Effectiveness of Progressive Pressure Release Technique in Patients With Mechanical Neck Pain Associated With Myofascial Trigger Points

Abstract

Background: Mechanical neck pain is a common musculoskeletal condition frequently associated with myofascial trigger points in cervical musculature, contributing to high pain intensity and functional limitation. Progressive Pressure Release Technique (PPRT) is a trigger point–directed manual therapy intended to reduce nociceptive sensitivity and improve function through gradual, tolerable pressure application. Objective: To evaluate within-participant changes in pain intensity and neck-related disability following a three-week PPRT program in adults with mechanical neck pain associated with myofascial trigger points. Methods: A quasi-experimental single-group pre–post study was conducted in the outpatient physiotherapy department of Nishtar Hospital, Multan, Pakistan, enrolling 30 adults aged 20–45 years with mechanical neck pain for ≥4 weeks and active trigger points in the upper trapezius, levator scapulae, and/or suboccipital muscles. Participants received PPRT three sessions/week for three weeks (20–30 minutes/session), alongside standardized ergonomic advice and home isometric exercises. Outcomes were assessed at baseline and week 3 using the Numeric Pain Rating Scale (NPRS) and Neck Disability Index (NDI). Normality was tested with Shapiro–Wilk; Wilcoxon signed-rank and paired t-tests were applied accordingly. Results: Pain decreased significantly (median NPRS 8.0 [IQR 1.25] to 3.0 [IQR 1.0]; p<0.001), with a large effect (r=0.87). Disability improved substantially (NDI mean 26.83±3.52 to 11.86±2.37; mean difference 14.96; 95% CI 13.65–16.27; p<0.001; Cohen’s d=4.18). Conclusion: A three-week PPRT program was associated with large, clinically meaningful improvements in pain and disability in adults with mechanical neck pain and myofascial trigger points; controlled trials are warranted to confirm effectiveness and isolate treatment-specific effects.