Comparing Physical Therapy Interventions on Craniovertebral Angle (CVA) in Cervical Myofascial Pain Syndrome (MPS)

NCT07098754 | Recruiting

• 1 other identifier: NOGH/NasirMehmoodPhD/0125/001
• Study Type: interventional
• Target: 100
• Locations: 1 country
• Sites: 1

Brief Summary

Myofascial pain syndrome (MPS) and radiculopathy are prevalent musculoskeletal conditions that afflict a substantial portion of the population, causing significant discomfort and impairments in daily functioning. MPS is characterized by localized muscle pain, trigger points, and referred pain, often accompanied by stiffness and restricted range of motion. A common feature shared by individuals with MPS and radiculopathy is the presence of postural abnormalities and balance impairments . The craniovertebral angle, which reflects the relationship between the head and neck, is often compromised in these individuals due to muscle imbalances, pain-related guarding, and structural changes in the spine. Various physiotherapy modalities, including dry needling, manual mobilization and soft tissue release, trigger point therapy, stretching, cupping therapy, and electrotherapy, have been utilized in clinical practice, but their relative efficacy in improving the craniovertebral angle and alleviating symptoms in individuals with MPS and radiculopathy has not been comprehensively compared. Understanding the underlying mechanisms and comparative effectiveness of various physiotherapy interventions is essential for guiding evidence-based clinical decision-making and optimizing treatment outcomes for individuals with MPS and radiculopathy. By elucidating the effects of different treatment modalities on the craniovertebral angle and associated outcomes, this research endeavor aims to contribute to the development of more tailored and effective physiotherapy approaches for improving the well-being of individuals affected by these debilitating musculoskeletal conditions.

Conditions

Myofascial Pain Syndrome - Neck

Keywords

myofascial pain syndrome; dry needling in myofascial pain syndrome; cupping therapy in myofascial pain syndrome; best intervention for myofascial pain syndrome

Outcome Measures

Primary Outcomes (2)

• Craniovertebral (CV) Angle

  Angle between horizontal line crossing spinous process of C7 and line joining the same with tragus of ear. it is assessed using digital photography and then calculating angle using MicroDiCom Software.

  Four Weeks

• Pain Severity

  Pain severity will be checked by Numeric Pain Rating Scale (NPRS). this scale consists of 0-10 values with 0 being no pain and 10 being the worst possible pain. Increasing pain scores show high severity of pain and decreasing/less scores show less severity of pain.

  Four weeks

Secondary Outcomes (1)

• Balance

  Four weeks

Study Arms (4)

Dry Needling

EXPERIMENTAL

this group will receive dry needling with myofascial release

Other: Dry Needling

Trigger Point Therapy

EXPERIMENTAL

this will receive trigger point therapy with stretching

Other: Trigger point therapy

Cupping Therapy

EXPERIMENTAL

this will receive dry cupping therapy with Mobilizations Grade-1\&2

Other: Maitlands' Mobilizations

Conventional Physiotherapy

ACTIVE COMPARATOR

Will receive electrotherapy with stretching and ROM exercises

Other: Tens and ultrasound

Interventions

Dry Needling OTHER

will use dry needles of different recommended sizes to intercept the trigger points will add on myofascial release technique manually.

Dry Needling

Trigger point therapy OTHER

will release trigger points by manual pressure using trigger point therapy technique protocols will ad on stretching techniques

Trigger Point Therapy

Maitlands' Mobilizations OTHER

Maitlands' Mobilizations Grade-1\& Grade-2 will be applied to upper thoracic and cervical regions dry cupping therapy will be applied as ad on therapy

Cupping Therapy

Tens and ultrasound OTHER

TENS and ultrasound will be applied according to recommended dosages followed by stretching and Range of motion activities

Conventional Physiotherapy

Eligibility Criteria

• Age: 20 Years - 40 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Age: Participants must be between 20 and 40 years old.
• Gender: Both genders, Male and Female have equal chance of selection as participant in the study.
• Diagnosis: Participants must have a confirmed diagnosis of myofascial pain syndrome (MPS), altered cervical posture, restricted range of motion of cervical spine due to muscular spasm etc, altered craniovertebral angle, pain in cervical region or upper extremity and/or radiculopathy by a qualified healthcare professional, based on standardized diagnostic criteria (e.g., clinical examination, imaging studies).
• Severity: Participants should have mild to moderate symptoms of MPS and/or radiculopathy, as determined by the assessing healthcare provider.
• Willingness to Participate: Participants must be willing and able to comply physically and mentally with the study procedures, including attending scheduled physiotherapy sessions and completing outcome assessments.
• Informed Consent: Participants will have to provide written informed consent mendatorily to be selected as participant in the study after receiving detailed information about the study aims, procedures, potential risks, and benefits.

