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

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. 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. 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. 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. 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. The study protocol was retrospectively registered to the “ClinicalTrials.gov” under an assigned Identifier: NCT07002593 on 25/05/2025 (https://clinicaltrials.gov/study/NCT07002593).