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Trapezius Myalgia

Original Editor - Lauren Trehout

Top Contributors - Nick Van Doorsselaer, Lauren Trehout, Shailly Yadav, Abbey Wright, Elien Clerix, Camille Dewaele, Gayatri Jadav Upadhyay, Kim Jackson, Vanessa Rhule, Admin, Joao Costa, Rachael Lowe, Vidya Acharya, Kai A. Sigel, Kirenga Bamurange Liliane, Aminat Abolade, Rishika Babburu, Alexandra Stead and Ajay Upadhyay



Page Summary

  • Trapezius myalgia is pain, stiffness and tightness of the upper trapezius muscle, presenting as acute or persistent neck-shoulder pain classed within non-specific neck pain.
  • Risk factors include repetitive work, forceful exertion, sustained static loading and constrained postures, plus psychosocial factors such as stress, anxiety, depression and low social support.
  • Diagnosis is clinical and largely by exclusion, as no specific objective tests exist, with cervical radiculopathy, spondylosis and shoulder pathology among key differentials.
  • Specific strength training has the strongest trapezius myalgia-specific evidence, while manual therapy, dry needling and some electrophysical agents may add short-term pain relief.


Introduction

Trapezius myalgia (TM) is the complaint of pain, stiffness, and tightness of the upper trapezius muscle. It is characterised by acute or persistent neck-shoulder pain.[1]


TM falls under non-specific neck pain as it not a medical disorder or disease but rather a symptom of an existing underlying condition, where pain is felt in the neck and/or shoulder girdle, does not follow a dermatomal pattern, and usually has no identifiable structural cause.[2][3]

Clinically Relevant Anatomy

Trapezius muscle

Trapezius is a large, flat, fan-shaped muscle on the posterior neck and upper trunk.[4] It extends from the cervical and thoracic regions and attaches onto the clavicle and scapula.[4] It has three functional parts:[4]

  • Superior (descending) fibres: elevate the shoulder girdle
  • Middle fibres: retract the scapula
  • Inferior (ascending) fibres: depress the scapula

Motor supply is from the spinal accessory nerve (cranial nerve XI), with sensory fibres from C3 and C4.[4]

Pain in TM is typically located over the superior fibres.[1][5]

Aetiology

Neck and shoulder disorders, including TM, are associated with work involving high repetition, forceful exertion, sustained static muscle contraction, prolonged static loading and constrained postures, often in combination.[2] Computer work is frequently linked with neck pain, but the evidence is not strong enough to conclude that computer use alone causes musculoskeletal disorders of the neck and upper limb.[6]

Psychosocial factors also contribute to neck pain.[7] Long-term stress, low social support, anxiety and depression are recognised risk factors for neck pain, alongside physical inactivity, longer daily computer use and female sex.[7]

Epidemiology

Neck pain affected an estimated 203 million people worldwide in 2020.[8] Age-standardised prevalence is higher in females than males and peaks between 45 and 74 years.[8] Female sex is among the neck pain risk factors with stronger supporting evidence.[7]

Clinical Presentation

TM typically presents as pain, stiffness and tightness over the upper trapezius.[1] Onset can be acute, but work-related cases often develop gradually and may become persistent.[1][2]

Common features include:

  • Neck and shoulder pain with stiffness[1]
  • Tightness of the upper trapezius, often noticed during lateral flexion of the head[5]
  • Tenderness or palpable tender areas in the upper trapezius[1][5]
  • Headache[9]


Some patients also report:

  • Low mood and anxiety, which have been linked with heightened pain sensitivity in women with chronic neck and shoulder pain[10]
  • Paraesthesia in a non-segmental distribution, without objective sensory loss[11]

Persistent TM can cause pain and stiffness after periods of inactivity, which usually eases with activity.[12]

Discomfort in the trapezius can also affect neck movement. When pain was artificially triggered in the trapezius of healthy individuals, the range of cervical joint motion during extension was decreased throughout all segments instead of being limited to just one level.[13]

Differential Diagnosis

TM is largely a diagnosis of exclusion, made in the absence of tension neck syndrome or cervical syndrome.[2] Conditions to consider include:

Examination

There are no objective tests specific to TM, and diagnostic terminology and criteria vary between studies.[2] Diagnosis therefore rests on the history, the symptom pattern and the exclusion of other causes.[2]

