Effectiveness of Tele-Rehabilitation in Managing Rhomboid Trigger Points in Patients With Myofascial Pain Syndrome

This randomized controlled trial aims to assess the effectiveness of tele-rehabilitation, including self-myofascial release and exercise therapy, in reducing pain, improving functional range of motion, and decreasing neck disability in patients with rhomboid trigger points associated with myofascial pain syndrome.

Study Overview

• Status: Not yet recruiting
• Conditions: Myofascial Pain Syndrome
• Intervention / Treatment: Other: Tele-rehabilitation (ET + Self-Myofascial Release); Other: Conventional Myofascial Release Treatment

Detailed Description

Rhomboid myofascial pain syndrome is a common yet often underreported musculoskeletal condition characterized by the presence of myofascial trigger points within the rhomboid muscles. These trigger points produce localized and referred pain, reduced range of motion, and functional limitations that can significantly affect daily activities. The condition is strongly associated with poor posture, prolonged sitting, and repetitive upper limb activities, particularly among individuals with sedentary lifestyles and high occupational demands. Evidence indicates a high prevalence of rhomboid trigger points, with many individuals experiencing moderate pain that interferes with their routine work and overall quality of life.

Biomechanically, sustained postural stress such as forward head posture and rounded shoulders increases the load on scapular stabilizing muscles, leading to muscle fatigue, microtrauma, and the development of trigger points. These changes contribute to altered scapular kinematics, muscle imbalance, and restricted movement. Self-myofascial release techniques have been shown to reduce pain sensitivity, improve circulation, and restore muscle function, making them an effective approach for managing myofascial pain.

Tele-rehabilitation has emerged as a practical and accessible method for delivering physiotherapy interventions remotely, allowing patients to perform guided exercises and self-myofascial release without the need for frequent in-person visits. This is particularly beneficial for individuals with busy schedules or limited access to healthcare services.

This randomized controlled trial aims to evaluate the effectiveness of tele-rehabilitation, incorporating self-myofascial release and exercise therapy, in reducing pain intensity, improving functional range of motion, and decreasing neck disability in patients with rhomboid trigger points associated with myofascial pain syndrome. The study also seeks to determine the feasibility of tele-rehabilitation as a convenient and sustainable alternative to conventional physiotherapy for managing rhomboid-related musculoskeletal pain.

• Study Type: Interventional
• Enrollment (Estimated): 36
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Maria Khalid, MSOMPT; Phone Number: 03315369768; Email: maria.khaild@riphah.edu.pk

Study Locations

• Pakistan
  • Sindh
    • Karachi, Sindh, Pakistan
      • JPMC
      • Contact: maria khalid, MSOMPT; Phone Number: 03315369768; Email: maria.khalid@riphah.edu.pk
      • Contact: Rameeqa Aamir, MSOMPT*
      • Principal Investigator: Rameeqa Aamir, MSOMPT*

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Participants falling in this category would be recruited into the study.

  • Age 18-35 years
  • Both Genders: Male and Female
  • Paitents experiencing Neck and upper back pain due to active trigger points.(16) According to Travell and Simons (1999)criteria, active myofascial trigger points (MTrPs) are identified.
  • NPRS ≥4
  • Presence of maximum one or more than one MTrPs in the Romboids muscle.
  • Prolong sitting at least 6 hours per day.
  • Access to a device with internet connection ( for tele rehabilitation group).

Exclusion Criteria:

• Participants falling in this category would be excluded from the study.

