Comparative Effect of Active Release Technique and Myofascial Release in Cervical Myofascial Syndrome

Comparative Effect of Active Release Technique and Myofascial Release to Improve Asthenopia, Sleep and Stress in Patients With Cervical Myofascial Pain Syndrome

The aim of this randomized controlled trial is to find the comparative effect of Active Release Technique and Myofascial release, each combined with eye exercises, on asthenopia, sleep quality, stress, pain and functional disability in patients with CMPS. A total of 44 participants will be randomized into two groups, ART + eye exercises and MFR+ eye exercises with interventions provided 3 days per week for 4 weeks. Outcomes will be assessed at baseline, 2 weeks and then after 4 weeks.

Study Overview

• Status: Not yet recruiting
• Conditions: Cervical Myofascial Pain Syndrome
• Intervention / Treatment: Other: Active Release Technique + Eye exercises; Other: Myofascial Release + Eye exercises

Detailed Description

A musculoskeletal condition known as myofascial pain is characterized by discomfort in the region of a muscle and the fascia, the connective tissue that surrounds it. In addition to having several trigger sites, the pain may be local or widespread. Trigger points are very sensitive muscle foci that radiate pain to the surrounding area and hurts to touch. In particular, the rhomboids, trapezius, levator scapulae, supraspinatus, and infraspinatus often affected muscles in the cervical area. Acute or chronic pain is possible, and it is most likely brought on by overuse, altered posture, or muscular injury. Cervical myofascial pain is highly prevalent globally. A 2021 study by Kamran Ezzati found that 88.9% of Iranian participants had at least one neck trigger point. Similarly, a 2024 study by Sahib Rehman et al in Pakistan reported high prevalence of Myofascial Trigger Points in cervical radiculopathy patients, with mean scores of MTrPs.

Cervical myofascial pain or neck muscle pain is often caused by poor posture or prolonged use of electronic devices, leading to muscle knots or trigger points. A component of myofascial pain is the emotional stress we carry which contributes to muscle tension (in the form of, increased activation of the "fight or flight" response) releasing stress hormones like cortisol that increase muscle tension. As a health care profession, we know that physical injuries like whiplash cause damage to the structures of the neck and may also alter how certain structures respond post injury (inflammation and stiffness). There are many other conditions, such as degenerative disc disease, osteoarthritis, and fibromyalgia, both predispose the patient to altered spinal posture. As a result, muscle may function differently resulting in myofascial pain Cervical myofascial pain can be managed with orthopedic manual techniques like Active Tissue Release (ATR) and Myofascial Release (MFR). ATR, developed by Dr. Michael Leahy, combines pressure with movement to break down adhesions, improve circulation, and reduce trigger point activity. It helps restore muscle balance and relieve postural strain. MFR, popularized by John F. Barnes, uses gentle sustained pressure to release fascial restrictions, improve blood flow, and reduce nervous system overactivity. Both techniques enhance mobility, reduce pain, and promote better posture and function in the neck.

Combining these interventions with eye exercises targets both neuromuscular and visual dysfunction, offering a holistic approach to improving sleep quality, reducing stress, and alleviating cervical pain. The study addresses a gap in evidence by directly comparing ART and MFR with integrated eye exercises, potentially guiding physiotherapists and clinicians toward the most effective treatment strategy for CMPS.

• Study Type: Interventional
• Enrollment (Estimated): 44
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: KINZA ANWAR, MS-OMPT; Phone Number: +92-3239735427; Email: kinza.anwar@riphah.edu.pk

Study Locations

• Pakistan
  • Punjab Province
    • Rawalpindi, Punjab Province, Pakistan, 46600
      • Railway General Hospital, Rawalpindi
      • Contact: KINZA ANWAR, MS-OMPT; Phone Number: +92-3239735427; Email: kinza.anwar@riphah.edu.pk
      • Contact: IQRA, MS-OMPT*; Phone Number: IFTIKHAR
      • Sub-Investigator: IQRA iFTIKHAR, MS-OMPT*

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• • Both genders

  • Age between 18 and 40 years
  • Neck pain since last month with NPRS >3
  • Cervical Myofascial pain (Presence of one or more trigger point in neck/ shoulder muscles particularly (upper trapezius, SCM and levator)
  • PSQI score > 5
  • Subjects with ASQ-17 score > 13

Exclusion Criteria:

• • Subjects with a history of cervical trauma or surgery

  • Subjects with a history of substance abuse
  • Subjects with use of sleep medications
  • Subjects with psychological disturbance (stress, depression or anxiety)
  • Visual impairment or ophthalmologic disease other than asthenopia

