Muscle Energy Technique Versus Myofascial Release in Chronic Non Specific Neck Pain

Muscle Energy Technique Versus Myofascial Release in Chronic Non-Specific Neck Pain

Chronic non-specific neck pain is a common musculoskeletal condition that can significantly affect daily activities, sleep quality, and overall quality of life. It is often associated with muscle tightness, poor posture, and reduced neck mobility without any specific underlying structural pathology such as fracture or nerve compression.

This study aims to compare two commonly used physiotherapy treatment techniques: Muscle Energy Technique (MET) and Myofascial Release Therapy (MFR) in individuals with chronic non-specific neck pain.

A total of 52 participants aged 18-45 years with neck pain lasting more than three months will be included in this randomized controlled trial. Participants will be randomly assigned to one of two groups:

Group A: Conventional physiotherapy plus Muscle Energy Technique Group B: Conventional physiotherapy plus Myofascial Release Therapy

Both groups will receive treatment twice weekly for four weeks

. Conventional physiotherapy will include moist heat application and stretching exercises for neck muscles. In addition, one group will receive Muscle Energy

Technique targeting the upper trapezius, levator scapulae, and scalene muscles, while the other group will receive Myofascial Release Therapy targeting the same muscle groups.

Outcome measures will be assessed at baseline, at the second week, and at the fourth week. The study will evaluate:

Pain intensity (Numeric Pain Rating Scale) Neck range of motion (Inclinometer) Sleep quality (Pittsburgh Sleep Quality Index) Neck-related disability (Neck Disability Index)

The results of this study may help determine which technique is more effective in reducing pain, improving movement, enhancing sleep quality, and reducing disability in individuals with chronic non-specific neck pain. This may support clinicians in selecting the most appropriate treatment approach.

Study Overview

• Status: Completed
• Conditions: Chronic Neck Pain; Mechanical Neck Pain
• Intervention / Treatment: Procedure: Muscle Energy Technique; Procedure: Myofascial Release Therapy

Detailed Description

Neck pain is one of the most prevalent musculoskeletal disorders globally and is a leading cause of disability. Chronic non-specific neck pain (NSNP) is characterized by mechanical neck pain lasting more than three months without identifiable structural pathology such as fracture, infection, radiculopathy, or malignancy. It is commonly associated with postural dysfunction, muscle tightness, and impaired cervical mobility.

Various physiotherapy interventions are used in the management of NSNP. Among them, Muscle Energy Technique (MET) and Myofascial Release Therapy (MFR) are widely practiced manual therapy techniques. However, limited direct comparative evidence exists regarding their relative effectiveness in individuals with chronic non-specific neck pain, particularly concerning outcomes such as sleep quality and functional disability.

This study is designed as a single-blinded randomized controlled trial conducted at the University of Lahore Teaching Hospital, Lahore. The study duration will be six months following research board approval.

A total of 52 participants (26 per group), aged 18-45 years, diagnosed with chronic non-specific neck pain of at least three months duration, will be recruited using non-probability convenience sampling. Sample size calculation was performed using pain (NPRS) as the primary outcome measure, with 95% confidence interval and 80% power.

Participants will be randomly allocated using sealed opaque envelope simple randomization into:

Group A (Conventional Physiotherapy + Muscle Energy Technique)

Participants will receive:

Moist heat pack application (10 minutes) Static stretching of upper trapezius, levator scapulae, and scalene muscles

Followed by:

Muscle Energy Technique targeting upper trapezius, levator scapulae, and scalene muscles using post-isometric relaxation principles (20% isometric contraction held for 7-10 seconds, repeated in sets).

Total session duration: 40 minutes Frequency: 2 sessions per week for 4 weeks.

Group B (Conventional Physiotherapy + Myofascial Release Therapy)

Participants will receive:

Moist heat pack application Static stretching exercises

Followed by:

Myofascial Release Therapy applied to upper trapezius, levator scapulae, and scalene muscles using sustained manual pressure (90-120 seconds) and controlled stretching techniques.

Total session duration: 35 minutes Frequency: 2 sessions per week for 4 weeks.

Outcome measures will be assessed at baseline, second week, and fourth week:

Pain intensity: Numeric Pain Rating Scale (NPRS) Cervical range of motion: Inclinometer Sleep quality: Pittsburgh Sleep Quality Index (PSQI) Disability: Neck Disability Index (NDI)

The assessor will be blinded to group allocation.

Data will be analyzed using SPSS version 27.0. Normality testing will be performed using the Kolmogorov-Smirnov test. Between-group comparisons will be conducted using Independent Sample t-test or Mann-Whitney U test. Within-group comparisons will be analyzed using Repeated Measures ANOVA or Friedman test, depending on data distribution.