You may not qualify if:

• Severe Comorbidities: Participants with severe comorbidities or medical conditions that may interfere with their ability to participate in the study or confound the interpretation of results will be excluded. C1, C2 compression… vertigo
• Surgeries: Participants who have undergone surgeries in the cervical or head region in past will be excluded due to potential confounding effects on outcomes.
• Pregnancy: Pregnant individuals will be excluded from the study due to the potential risks associated with certain physiotherapy modalities and the need for specialized considerations in this population.
• Contraindications: Participants with contraindications to specific physiotherapy modalities included in the study protocol (e.g., contraindications to dry needling, electrotherapy) will be excluded to ensure participant safety.
• Inability to Attend Sessions: Participants who are unable to attend scheduled physiotherapy sessions due to logistical constraints (e.g., transportation issues, scheduling conflicts) will be excluded.
• Cognitive Impairment: Participants with significant cognitive impairment or communication difficulties that may impede their ability to understand and follow study instructions will be excluded.
• Participation in Other Research: Participants who are currently participating in other research studies involving treatment interventions for MPS and/or radiculopathy will be excluded to avoid potential confounding effects on outcomes and treatment adherence.
• Malignancies: participants suffering from any kind of malignancies will be excluded from the study.
• Trauma: Participants having a history of trauma and fractures in head and neck region will also be excluded from the study.

Sponsors & Collaborators

• National Orthopedic and General Hospital: lead

Study Sites (1)

National Orthopedic and General Hospital

Bahawalpur, Punjab Province, 63100, Pakistan

RECRUITING

Related Publications (16)

• Tekin L, Akarsu S, Durmus O, Cakar E, Dincer U, Kiralp MZ. The effect of dry needling in the treatment of myofascial pain syndrome: a randomized double-blinded placebo-controlled trial. Clin Rheumatol. 2013 Mar;32(3):309-15. doi: 10.1007/s10067-012-2112-3. Epub 2012 Nov 9.

  PMID: 23138883 RESULT

• Cheung Lau HM, Wing Chiu TT, Lam TH. Clinical measurement of craniovertebral angle by electronic head posture instrument: a test of reliability and validity. Man Ther. 2009 Aug;14(4):363-8. doi: 10.1016/j.math.2008.05.004. Epub 2008 Aug 9.

  PMID: 18694655 RESULT

• Al Bedah AM, Khalil MK, Posadzki P, Sohaibani I, Aboushanab TS, AlQaed M, Ali GI. Evaluation of Wet Cupping Therapy: Systematic Review of Randomized Clinical Trials. J Altern Complement Med. 2016 Oct;22(10):768-777. doi: 10.1089/acm.2016.0193. Epub 2016 Aug 24.

  PMID: 27557333 RESULT

• Joghataei MT, Arab AM, Khaksar H. The effect of cervical traction combined with conventional therapy on grip strength on patients with cervical radiculopathy. Clin Rehabil. 2004 Dec;18(8):879-87. doi: 10.1191/0269215504cr828oa.

  PMID: 15609843 RESULT

• Alfawaz S, Lohman E, Alameri M, Daher N, Jaber H. Effect of adding stretching to standardized procedures on cervical range of motion, pain, and disability in patients with non-specific mechanical neck pain: A randomized clinical trial. J Bodyw Mov Ther. 2020 Jul;24(3):50-58. doi: 10.1016/j.jbmt.2020.02.020. Epub 2020 Feb 22.

  PMID: 32826008 RESULT

• Mahajan R, Kataria C, Bansal K (2012). Comparative Effectiveness of Muscle Energy Technique and Static Stretching for Treatment of Subacute Mechanical Neck Pain. International Journal of Health and Rehabilitation Sciences; 1(1): 16-24.

  RESULT

• Arjona Retamal JJ, Fernandez Seijo A, Torres Cintas JD, de-la-Llave-Rincon AI, Caballero Bragado A. Effects of Instrumental, Manipulative and Soft Tissue Approaches for the Suboccipital Region in Subjects with Chronic Mechanical Neck Pain. A Randomized Controlled Trial. Int J Environ Res Public Health. 2021 Aug 16;18(16):8636. doi: 10.3390/ijerph18168636.