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Active Release Technique + Eye exercises	Other: Active Release Technique + Eye exercises; ART applied to cervical region (upper trapezius, Levator scapula and SCM) deep tension stretch with thumb over the tender areas , repeated 3-5 times. Frequency: 3 days/week for 4 weeks Followed by Eye exercises (3 days/week for 4 weeks); Trataka (focusing on one point) = 30s/ 3 times; Eye ball movements = 10 reps/ 2sets i. Sideways ii. Up and down iii. Two ways diagonal movement iv. Clockwise and anticlockwise rotational movements; Eye blinking and opening = 10 reps/ 2sets; Palming = 30s/1 time
Other: Myofascial Release + Eye exercises	Other: Myofascial Release + Eye exercises; MFR applied with forearm/ulnar border of palm, gliding towards neck base/upper scapula, Sustained gentle pressure is maintained, held until a release (softening/yield) of fascial tissue is felt; the pressure is gradually increased as tolerance allows.; 3-4 glides × 90 seconds each, according to tolerance.; Frequency: 3 days/week for 4 weeks.; Followed by the same Eye Exercises as in experimental group

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
: Neck Disability Index (NDI)	The Neck impairment Index (NDI) is a self-report questionnaire designed to measure the self-rated impairment of patients with neck pain and to establish how neck pain impacts a patient's everyday life. A vertical scale from 0 to 5 is used to rate the questions; After scoring, 0-4 points (0-8%) indicate no disability, 5-14 points (10-28%) indicate mild disability, 15-24 points (30-48%) indicate moderate disability, 25-34 points (50-64%) indicate severe disability, and 35-50 points (70-100%) indicate complete disability	Baseline, 2 weeks and 4 weeks (one-month follow-up)
Numeric Pain Rating Scale NPRS	The numeric pain rating scale (NPRS) is a tool used to assess pain intensity, where patients rate their pain on a scale of 0 to 10, with 0 representing no pain and 10 representing the worst possible pain.	Baseline, 2 weeks and 4 weeks (one-month follow-up)
Pittsburgh Sleep Quality Index (PSQI)	The Pittsburgh Sleep Quality Index (PSQI) is a standardized questionnaire used to assess sleep quality and disturbances over a one-month period. It consists of 19 self-rated questions grouped into seven components: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction. a global score ranging from 0 to 21. A global PSQI score greater than 5 indicates poor sleep quality, while a score of 5 or below reflects good sleep quality.	Baseline, 2 weeks and 4 weeks (one-month follow-up)
ASQ-17 (Asthenopia Survey Questionnaire)	The ASQ-17 (Asthenopia Survey Questionnaire) is a self-administered questionnaire that measures asthenopia (or eye strain) and associated symptoms. The ASQ-17 covers 7 items of eye strain symptoms, 6 items of visual symptoms and 4 items of systemic and psychological symptoms with a maximum total score of 51 and an optimal cut-off threshold value of 12.5, indicating the presence of asthenopia.	Baseline, 2 weeks and 4 weeks (one-month follow-up)
Perceived Stress Scale (PSS)	The Perceived Stress Scale (PSS) is a widely used psychological instrument designed to measure the degree to which individuals perceive their lives as stressful. The scale typically includes 10 items (PSS-10), yielding a total score ranging from 0 to 40. Scoring involves reversing the scores for positively worded items (items 4, 5, 7, and 8), then summing all item scores. Interpretation of scores is generally categorized as follows: 0-13 indicates low stress, 14-26 suggests moderate stress, and 27-40 reflects high perceived stress. Higher scores indicate greater levels of perceived stress.	Baseline, 2 weeks and 4 weeks (one-month follow-up)

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: KINZA ANWAR, MS-OMPT, Riphah International University

Study record dates

Study Major Dates

• Study Start (Estimated): June 5, 2026
• Primary Completion (Estimated): March 5, 2027
• Study Completion (Estimated): March 5, 2027

Study Registration Dates

• First Submitted: April 30, 2026
• First Submitted That Met QC Criteria: April 30, 2026
• First Posted (Actual): May 6, 2026

Study Record Updates

• Last Update Posted (Actual): June 3, 2026
• Last Update Submitted That Met QC Criteria: June 1, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Myofascial Release; Asthenopia; Active Release Technique; Cervical Myofascial Pain Syndrome; Sleep, Stress; functional Disability and Pain
• Additional Relevant MeSH Terms: Neurologic Manifestations; Eye Diseases; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain; Asthenopia; Therapeutics; Complementary Therapies; Physical Therapy Modalities; Rehabilitation; Therapy, Soft Tissue; Musculoskeletal Manipulations; Massage; Myofascial Release Therapy
• Other Study ID Numbers: Iqra Iftikhar

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No