Comparison of Treatment Modalities in Myofascial Pain Syndrome

• Conventional treatment (Other): Participants inthis group will receive a conventional physiotherapy program consisting of moist heat application for 15 minutes, pain-limited static stretching of the upper trapezius muscle (30-second stretch with 10-second rest, repeated five times), electrotherapy modalities (TENS, ultrasound, and infrared therapy), and postural education with a home exercise program for approximately 10 minutes.
• Therapeutic Massage (Other): Participants in this group will receive a 20-minute therapeutic massage intervention identical in technique and sequence to the massage component applied in combined group, targeting the neck and upper back muscles using Swedish massage techniques, without additional conventional physiotherapy modalities.
• combined treatment (Other): Participants in this group will receive a combined intervention consisting of a conventional physiotherapy program together with a 20-minute therapeutic massage applied to the neck and upper back muscles (erector spinae, upper and middle trapezius, and levator scapulae), delivered according to Swedish massage principles, including effleurage, kneading, and deep friction techniques targeting active trigger points.

Primary outcomes

• Pain Intensity [6 weeks]: The primary outcome of this study is pain intensity, will be assessed using the Visual Analog Scale (VAS), a 10-cm scale ranging from 0 (no pain) to 10 (worst imaginable pain), with higher scores indicating greater pain intensity.

Secondary outcomes

• Pressure Pain Threshold-Algometer [6 weeks]: Muscle sensitivity will be evaluated using a pressure algometer applied over the upper trapezius trigger point, where higher values indicate reduced tenderness. Results will be recorded in kg/cm².
• Muscle Activity [6 weeks]: Muscle activity will be evaluated using surface electromyography (EMG) through root mean square (RMS) values recorded at rest and during 90 degrees of shoulder abduction. Higher RMS values indicate greater muscle activation. Results will ve recorded in µV.
• Functional Status (Neck Disability Index) [6 weeks]: Functional disability related to neck pain will be evaluated using the Neck Disability Index (NDI). Total score ranges from 0 to 50; higher scores indicate greater disability. Lower scores reflect improved functional status.
• Quality of Life (SF-12) [6 weeks]: Health-related quality of life will be assessed using the Short Form-12 questionnaire. Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Higher scores indicate better quality of life.

Sex: All, ages: 30 Years to 50 Years

Inclusion Criteria:

* Diagnosis of myofascial pain syndrome confirmed by a physical medicine and rehabilitation physician, according to the criteria of Travell and Simons (1992)
* Male or female participants aged 30-50 years
* Presence of at least one active trigger point in the upper trapezius muscle confirmed by palpation
* Pain radiating to the neck and upper extremity persisting for at least 3 months
* Pain intensity of ≥4/10 on the Visual Analog Scale (VAS)
* Functional impairment indicated by a Neck Disability Index (NDI) score ≥10/50 (≥20%)
* Written informed consent

Exclusion Criteria:

* Presence of diagnosed systemic musculoskeletal or rheumatologic disorders (e.g., fibromyalgia, rheumatoid arthritis)
* Signs or symptoms of neuropathic pain or cervical radiculopathy
* Conditions contraindicating massage therapy (e.g., skin infection, open wounds, bleeding disorders, active inflammation)
* Receipt of manual therapy, massage, dry needling, injections, or similar treatments targeting the affected region within the preceding 1 month
* Pregnancy or breastfeeding
* History of acute trauma, fracture, or surgical intervention involving the neck or shoulder region