Subjective assessment

The history should establish the onset, pattern and severity of symptoms, work and activity demands, and psychosocial factors such as stress, mood and social support.[7]

It should also screen for red flags and for features suggesting serious pathology.[15] The International Federation of Manual and Musculoskeletal Physical Therapists (IFOMPT) cervical framework guides assessment for vascular pathology of the neck before musculoskeletal interventions such as manual therapy.[17]

Objective assessment

Objective examination of the neck and upper limb helps support the diagnosis and exclude other pathology.[9] It should include:

  1. Active and passive cervical and shoulder range of movement[9]
  2. Muscle strength testing[9]
  3. Palpation, including for trigger points[18]
  4. Neurological examination[9]

Surface electromyography (EMG) has been used in research to study trapezius amplitude, timing, conduction velocity, fatigability and frequency characteristics.[19]

Quantitative imaging is also at a research stage.[20] A systematic review found that TM and neck and shoulder pain may be associated with reduced trapezius blood supply and oxygen saturation, at rest and during arm tasks.[20] These markers are not yet established for diagnosis.[20]

Further investigations and referral

Imaging may be considered when symptoms fail to improve, when neurological signs are present or when red flags are identified.[14] Diagnostic injections can help clarify the pain source, where the clinician is qualified to perform them.[14] Patients who do not improve with conservative management can be referred for an orthopaedic opinion.[16]

Outcome Measures

Pain and disability measures can be used at baseline and to track change over time.[21]

  • Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS): The VAS is a 100 mm line anchored at 0 mm (no pain) and 100 mm (worst imaginable pain), on which the patient marks their pain level.[21] The NRS asks the patient to rate pain from 0 to 10.[21]
  • McGill Pain Questionnaire (MPQ): assesses the quality and intensity of pain.[21][22]
  • Neck Disability Index (NDI): a 10-item questionnaire covering pain, personal care, lifting, reading, headaches, concentration, work, driving, sleeping and recreation.[23][24]
  • Neck Bournemouth Questionnaire (NBQ): a seven-item measure for non-specific neck pain covering pain intensity, function in daily and social activities, anxiety, depression, fear-avoidance and perceived control over pain.[25] It is reliable, valid and responsive to clinically meaningful change in this population.[24][25]

Medical Management

Medical management of neck pain includes:

Physical Therapy Management

The Journal of Orthopaedic & Sports Physical Therapy (JOSPT) neck pain clinical practice guideline (2017) classifies neck pain into mobility deficits, movement coordination impairments, headaches and radiating pain to guide treatment selection.[15]

Short-term outcomes could be enhanced by tailoring treatment to the clinical presentation.[28]

Education

Prevention centres on awareness and early advice for people exposed to the risk factors described under Aetiology, particularly repetitive or static work, sustained computer use, stress due to high work demands, work posture, exposure to vibrations and low physical activity.[2][7][27]

Exercise Therapy

Exercise is recommended for both acute and persistent neck pain. [27]

Physical activity and exercise have been proven to give the most immediate and long-term pain relief in patients with TM.[29] A network meta-analysis found that no single type of exercise was superior for chronic non-specific neck pain.[30] Motor control training, strengthening, and yoga, Pilates, Tai Chi and Qigong produced similar effects.[30]

For TM specifically, both general fitness training and specific strength training reduced neck muscle pain, with greater benefit from specific strength training.[31] Workplace strength training based on progressive overload reduced neck pain in industrial workers.[32]

Adults with recurrent neck and shoulder pain experienced less pain and tenderness after two minutes of daily progressive resistance exercise.[33]

A one-year neck strengthening programme was associated with long-term pain reduction after the programme ended.[34]

Exercises used in TM strength training trials include the following, performed with dumbbells:[31]

  • Shoulder shrugs: The individual stands upright with dumbbells held at their sides. The shoulders are elevated towards the ears, targeting the upper trapezius muscles.

[35]

  • One-arm row: The individual rests one knee and hand on a bench, with the trunk inclined approximately 30° from horizontal. The dumbbell is pulled towards the lower ribs on the same side.

[36]

  • Upright row: The individual stands with dumbbells positioned in front of the thighs. The dumbbells are lifted vertically towards the chest, remaining close to the body, with the elbows leading outwards and upwards.

