An interventional study of Group A = Emmett Technique with conventional physiotherapy and Group B = Bowen Technique with conventional physiotherapy in Myofascial Pain Syndrome (Upper Trapezius), sponsored by University of Management and Technology Sialkot Pakistan. Enrolling by invitation at 1 site in Pakistan. Open to participants aged 18 Years to 45 Years. Per ClinicalTrials.gov, last updated 2026-08-21.
Sponsored by University of Management and Technology Sialkot Pakistan · Not applicable, Interventional, and Treatment
This randomized clinical trial compares the Emmett Technique and Bowen Therapy for patients with upper trapezius myofascial pain syndrome, focusing on their effects on pain, cervical range of motion, and functional disability. The study includes 46 participants, randomly allocated into two groups of 23: Group A receives the Emmett Technique with conventional physiotherapy, while Group B receives Bowen Therapy with conventional physiotherapy. Outcomes are assessed using the Numerical Pain Rating Scale (NPRS), Neck Disability Index (NDI), and Universal Goniometer before and after treatment. The study aims to determine which manual therapy provides greater improvement in pain reduction, cervical mobility, and functional ability.
This research is a randomized clinical trial designed to compare the effects of the Emmett Technique and Bowen Therapy on pain intensity, cervical range of motion, and functional disability in patients with upper trapezius myofascial pain syndrome (MPS). Upper trapezius MPS is characterized by the presence of myofascial trigger points within taut skeletal muscle bands and may present with localized or referred pain, muscle stiffness, restricted cervical movement, weakness, and reduced functional performance.
The rationale for conducting this study is that although both the Emmett Technique and Bowen Therapy are increasingly used as manual therapy approaches, there is limited evidence directly comparing their effectiveness. Existing research has largely investigated these techniques independently, creating a gap regarding which intervention may provide superior improvement in pain, range of motion, and functional ability in patients with upper trapezius MPS. The primary objective is therefore to evaluate their relative efficacy in this patient population.
The study includes a total sample of 46 participants, with the sample size calculated using G*Power with an additional 5% attrition rate. A non-probability purposive convenient sampling strategy is used for recruitment. Eligible participants include both males and females aged 18-45 years with a clinical diagnosis of upper trapezius MPS according to Travell and Simons' criteria, including features such as a taut band, hypersensitive trigger point, referred pain pattern, restricted range of motion, and reproduction of pain on probing. Participants are also required to have pain lasting more than three months, an NPRS score of 3-10, and an NDI score between 20 and 35.
Following recruitment, participants are randomized into two groups. Group A consists of 23 participants receiving the Emmett Technique, while Group B consists of 23 participants receiving Bowen Therapy. Both groups additionally receive the same standardized physiotherapy protocol.
In the Emmett Technique group, mild pressure is applied to specific EMMETT points for approximately 5-20 seconds and repeated three times at each point. The first application is used to evaluate the tissue, the second is intended to produce the therapeutic response, and the third reassesses the tissue response. In the Bowen Therapy group, gentle cross-fibre rolling movements are performed over the fascia, tendons, muscles, and ligaments of the upper trapezius and cervical region using light pressure, with approximately two-minute pauses between sets of Bowen movements. Each intervention session lasts approximately 20 minutes, and both groups receive 12 treatment sessions over four weeks, at three sessions per week.
Both groups also receive a standardized physiotherapy protocol, consisting of TENS, hot pack application, strengthening and stretching exercises, and ischemic compression release. The exercise component includes isometric strengthening and stretching of the upper trapezius, supraspinatus, and pectoral muscles.
The primary clinical outcomes are assessed before and after treatment using three measurement tools. The Numerical Pain Rating Scale (NPRS) assesses pain intensity on a 0-10 scale; the Neck Disability Index (NDI) evaluates the impact of neck symptoms on functional activities; and a Universal Goniometer measures cervical range of motion, including flexion, extension, right and left lateral flexion, and right and left rotation.
