Comparative efficacy of myofascial release versus stretching combined with high-powered pulsed therapeutic ultrasound in amateur overhead athletes with active trapezius trigger point pain: a randomized clinical trial

BACKGROUND: Active myofascial trigger points (MTrPs) in the upper trapezius are a leading source of neck pain and functional limitation in athletes. Although myofascial release (MFR) and stretching are frequently used, their comparative effectiveness when combined with high‐power pulsed therapeutic ultrasound (HPPT‐US) remains unclear. OBJECTIVE: To compare the efficacy of MFR + HPPT‐US versus stretching + HPPT‐US on pain intensity, cervical range of motion (Cx‐ROM), muscle length (ML), and neck disability in amateur overhead athletes with unilateral upper trapezius active MTrPs. Trial design: A two‐arm parallel group, randomized clinical trial design. METHODS: Thirty‐two athletes meeting Travell and Simons’ criteria for active MTrPs were randomized to receive either MFR + HPPT‐US (Group A) or stretching + HPPT‐US (Group B), administered thrice weekly for two weeks. Primary outcome measure—Pain intensity and secondary outcomes—Cx‐ROM, ML, and Neck Disability Index (NDI) were recorded using a visual analog scale (VAS), universal goniometer, Vernier caliper, and neck disability index (NDI) questionnaire, at baseline, week 1, week 2, and one‐week follow‐up. 26 out of 32 data of enrolled participants were analyzed using a two‐way mixed repeated‐measures ANOVA (Group × Time) with Bonferroni‐adjusted post‐hoc tests; statistical significance was set at p < 0.05, and effect sizes were reported as partial eta‐squared (η²ₚ) for ANOVA and Cohen’s d for pairwise differences. RESULTS: Significant main effects of Group (η²ₚ = 0.07–0.26) and Time (η²ₚ = 0.83–0.92) were observed for all outcomes, with a significant Group × Time interaction for ML (η²ₚ = 0.34). Both interventions produced significant improvements across time points; however, Group A demonstrated greater gains following treatment. At follow‐up, between‐group differences favored Group A for VAS (MD = − 0.77; 95% CI − 1.31 to − 0.39; d = 1.12), Cx‐ROM (MD = 2.69°; 95% CI 0.80 to 4.58; d = 1.07), ML (MD = 0.80 cm; 95% CI 0.27 to 1.33; d = 1.14), and NDI (MD = − 4.70; 95% CI − 8.04 to − 1.36; d = 1.09). Improvements were consistent across post‐baseline assessments, although the magnitude of change varied by outcome. CONCLUSION: The combination of MFR and HPPT‐US was more effective than stretching with HPPT‐US in reducing pain, increasing ML and Cx‐ROM, and improving functional outcomes in amateur overhead athletes with active upper trapezius MTrPs. This combined approach may offers superior clinical benefits for managing MTrP‐related neck pain and promoting faster recovery in athletic rehabilitation settings. TRIAL REGISTRATION: The study protocol was retrospectively registered to the “ClinicalTrials.gov” under an assigned Identifier: NCT07002593 on 25/05/2025 ( https://clinicaltrials.gov/study/NCT07002593 ).