[37]

  • Reverse flies: The individual lies prone on a bench inclined at 45°, with the arms hanging downwards. The dumbbells are raised until the upper arms are horizontal, maintaining a slight, fixed bend at the elbows.

[38]

  • Lateral raise: The individual stands with dumbbells held at their sides. The arms are abducted until the upper arms are horizontal, maintaining a slight, fixed bend at the elbows.

[39]


Load should be progressed over time in line with progressive overload principles.[32][33]

General exercise, such as cycling, may also improve oxygenation of the neck and shoulder muscles.[40] This is relevant because reduced trapezius oxygen saturation has been associated with TM.[20]

Psychosocial considerations

Stress, anxiety, depression and low social support are associated with neck pain and should be considered from the first assessment.[7] Explanation of pain and the influence of psychosocial factors should also be included in the treatment of TM alongside exercise therapy.[41]

Manual therapy

Ischaemic compression, upper trapezius stretching and transverse friction massage are used for trigger points in TM.[42] They appear to give short-term pain relief, but long-term effects have not been well investigated.[42]

In young adults with TM, a four-week myofascial release programme (deep transverse friction and stretching, followed by a cold pack) improved pain and neck disability more than high-frequency transcutaneous electrical nerve stimulation (TENS).[43] Because the programme combined several techniques and the report is inconsistent about its design, this result should be interpreted cautiously.[43]

A course of trigger point ischemic compression improved headache and neck and shoulder pain in women with episodic migraine by reducing upper trapezius tone and stiffness.[44]

Dry needling

A meta-analysis found low to moderate certainty evidence that dry needling lessens neck discomfort related to trigger points in the short term, both in terms of pain intensity and pain-related impairment.[45] One known disadvantage of needling is soreness.[46]

Electrophysical agents

There is moderate evidence that TENS and low-level laser therapy give short-term relief of trigger point pain.[42][47] Evidence for therapeutic ultrasound is conflicting, with some studies finding it no more effective than placebo, so it is not recommended.[42]

In a sham-controlled trial in upper trapezius myofascial pain syndrome, four weekly sessions of focused extracorporeal shockwave therapy reduced pain and trigger point stiffness more than sham.[48] Neck disability improved equally in both groups, suggesting part of the functional gain may reflect non-specific effects.[48]

Taping

In workers with TM, biomechanical taping and kinesiology taping, each combined with upper trapezius stretching, produced similar short-term improvements in pain and upper limb function.[49] Neither technique restricted shoulder range of movement.[49] Because both groups also stretched and there was no untreated control group, the specific contribution of taping is unclear.[49]

Biofeedback

Neck and shoulder pain from the workplace may potentially benefit from biofeedback training.[26] EMG biofeedback has been studied as a means of increasing muscular rest intervals while computer work and decreasing trapezius activity. According to a study, six weeks of biofeedback training reduced neck impairment and pain compared to active and passive treatment, which persisted six months after the intervention in the control group.[26]

Summary

TM is a clinical term for pain, stiffness and tightness of the upper trapezius, within non-specific neck pain.[1][3] It may begin acutely or develop gradually, and can become persistent.[1][2] Physical work demands and psychosocial factors both contribute.[2][7]

Diagnosis is clinical, based on the history, palpation and the exclusion of other causes, including serious and vascular pathology.[2][17] No single exercise type is clearly superior for neck pain, but specific strength training has the strongest TM-specific support.[30][31] Manual therapy, dry needling and some electrophysical agents may add short-term pain relief.[42][45]