This study aims to determine whether Muscle Energy Technique or Myofascial Release Therapy provides superior outcomes in reducing pain, improving cervical mobility, enhancing sleep quality, and decreasing disability in individuals with chronic non-specific neck pain.

The findings may help optimize evidence-based physiotherapy management strategies for this population.

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

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan
      • University of Lahore Teaching Hospital, Lahore

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Both gender
• Participant with neck pain from the past 3 months.
• Participant with neck pain ≥7 on Visual analogue scale.
• Participant with unilateral tightness of upper trapezius, scalene and levator scapulae on manual palpation.
• Diagnosis consistent with Non-Specific Neck Pain (NSNP): mechanical pain aggravated by posture or movement, no neurological signs, no red flags, and pain localized to the neck with referral not extending below the shoulder.
• Positive Craniocervical Flexion Test (CCFT) indicating deep cervical flexor dysfunction.

Exclusion Criteria:

• Participant who received any therapeutic intervention for neck pain.
• Participate with any inflammatory, neurological or malignant condition like rheumatoid arthritis, cervical radiculopathy or tumor of the neck respectively.
• Participant with associated neck pain with facial pain or headache as a result of any fracture or major trauma to the cervical spine.
• Participant with the history of surgery of cervical spine in the last 12 months.
• Participant with disc prolapse or stenosis.
• Participant with any deformity such as torticollis, sprengel's deformity or scoliosis.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Conventional Physiotherapy + Muscle Energy Technique; Participants in this group will receive conventional physiotherapy consisting of moist heat pack application for 10 minutes followed by static stretching exercises for the upper trapezius, levator scapulae, and scalene muscles. In addition, Muscle Energy Technique (MET) will be applied targeting the same muscles using post-isometric relaxation principles with 20% isometric contraction held for 7-10 seconds followed by stretch. Treatment sessions will be conducted twice weekly for four weeks.	Procedure: Muscle Energy Technique; Muscle Energy Technique (MET) is a manual therapy procedure based on post-isometric relaxation principles. In this study, MET will be applied to the upper trapezius, levator scapulae, and scalene muscles. Participants will perform a gentle isometric contraction (approximately 20% effort) against therapist resistance for 7-10 seconds, followed by relaxation and passive stretch. The technique will be performed in 3 sets with 5 repetitions per muscle. Each session will last approximately 20 minutes and will be administered twice weekly for four weeks, in addition to conventional physiotherapy.
Experimental: Conventional Physiotherapy + Myofascial Release; Participants in this group will receive conventional physiotherapy including moist heat pack application and static stretching exercises for the upper trapezius, levator scapulae, and scalene muscles. In addition, Myofascial Release Therapy (MFR) will be administered using sustained manual pressure techniques (90-120 seconds) to reduce myofascial restrictions. Treatment sessions will be conducted twice weekly for four weeks.	Procedure: Myofascial Release Therapy; Myofascial Release Therapy (MFR) is a hands-on manual therapy technique aimed at reducing fascial restrictions and muscle tightness. In this study, sustained manual pressure (90-120 seconds) will be applied to the upper trapezius, levator scapulae, and scalene muscles to achieve tissue release. Slow, controlled stretching will be performed without forceful movements. Each session will last approximately 15 minutes and will be administered twice weekly for four weeks, in addition to conventional physiotherapy.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric Pain Rating Scale	Pain intensity will be assessed using the Numeric Pain Rating Scale (NPRS), an 11-point self-reported scale ranging from 0 (no pain) to 10 (worst imaginable pain).	Baseline, Week 2, and Week 4

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cervical Range of Motion	Cervical range of motion will be measured using an inclinometer to assess movement in degrees.	Baseline, Week 2, and Week 4
Neck Disability Index	Disability will be assessed using the Neck Disability Index (NDI), a 10-item questionnaire measuring functional limitations due to neck pain. Scores range from 0 to 50, with higher scores indicating greater disability.	Baseline, Week 2, and Week 4

Collaborators and Investigators

• Sponsor: University of Lahore

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2025
• Primary Completion (Actual): December 31, 2025
• Study Completion (Actual): February 15, 2026

Study Registration Dates

• First Submitted: July 14, 2026
• First Submitted That Met QC Criteria: July 14, 2026
• First Posted (Actual): July 17, 2026

Study Record Updates

• Last Update Posted (Actual): July 17, 2026
• Last Update Submitted That Met QC Criteria: July 14, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: muscle energy technique; mechanical neck pain; non specific neck pain
• Additional Relevant MeSH Terms: Therapeutics; Complementary Therapies; Physical Therapy Modalities; Rehabilitation; Therapy, Soft Tissue; Musculoskeletal Manipulations; Massage; Myofascial Release Therapy
• Other Study ID Numbers: UOL/IREB/26/19/01/0037

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

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