For statistical analysis, the study uses IBM SPSS version 26.0. The Shapiro-Wilk test is used to assess normality. According to the methodology, the data are considered normally distributed; therefore, paired-sample t-tests are planned for within-group pre- versus post-treatment comparisons, while independent-samples t-tests are used to compare outcomes between the two intervention groups.
Overall, the study is intended to determine whether the Emmett Technique or Bowen Therapy provides greater clinical benefits when combined with standardized physiotherapy for upper trapezius myofascial pain syndrome. By comparing changes in pain, cervical mobility, and neck-related functional disability, the research aims to provide evidence that may assist physiotherapists in selecting a more effective manual therapy approach for this patient population.
Taut band Hypersensitive trigger point Referral pain pattern Restricted range of motion
Exclusion Criteria:
Participants in Group A will receive the Emmett Technique combined with standardized conventional physiotherapy for upper trapezius myofascial pain syndrome. The Emmett Technique will be applied in a prone position using gentle pressure over specific Emmett points around the upper trapezius and adjacent cervical/shoulder region for approximately 5-20 seconds, repeated three times at each point. Treatment will be provided 3 sessions per week for 4 weeks, for a total of 12 sessions. Conventional physiotherapy will include TENS, hot pack, stretching and strengthening exercises, and ischemic compression release. Outcomes will be assessed before and after treatment using NPRS, NDI, and cervical range of motion measured with a universal goniometer.
Other: Group A = Emmett Technique with conventional physiotherapy
Participants in Group B will receive the Bowen Technique combined with the same standardized conventional physiotherapy provided to Group A. The Bowen Technique will involve gentle, precise rolling and cross-fiber movements over the upper trapezius and surrounding cervical-shoulder soft tissues, with short rest intervals between sets of movements to allow tissue relaxation and neuromuscular response. Treatment will be administered 3 sessions per week for 4 weeks, for a total of 12 sessions. Conventional physiotherapy will remain identical in both groups so that the comparative effect of the Bowen Technique versus Emmett Technique can be evaluated on pain, disability, and cervical range of motion.
Other: Group B = Bowen Technique with conventional physiotherapy
The Emmett Technique is a gentle manual therapy approach developed by Ross Emmett. It involves applying light, precise pressure to specific points on the body, known as EMMETT points, where sensory and muscular receptors are thought to interact. In this study, mild pressure is applied to the selected points for approximately 5-20 seconds and repeated three times at the same point. The first application is used to assess the tissue response, the second aims to produce the therapeutic effect, and the third reassesses whether the desired change has occurred. The technique is intended to help reduce pain, improve movement, promote myofascial release, enhance muscle function, and improve overall mobility.
The Bowen Technique (Bowen Therapy) is a gentle, non-invasive manual therapy approach developed by Thomas Bowen. It involves performing light cross-fibre rolling movements over muscles, fascia, tendons, and ligaments, with minimal pressure applied to the tissues. In this study, the technique is applied over the upper trapezius and adjacent cervical region, with approximately 2-minute pauses between sets of Bowen moves to allow the body to respond to the stimulation
Numerical Pain Rating Scale
The NPRS is used to measure the severity of pain experienced by the patient. It is an 11-point scale ranging from 0 to 10, where 0 represents no pain and 10 represents the worst possible pain. In this study, it is used before and after treatment to determine the change in pain intensity following the Emmett Technique or Bowen Therapy.
Time frame: 6 weeks
Functional Disability - Neck Disability Index (NDI)
The NDI is a self-reported questionnaire used to assess the level of disability associated with neck pain. It contains 10 sections, including pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and recreation. Each section is scored from 0 to 5, giving a maximum total score of 50, with higher scores indicating greater functional disability
Time frame: 6 weeks
Cervical Range of Motion - Universal Goniometer
The Universal Goniometer is a simple clinical instrument used to measure joint range of motion in degrees. In this study, it is used to assess cervical flexion, extension, right and left lateral flexion, and right and left rotation before and after the intervention. It consists of a stationary arm, movable arm, and degree scale, allowing objective measurement of changes in cervical mobility.
Time frame: 6 weeks
Plan to share: Undecided
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University of Management and Technology Sialkot Pakistan