References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 De Meulemeester K, Calders P, De Pauw R, Grymonpon I, Govaerts A, Cagnie B. Morphological and physiological differences in the upper trapezius muscle in patients with work-related trapezius myalgia compared to healthy controls: A systematic review. Musculoskeletal Science and Practice. 2017 Jun 1;29:43-51.
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 Larsson B, Søgaard K, Rosendal L. Work-related neck/shoulder pain: a review on the magnitude, risk factors, biochemical characteristics, clinical picture, and preventive interventions. Best Practice & Research Clinical Rheumatology. 2007 Jun 1;21(3):447-63.
  3. ↑ 3.0 3.1 3.2 NHS Scotland Right Decisions. Non-specific neck pain. MSK pathways: cervical spine. Available from: rightdecisions.scot.nhs.uk (accessed 25 October 2026).
  4. ↑ 4.0 4.1 4.2 4.3 Kenhub. Trapezius muscle. Available from: kenhub.com/en/library/anatomy/trapezius-muscle (accessed 25 October 2026).
  5. ↑ 5.0 5.1 5.2 Hadrevi J, Ghafouri B, Larsson B, Gerdle B, Hellström F. Multivariate modeling of proteins related to trapezius myalgia, a comparative study of female cleaners with or without pain. PLOS one. 2013 Sep 4;8(9):e73285.
  6. ↑ Wærsted M, Hanvold TN, Veiersted KB. Computer work and musculoskeletal disorders of the neck and upper extremity: a systematic review. BMC musculoskeletal disorders. 2010 Dec;11(1):79.
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 Kazeminasab S, Nejadghaderi SA, Amiri P, Pourfathi H, Araj-Khodaei M, Sullman MJM, et al. Neck pain: global epidemiology, trends and risk factors. BMC Musculoskelet Disord. 2022;23(1):26. doi:10.1186/s12891-021-04957-4
  8. ↑ 8.0 8.1 GBD 2021 Neck Pain Collaborators. Global, regional, and national burden of neck pain, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2024;6(3):e142-55. doi:10.1016/S2665-9913(23)00321-1
  9. ↑ 9.0 9.1 9.2 9.3 9.4 Sjøgaard G, Søgaard K, Hermens HJ, Sandsjö L, Läubli T, Thorn S, Vollenbroek-Hutten MM, Sell L, Christensen H, Klipstein A, Kadefors R. Neuromuscular assessment in elderly workers with and without work-related shoulder/neck trouble: the NEW-study design and physiological findings. European Journal of Applied Physiology. 2006 Jan 1;96(2):110-21.
  10. ↑ Sjörs A, Larsson B, Persson AL, Gerdle B. An increased response to experimental muscle pain is related to psychological status in women with chronic non-traumatic neck-shoulder pain. BMC Musculoskelet Disord. 2011;12:230. doi:10.1186/1471-2474-12-230
  11. ↑ Independent Nurse. Non-specific neck pain. Available from: independentnurse.co.uk (accessed 25 October 2026).
  12. ↑ Waling K, Sundelin G, Ahlgren C, Järvholm B. Perceived pain before and after three exercise programs–a controlled clinical trial of women with work-related trapezius myalgia. Pain. 2000 Mar 1;85(1-2):201-7.
  13. ↑  Qu N, Lindstrøm R, Hirata RP, Graven-Nielsen T. Origin of neck pain and direction of movement influence dynamic cervical joint motion and pressure pain sensitivity. Clin Biomech. 2019;61:120-8. doi:10.1016/j.clinbiomech.2018.12.002
  14. ↑ 14.0 14.1 14.2 Pateder DB, Berg JH, Thal R. Neck and shoulder pain: differentiating cervical spine pathology from shoulder pathology. Journal of surgical orthopaedic advances. 2009;18(4):170-4.
  15. ↑ 15.0 15.1 15.2 15.3 Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, et al. Neck pain: revision 2017. J Orthop Sports Phys Ther. 2017;47(7):A1-83. doi:10.2519/jospt.2017.0302
  16. ↑ 16.0 16.1 16.2 Mitchell C, Adebajo A, Hay E, Carr A. Shoulder pain: diagnosis and management in primary care. BMJ: British Medical Journal. 2005 Nov 12;331(7525):1124.
  17. ↑ 17.0 17.1 Rushton A, Carlesso LC, Flynn T, Hing WA, Rubinstein SM, Vogel S, et al. International framework for examination of the cervical region for potential of vascular pathologies of the neck prior to musculoskeletal intervention: International IFOMPT Cervical Framework. J Orthop Sports Phys Ther. 2023;53(1):7-22. doi:10.2519/jospt.2022.11147
