This study ill include four treatment groups. Group A who will receive traditional physical therapy, group B who will receive INIT plus traditional physical therapy , group C who will receive dry cupping therapy plus traditional physical therapy or group D will receive Dry needling therapy plus traditional physical therapy . All groups completed 4 weeks of intervention.
Medically competent men and women will be included They had chronic MTrPs in the upper trapezius for more than 6 months Diagnostic criteria of being a tight band with a palpable nodule and distant pain when subjected to pressure
subjects with previous neck or shoulder pathology (e.g., fracture, sur¬gery, inflammatory and infectious diseases), cervical disc pathology, systemic disorder, fibromyalgia, those who underwent physical therapy for at least the previous 3 months
Parallel
strengthening and stretching exercises
Other interventionsubjects will receive strengthening and stretching exercises
Integrated neuromuscular inhibition technique
Other interventionThe subjects receive the Integrated Neuromuscular Inhibition Technique, which consists of ischemic compression, strain-counterstrain, and muscle energy techniques.
Dry Needling
Devicesubjects in this group will receive Dry needling therapy, two sessions per week for four weeks
Dry cupping
DevicePatients in this group will receive Dry cupping therapy, two sessions per week for four weeks
pain intensity
pain intensity will be measured by visual analogue scale
pain pressure threshold
The pressure algometer will measure the pain pressure threshold
Neck Disability Index
The Neck Disability Index is a questionnaire to measure function
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