trigger points.
Secondary outcomes
1
Description
Neck Active Range of Motion
Timepoint
Neck Active Range of Motion will be measured at baseline (before intervention), immediately after completion of the 2-week intervention period, and at one-week follow-up after the end of the intervention.
Method of measurement
Active cervical range of motion (AROM) will be assessed for contralateral lateral flexion, flexion, and extension using a Universal goniometer. All measurements will follow the standardized protocol described by Farooq et al. (2016) Participants will be seated upright in a standardized position, with the trunk stabilized against the backrest of a wooden chair, hips and knees at 90°, feet flat on the floor, and arms folded across the chest to minimize thoracic compensation. The head will be positioned in neutral alignment before each measurement For contralateral lateral flexion, the axis of the goniometer will be placed over the spinous process of C7, the stationary arm aligned vertically along the thoracic spine (perpendicular to the floor), and the moving arm aligned with the midline of the head toward the external occipital protuberance. Participants will actively bend the neck away from the symptomatic upper trapezius side until their end range of motion. For flexion and extension, the axis of the goniometer will be placed over the external auditory meatus, the stationary arm aligned vertically (perpendicular to the ground), and the moving arm aligned with the base of the nares. Participants will actively flex or extend the cervical spine to their comfortable end range. Each participant will perform three trials for each direction. A brief familiarization will be provided before taking measurements, consistent with PJMS protocol. Scapular elevation, thoracic movement, or trunk lean will be avoided through verbal cues and standardized positioning. A rest interval of 10–15 seconds will be provided between trials to minimize fatigue. The mean value (in degrees) of the three trials will be used as the final outcome. Universal goniometry was selected due to its excellent inter- and intra-rater reliability for measuring active cervical ROM in clinical setting.
2
Description
Functional rating scale
Timepoint
Secondary outcome will be measured at baseline (before intervention), immediately after completion of the 2-week intervention period, and at one-week follow-up after the end of the intervention
Method of measurement
The Functional Rating Index (FRI) is a self-reported questionnaire developed to evaluate the functional impact of spinal conditions, especially those involving the neck and lower back. It consists of 10 items addressing pain and functional activities such as work, sleep, and recreation. Each item is scored from 0 to 4, and the total score is converted into a percentage, with higher scores indicating greater disability. The Arabic FRI has shown strong validity, reliability, and responsiveness in musculoskeletal populations.
Intervention groups
1
Description
Intervention group: Participants receive muscle energy technique (MET) combined with static stretching for the upper trapezius muscle, delivered by a qualified physiotherapist according a standardized protocol. Patients will be positioned in supine lying with the head supported. The cervical spine will be passively positioned in lateral flexion to place the upper trapezius fibers on the involved side in a lengthened position. Then the muscle will be brought to a comfortable resistance barrier and the therapist will instruct the patient to perform an isometric contraction of the upper trapezius while the therapist provides a precisely matched counterforce. At the end of the 5-second isometric contraction, the patient will be instructed to be relax completely. A relaxation phase of approximately 3 seconds will be allowed, coordinated with slow exhalation. This contraction–relaxation–repositioning cycle constitutes one MET repetition. The procedure will be repeated four times in each treatment session for the involved upper trapezius muscle. The technique will be applied unilaterally, only on the side where active myofascial trigger point(s) are clinically identified.
Category
Rehabilitation
2
Description
Control group: Participants receive static stretching exercises for the upper trapezius muscle only, delivered by a qualified physiotherapist. Stretching of the upper trapezius muscle will be carried out as a therapist-supervised exercise. Patients will be positioned in sitting on a chair with a backrest, without armrests. The subject will be instructed to slowly move the head and neck into contralateral side flexion (i.e., side-bending away from the involved shoulder) until a mild to moderate, non-painful stretching sensation is felt over the superior shoulder and lateral neck region. The ipsilateral shoulder will be encouraged to remain relaxed and depressed, either by verbal cueing or gentle manual contact, to enhance the stretch on the upper trapezius fibers. In accordance with the original intervention plan, active stretching will be performed slowly, with 5 repetitions per treatment session. Each repetition will be held at the point of a comfortable stretch (not pain) for 10 seconds, during which the patient will be encouraged to breathe slowly and avoid any compensatory trunk or shoulder movements. After each 10-second stretch, the head and neck will be returned to the neutral position and the muscle will be allowed to relax for 10 seconds before initiating the next repetition. This pattern—10-second stretch followed by 10-second relaxation—will be repeated for all 5 repetitions in each session.
Category
Rehabilitation
Recruitment centers
1
Recruitment center
Name of recruitment center
the Physical Therapy Departments of Imam Al Hassan Al Mujtaba Teaching Hospital
Full name of responsible person
kadhim hashim saud
Street address
Almulhak street , Karbala , Iraq
City
Karbala
Postal code
1234567890
Phone
+964 771 443 5044
Email
kazemhashem987@gmail.com
Web page address
2
Recruitment center
Name of recruitment center
Al-Hindiyah teaching hospital karbala
Full name of responsible person
kadhim hashim saud
Street address
Al-Jamaeeh Street, Karbala, Hindi, Iraq
City
Karbala
Postal code
1234567891
Phone
+964 771 443 5044
Email
kazemhashem987@gmail.com
Web page address
Sponsors / Funding sources
1
Sponsor
Name of organization / entity
Tehran University of Medical Sciences
Full name of responsible person
Ramin Kordi
Street address
Number 21, Dameshgh St., Vali-e Asr Ave., Tehran
City
Tehran
Province
Tehran
Postal code
1416753955
Phone
+98 21 8889 6690
Email
Gsia@tums.ac.ir
Grant name
Grant code / Reference number
Is the source of funding the same sponsor organization/entity?
Yes
Title of funding source
Tehran University of Medical Sciences
Proportion provided by this source
100
Public or private sector
Public
Domestic or foreign origin
Domestic
Category of foreign source of funding
empty
Country of origin
Type of organization providing the funding
Academic
Person responsible for general inquiries
Contact
Name of organization / entity
self funded
Full name of responsible person
kadhim hashim saud
Position
physiotherapist
Latest degree
Bachelor
Other areas of specialty/work
Physiotherapy
Street address
Al-Jamaeeh Street, Karbala, Hindi, Iraq
City
Karbala
Province
Karbala
Postal code
1234567890
Phone
+964 771 443 5044
Email
kazemhashem987@gmail.com
Person responsible for scientific inquiries
Contact
Name of organization / entity
Tehran University of Medical Sciences
Full name of responsible person
Noureddin Nakhostin Ansari
Position
Professor
Latest degree
Ph.D.
Other areas of specialty/work
Physiotherapy
Street address
Piche Shemiran, Enghelab Ave.,Tehran
City
Tehran
Province
Tehran
Postal code
1148965111
Phone
+98 21 7753 5132
Fax
Email
nakhostin@tums.ac.ir
Person responsible for updating data
Contact
Name of organization / entity
Tehran University of Medical Sciences
Full name of responsible person
Kadhim Saud
Position
Student
Latest degree
Bachelor
Other areas of specialty/work
Physiotherapy
Street address
Muktari, Haderi aram No 2
City
Tehran
Province
Tehran
Postal code
1148965111
Phone
+98 939 462 1855
Fax
Email
kazemhashem987@gmail.com
Sharing plan
Deidentified Individual Participant Data Set (IPD)
Undecided - It is not yet known if there will be a plan to make this available