  18. ↑ Fernández-de-las-Peñas C, Dommerholt J. International consensus on diagnostic criteria and clinical considerations of myofascial trigger points: a Delphi study. Pain Med. 2018;19(1):142-50. doi:10.1093/pm/pnx207
  19. ↑ Castelein B, Cools A, Bostyn E, Delemarre J, Lemahieu T, Cagnie B. Analysis of scapular muscle EMG activity in patients with idiopathic neck pain: a systematic review. Journal of Electromyography and Kinesiology. 2015 Apr 1;25(2):371-86.
  20. ↑ 20.0 20.1 20.2 20.3 Gold JE, Hallman DM, Hellström F, Björklund M, Crenshaw AG, Mathiassen SE, et al. Systematic review of quantitative imaging biomarkers for neck and shoulder musculoskeletal disorders. BMC Musculoskelet Disord. 2017;18(1):395. doi:10.1186/s12891-017-1694-y
  21. ↑ 21.0 21.1 21.2 21.3 Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual analog scale for pain (vas pain), numeric rating scale for pain (nrs pain), mcgill pain questionnaire (mpq), short‐form mcgill pain questionnaire (sf‐mpq), chronic pain grade scale (cpgs), short form‐36 bodily pain scale (sf‐36 bps), and measure of intermittent and constant osteoarthritis pain (icoap). Arthritis care & research. 2011 Nov 1;63(S11):S240-52.
  22. ↑ Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain. 1975 Sep 1;1(3):277-99.
  23. ↑ Macdermid JC, Walton DM, Avery S, Blanchard A, Etruw E, Mcalpine C, Goldsmith CH. Measurement properties of the neck disability index: a systematic review. Journal of orthopaedic & sports physical therapy. 2009 May;39(5):400-C12.
  24. ↑ 24.0 24.1 Gay RE, Madson TJ, Cieslak KR. Comparison of the Neck Disability Index and the Neck Bournemouth Questionnaire in a sample of patients with chronic uncomplicated neck pain. Journal of Manipulative and Physiological Therapeutics. 2007 May 1;30(4):259-62.
  25. ↑ 25.0 25.1 Bolton JE, Humphreys BK. The Bournemouth Questionnaire: a short-form comprehensive outcome measure. II. Psychometric properties in neck pain patients. Journal of manipulative and physiological therapeutics. 2002 Mar 1;25(3):141-8.
  26. ↑ 26.0 26.1 26.2 Holtermann A, Søgaard K, Christensen H, Dahl B, Blangsted AK. The influence of biofeedback training on trapezius activity and rest during occupational computer work: a randomized controlled trial. European journal of applied physiology. 2008 Dec 1;104(6):983-9.
  27. ↑ 27.0 27.1 27.2 27.3 27.4 Jensen, IreneHarms-Ringdahl, Karin et al. Strategies for prevention and management of musculoskeletal conditions. Neck pain. Best Practice & Research Clinical Rheumatology , 2007 Feb;21(1):93-108.
  28. ↑ Mastromarchi P, McLean S, Ali N, May S. Effects of matched versus unmatched physical therapy interventions on pain or disability in patients with neck pain: a systematic review and meta-analysis. Physiother Theory Pract. 2024;40(12):3000-19. doi:10.1080/09593985.2023.2285892
  29. ↑ Nielsen PK, Andersen LL, Olsen HB, Rosendal L, Sjøgaard G, Søgaard K. Effect of physical training on pain sensitivity and trapezius muscle morphology. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine. 2010 Jun;41(6):836-44.
  30. ↑ 30.0 30.1 30.2 de Zoete RMJ, Armfield NR, McAuley JH, Chen K, Sterling M. Comparative effectiveness of physical exercise interventions for chronic non-specific neck pain: a systematic review with network meta-analysis of 40 randomised controlled trials. Br J Sports Med. 2021;55(13):730-42. doi:10.1136/bjsports-2020-102664
  31. ↑ 31.0 31.1 31.2 Andersen LL, Kjaer M, SØgaard K, Hansen L, Kryger AI, Sjögaard G. Effect of two contrasting types of physical exercise on chronic neck muscle pain. Arthritis Care & Research: Official Journal of the American College of Rheumatology. 2008 Jan;59(1):84-91.