  PMID: 34444389 RESULT

• Wang SQ, Jiang AY, Gao Q. Effect of manual soft tissue therapy on the pain in patients with chronic neck pain: A systematic review and meta-analysis. Complement Ther Clin Pract. 2022 Nov;49:101619. doi: 10.1016/j.ctcp.2022.101619. Epub 2022 Jun 12.

  PMID: 35988324 RESULT

• Kalichman L, Ben David C. Effect of self-myofascial release on myofascial pain, muscle flexibility, and strength: A narrative review. J Bodyw Mov Ther. 2017 Apr;21(2):446-451. doi: 10.1016/j.jbmt.2016.11.006. Epub 2016 Nov 14.

  PMID: 28532889 RESULT

• Ümit Dündar, Özlem Solak, Fatma aml, Vural Kavuncu. (2010). Effectiveness of Ultrasound Therapy in Cervical Myofascial Pain Syndrome: A Double Blind, Placebo-Controlled Study. Turk J Rheumatol; 25: 110-5

  RESULT

• Siddique MAE, Rahman MM, Islam MS, Islam MW, Islam N, Uddin Z, et al. Physiotherapy versus pain medication for managing chronic Cervical Radiculopathy: protocol for a multi-arm parallel-group randomized clinical trial. F1000Research. 2023; 12:465.

  RESULT

• Titcomb DA, Melton BF, Miyashita T, Bland HW. The Effects of Postural Education or Corrective Exercise on the Craniovertebral Angle in Young Adults with Forward Head Posture: A Randomized Controlled Trial. Int J Exerc Sci. 2023 Aug 1;16(1):954-973. doi: 10.70252/PYPQ8483. eCollection 2023.

  PMID: 37649869 RESULT

• Amjad F, Mohseni-Bandpei MA, Gilani SA, Ahmad A, Hanif A. Effects of non-surgical decompression therapy in addition to routine physical therapy on pain, range of motion, endurance, functional disability and quality of life versus routine physical therapy alone in patients with lumbar radiculopathy; a randomized controlled trial. BMC Musculoskelet Disord. 2022 Mar 16;23(1):255. doi: 10.1186/s12891-022-05196-x.

  PMID: 35296293 RESULT

• Han SC, Harrison P. Myofascial pain syndrome and trigger-point management. Reg Anesth. 1997 Jan-Feb;22(1):89-101. doi: 10.1016/s1098-7339(06)80062-3.

  PMID: 9010953 RESULT

• Cao QW, Peng BG, Wang L, Huang YQ, Jia DL, Jiang H, Lv Y, Liu XG, Liu RG, Li Y, Song T, Shen W, Yu LZ, Zheng YJ, Liu YQ, Huang D. Expert consensus on the diagnosis and treatment of myofascial pain syndrome. World J Clin Cases. 2021 Mar 26;9(9):2077-2089. doi: 10.12998/wjcc.v9.i9.2077.

  PMID: 33850927 RESULT

• Galasso A, Urits I, An D, Nguyen D, Borchart M, Yazdi C, Manchikanti L, Kaye RJ, Kaye AD, Mancuso KF, Viswanath O. A Comprehensive Review of the Treatment and Management of Myofascial Pain Syndrome. Curr Pain Headache Rep. 2020 Jun 27;24(8):43. doi: 10.1007/s11916-020-00877-5.

  PMID: 32594264 RESULT

MeSH Terms

Conditions

Myofascial Pain Syndromes

Interventions

Dry Needling; Transcutaneous Electric Nerve Stimulation; High-Energy Shock Waves

Condition Hierarchy (Ancestors)

Muscular Diseases; Musculoskeletal Diseases

Intervention Hierarchy (Ancestors)

Complementary Therapies; Therapeutics; Physical Therapy Modalities; Electric Stimulation Therapy; Rehabilitation; Analgesia; Anesthesia and Analgesia; Ultrasonic Waves; Sound; Radiation, Nonionizing; Radiation; Physical Phenomena

Study Officials

• Mazhar A Professor, PhD

  Nazeer Hussain University

  STUDY CHAIR

Central Study Contacts

Nasir Mehmood, MPhil

CONTACT

+923346165226; n.mehmood777@gmail.com

Mahtab AM Patafi, M.Phil

CONTACT

+923017766019

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 18, 2025
• First Posted: August 1, 2025
• Study Start: March 15, 2025
• Primary Completion: August 5, 2025
• Study Completion: September 15, 2025
• Last Updated: August 1, 2025

Record last verified: 2025-07

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)