Combined Therapy and Jones Technique for Upper Trapezius Myofascial Trigger Points

Clinical Effects of Combined Therapy, Jones Technique, and Their Combination in Women With Upper Trapezius Myofascial Trigger Points: A Four-Arm Randomized Controlled Trial

Myofascial trigger points in the upper trapezius muscle are a common cause of neck pain and may negatively affect pressure pain threshold, upper limb function, sleep quality, and quality of life. This randomized, sham-controlled clinical trial aimed to compare the effects of the Jones Technique, combined therapy (therapeutic ultrasound plus transcutaneous electrical nerve stimulation [TENS]), their combination, and a sham intervention in women with active upper trapezius myofascial trigger points. The primary outcome was pressure pain threshold. Secondary outcomes included pain intensity, upper limb disability, sleep quality, quality of life, physical activity level, and participant satisfaction.

Study Overview

• Status: Completed
• Conditions: Myofascial Trigger Points; Neck Pain Musculoskeletal; Myofascial Pain Syndrome - Neck
• Intervention / Treatment: Procedure: Jones Technique; Device: Combined Therapy (Therapeutic Ultrasound + TENS); Combination product: Combined Therapy + Jones Technique; Procedure: Sham Intervention

Detailed Description

Myofascial trigger points (MTrPs) in the upper trapezius muscle are frequently associated with neck pain, reduced pressure pain threshold, and impaired upper limb function. Several conservative interventions have been proposed for the treatment of MTrPs; however, evidence comparing manual therapy and combined electrotherapy remains limited.

This single-center, randomized, sham-controlled, parallel-group clinical trial evaluated the effects of the Jones Technique and combined therapy (therapeutic ultrasound plus transcutaneous electrical nerve stimulation [TENS]) in women aged 18 to 40 years presenting with active myofascial trigger points in the upper trapezius muscle.

Participants were randomly allocated (1:1:1:1) into four groups: (1) Jones Technique; (2) combined therapy; (3) combined therapy plus Jones Technique; and (4) sham control. Randomization was performed using block randomization stratified by age. Participants underwent a single treatment session.

Baseline assessments included demographic data, pain intensity measured using the Visual Analog Scale (VAS), pressure pain threshold measured with a pressure algometer, upper limb disability (DASH), sleep quality (Pittsburgh Sleep Quality Index), quality of life (SF-36), and physical activity level (IPAQ). Immediately after the intervention, pain intensity, pressure pain threshold, and participant satisfaction were reassessed.

The primary outcome was pressure pain threshold. Secondary outcomes included pain intensity, upper limb disability, sleep quality, quality of life, physical activity level, and participant satisfaction.

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Brazil
  • Rio Grande do Sul
    • São Leopoldo, Rio Grande do Sul, Brazil
      • Physical Therapy Teaching Clinic, Universidade do Vale do Rio dos Sinos (UNISINOS)

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Female participants aged 18 to 40 years.
• Presence of active myofascial trigger points in the upper trapezius muscle for no longer than 12 weeks.
• Neck pain lasting less than 3 months.
• Pain intensity of at least 3 cm on the 10-cm Visual Analog Scale (VAS).
• Ability to understand the study procedures and provide written informed consent.

Exclusion Criteria:

• Presence of a cardiac pacemaker or other contraindications to electrotherapy.
• Pregnancy.
• Uncontrolled cardiovascular disease.
• Psychiatric disorders that could interfere with study participation.
• Thrombosis or coagulation disorders.
• History of tumors or neoplasms.
• Physical therapy or myofascial treatment within the previous 3 weeks.
• Treatment for myofascial trigger points within the previous 3 months.
• Current use of analgesic medications.
• Cervical musculoskeletal disorders (e.g., cervical osteoarthritis or other cervical lesions).
• History of cervical trauma or surgery.
• Cervical spondylosis or spondylolisthesis with radiculopathy.
• Fibromyalgia or other systemic rheumatic diseases.
• Other musculoskeletal disorders that could interfere with the study outcomes.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Jones Technique; Participants received a single session of the Jones Technique for the treatment of active myofascial trigger points in the upper trapezius muscle.	Procedure: Jones Technique; Manual therapy technique applied to active myofascial trigger points of the upper trapezius muscle. Participants were positioned in prone lying, and sustained pressure with positional release was applied to each trigger point for 90 seconds. Five trigger points were treated during a single treatment session.
Experimental: Combined Therapy; Participants received a single session of combined therapy consisting of therapeutic ultrasound combined with transcutaneous electrical nerve stimulation (TENS) applied to active myofascial trigger points in the upper trapezius muscle.	Device: Combined Therapy (Therapeutic Ultrasound + TENS); Combined therapy consisting of pulsed therapeutic ultrasound (1 MHz, 20% duty cycle, 1.0 W/cm²) delivered simultaneously with transcutaneous electrical nerve stimulation (TENS; biphasic asymmetric waveform, 200 μs pulse duration, 100 Hz). Treatment was applied to five active upper trapezius myofascial trigger points during a single 10-minute session.
Experimental: Combined Therapy + Jones Technique; Participants received the Jones Technique followed immediately by combined therapy (therapeutic ultrasound plus transcutaneous electrical nerve stimulation [TENS]) during a single treatment session.	Combination product: Combined Therapy + Jones Technique; Participants received the Jones Technique followed immediately by combined therapy (therapeutic ultrasound plus transcutaneous electrical nerve stimulation [TENS]) during a single treatment session.
Sham Comparator: Sham Control; Participants underwent all study assessments and received sham treatment consisting of inactive combined therapy (device turned off) and a simulated Jones Technique without therapeutic pressure.	Procedure: Sham Intervention; Participants underwent sham treatment consisting of inactive combined therapy with the device turned off and a simulated Jones Technique performed without therapeutic pressure.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pressure Pain Threshold (PPT)	Pressure pain threshold measured with a pressure algometer at five active myofascial trigger points in the upper trapezius muscle. Three measurements were obtained at each assessment	Baseline and immediately after the intervention (single treatment session)
Pain Intensity	Pain intensity measured using a 10-cm Visual Analog Scale (VAS).	Baseline and immediately after the intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Upper Limb Disability	Upper limb disability assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.	Baseline
Sleep Quality	Sleep quality assessed using the Pittsburgh Sleep Quality Index (PSQI).	Baseline
Quality of life	Quality of life assessed using the 36-Item Short Form Health Survey (SF-36).	Baseline
Physical Activity Level	Physical activity level assessed using the International Physical Activity Questionnaire (IPAQ).	Baseline
Participant Satisfaction	Participant satisfaction assessed immediately after treatment using a Likert scale.	Immediately after the intervention

Collaborators and Investigators

• Sponsor: Isabel de Almeida Paz

Study record dates

Study Major Dates

• Study Start (Actual): October 7, 2024
• Primary Completion (Actual): October 20, 2024
• Study Completion (Actual): December 20, 2024

Study Registration Dates

• First Submitted: July 4, 2026
• First Submitted That Met QC Criteria: July 4, 2026
• First Posted (Actual): July 10, 2026

Study Record Updates

• Last Update Posted (Actual): July 10, 2026
• Last Update Submitted That Met QC Criteria: July 4, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Transcutaneous Electrical Nerve Stimulation; Upper Trapezius; Therapeutic Ultrasound; Strain Counterstrain; Jones Technique
• Additional Relevant MeSH Terms: Therapeutics; Physical Therapy Modalities; Psychotherapy; Behavioral Disciplines and Activities; Rehabilitation; Anesthesia and Analgesia; Diathermy; Hyperthermia, Induced; Electric Stimulation Therapy; Analgesia; Transcutaneous Electric Nerve Stimulation; Ultrasonic Therapy; Psychotherapy, Multiple
• Other Study ID Numbers: 7.119.287

Drug and device information, study documents

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