  32. ↑ 32.0 32.1 Zebis MK, Andersen LL, Pedersen MT, Mortensen P, Andersen CH, Pedersen MM, Boysen M, Roessler KK, Hannerz H, Mortensen OS, Sjøgaard G. Implementation of neck/shoulder exercises for pain relief among industrial workers: a randomized controlled trial. BMC musculoskeletal disorders. 2011 Dec;12(1):205.
  33. ↑ 33.0 33.1 Andersen LL, Saervoll CA, Mortensen OS, Poulsen OM, Hannerz H, Zebis MK. Effectiveness of small daily amounts of progressive resistance training for frequent neck/shoulder pain: randomised controlled trial. Pain. 2011;152(2):440-6.
  34. ↑ Ylinen J, Hakkinen A, Nykanen M, Kautiainen H, Takala E. Neck muscle training in the treatment of chronic neck pain: a three-year follow-up study. Europa medicophysica. 2007 Jun 1;43(2):161.
  35. ↑ MyTraining App.Dumbbell Shrug - Traps Exercise. Available from: http://www.youtube.com/watch?v=dMH0bHeiRNg [last accessed 6/6/2009
  36. ↑ PureGym. How To Do Single Arm Dumbbell Rows. Available from: https://www.youtube.com/watch?v=ZRSGpBUVcNw
  37. ↑ Buff Dudes Workouts. How-To Perform Upright Rows | Dumbbell Exercise Tutorial. Available from: https://www.youtube.com/watch?v=K0dYqPCaO14
  38. ↑ Milwaukee Journal Sentinel. In Motion: Prone Reverse Flies. Available from: https://www.youtube.com/watch?v=hVh-zN-TVvc
  39. ↑ National Academy of Sports Medicine (NASM). How to do a Dumbbell Lateral Raise. Available from: https://www.youtube.com/watch?v=XPPfnSEATJA
  40. ↑ Andersen LL, Blangsted AK, Nielsen PK, Hansen L, Vedsted P, Sjøgaard G, Søgaard K. Effect of cycling on oxygenation of relaxed neck/shoulder muscles in women with and without chronic pain. European journal of applied physiology. 2010 Sep 1;110(2):389-94.
  41. ↑ Burton AK. Back injury and work loss: biomechanical and psychosocial influences. Spine. 1997 Nov 1;22(21):2575-80.
  42. ↑ 42.0 42.1 42.2 42.3 42.4 Vernon H, Schneider M. Chiropractic management of myofascial trigger points and myofascial pain syndrome: a systematic review of the literature. Journal of manipulative and physiological therapeutics. 2009 Jan 1;32(1):14-24.
  43. ↑ 43.0 43.1 Joshi A, Jawade S, Chitale N. Effectiveness of myofascial release (MFR) vs. high-frequency transcutaneous electrical nerve stimulation (TENS) for pain relief and functional improvement in college students with trapezius myalgia. Cureus. 2022;14(10):e29898. doi:10.7759/cureus.29898
  44. ↑ Olesiejuk M, Marusiak J, Chalimoniuk M. Myofascial Trigger Points therapy decreases myotonometric tone and stiffness of trapezius muscle, benefits headaches and muscle pain in migraine. NeuroRehabilitation. 2023;52(2):299-310. doi:10.3233/NRE-220237.
  45. ↑ 45.0 45.1 Navarro-Santana MJ, Sanchez-Infante J, Fernández-de-las-Peñas C, Cleland JA, Martín-Casas P, Plaza-Manzano G. Effectiveness of dry needling for myofascial trigger points associated with neck pain symptoms: an updated systematic review and meta-analysis. J Clin Med. 2020;9(10):3300. doi:10.3390/jcm9103300
  46. ↑ U-anantrakool N, Buranarach K, Phongamwong C. Effectiveness of high-intensity laser therapy on post-needling soreness in the trigger point of the upper trapezius muscle: a randomized double-blinded sham-controlled trial. J Back Musculoskelet Rehabil. 2026. doi:10.1177/10538127261432695
  47. ↑ Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. The Lancet. 2009 Dec 5;374(9705):1897-908.
  48. ↑ 48.0 48.1 Vasvit P, Klarod K, Sukkho O, Kiatkulanusorn S, Werasirirat P, Wang XQ, et al. Therapeutic effect of focused-extracorporeal shockwave therapy on muscular and adjacent tissue stiffness and pain changes in myofascial pain syndrome: a randomized controlled trial study. Complement Ther Med. 2025;92:103203.
  49. ↑ 49.0 49.1 49.2 Dones VC III, Regino JM, Esplana NTS, Rivera IRV, Tomas MKR. The effectiveness of biomechanical taping and Kinesiotaping on shoulder pain, active range of motion and function of participants with Trapezius Myalgia: a randomized controlled trial. J Bodyw Mov Ther. 2020;24(3):273-281. doi:10.1016/j.jbmt.2020.02.004.
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