  • Participants fall in this category would be excluded of the study.
  • Patients currently taking analgesics (painkillers) or muscle relaxants.
  • Any inflammatory pathology, neurological impairment, and cervical tumor.
  • Other deformities such as scoliosis or torticollis.
  • Spinal Injuries and any other co morbidity.
  • Any surgery, trauma, fracture and fall.
  • Pregnancy.
  • Patient unwilling to comply follow up schedule.
  • Patient involvement in another interventional study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Tele-rehabilitation (Exercise Therapy + Self-Myofascial Release); Self-Myofascial Release: Using a tennis ball against the wall targeting rhomboid region (5 mintues in total).; Stretching Exercises: Upper trapezius and levator scapulae stretch (30 seconds hold × 5 repetitions).; Postural correction Exercises: cervical retraction and shoulder blade squeezing /retraction ( 5 repetitions).; Postural and ergonomic education .; Mode of Delivery: Live/video-guided tele-rehabilitation sessions.	Other: Tele-rehabilitation (ET + Self-Myofascial Release); Self-Myofascial Release: Using a tennis ball against the wall targeting rhomboid region (5 mintues in total).; Stretching Exercises: Upper trapezius and levator scapulae stretch (30 seconds hold × 5 repetitions).; Postural correction Exercises: cervical retraction and shoulder blade squeezing /retraction ( 5 repetitions).; Postural and ergonomic education .; Mode of Delivery: Live/video-guided tele-rehabilitation sessions.
Other: Conventional Myofascial Release Treatment; Manual Myofascial Release: Therapist performe myofascial release on rhomboid trigger points.( 5 mintues in total); Stretching Exercises: Upper trapezius and levator scapulae stretch (30 seconds hold × 5 repetitions).; Postural correction Exercises: cervical retraction and shoulder blade squeezing /retraction ( 5 repetitions).; Postural and ergonomic education .; Mode of Delivery: In hospital treatment.	Other: Conventional Myofascial Release Treatment; Manual Myofascial Release: Therapist performe myofascial release on rhomboid trigger points.( 5 mintues in total); Stretching Exercises: Upper trapezius and levator scapulae stretch (30 seconds hold × 5 repetitions).; Postural correction Exercises: cervical retraction and shoulder blade squeezing /retraction ( 5 repetitions).; Postural and ergonomic education .

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Inclinometer for functional range of motion	An inclinometer is a reliable and valid instrument used to measure cervical range of motion (ROM) in flexion, extension, rotation, and lateral flexion. It provides objective and reproducible angular measurements of spinal movement. Studies have reported excellent intra-rater and inter-rater reliability (ICC = 0.85-0.98) for cervical motion assessment using a dual inclinometer.	2 weeks
Numeric Pain Rating Scale (NPRS)	The Numerical Pain Rating Scale (NPRS) is a simple, reliable, and valid tool used to assess pain intensity. It consists of an 11-point scale ranging from 0 to 10.The NPRS shows strong construct and concurrent validity when compared with other established pain assessment tools.The NPRS has demonstrated excellent test-retest reliability (r = 0.95) is across various musculoskeletal and rehabilitation populations	2 weeks
Neck Disability Index (NDI)	The Neck Disability Index (NDI) is a standardized questionnaire used to assess the impact of neck pain on daily activities. It consists of 10 items, each scored from 0 to 5, with higher scores indicating greater disability. The NDI has shown excellent reliability (ICC = 0.89-0.94) and strong validity for evaluating functional limitations in patients with neck and upper back pain.	2 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Maria khalid, MSOMPT, Riphah International University

Study record dates

Study Major Dates

• Study Start (Estimated): May 1, 2026
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): January 1, 2027

Study Registration Dates

• First Submitted: April 30, 2026
• First Submitted That Met QC Criteria: April 30, 2026
• First Posted (Actual): May 7, 2026

Study Record Updates

• Last Update Posted (Actual): May 7, 2026
• Last Update Submitted That Met QC Criteria: April 30, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Neck Pain; Myofascial Release; Tele-rehabilitation; Postural Correction; scapular retraction; cervical retraction; Rhomboid Trigger Points; Self-Myofascial Release,; Upper Trapezius & Levator Scapulae Stretch
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Musculoskeletal Diseases; Muscular Diseases; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Myofascial Pain Syndromes; Neck Pain; Health Services Administration; Delivery of Health Care; Therapeutics; Patient Care; Health Services; Health Care Facilities Workforce and Services; Rehabilitation; Aftercare; Continuity of Patient Care; Telemedicine; Patient Care Management; Telerehabilitation
• Other Study ID Numbers: REC/ Rameeqa Aamir 02435

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