Comparison of Treatment Modalities in Myofascial Pain Syndrome

Inclusion Criteria: * Diagnosis of myofascial pain syndrome confirmed by a physical medicine and rehabilitation physician, according to the criteria of Travell and Simons (1992) * Male or female participants aged 30-50 years * Presence of at least one active trigger point in the upper trapezius muscle confirmed by palpation * Pain radiating to the neck and upper extremity persisting for at least 3 months * Pain intensity of ≥4/10 on the Visual Analog Scale (VAS) * Functional impairment indicated by a Neck Disability Index (NDI) score ≥10/50 (≥20%) * Written informed consent Exclusion Criteria: * Presence of diagnosed systemic musculoskeletal or rheumatologic disorders (e.g., fibromyalgia, rheumatoid arthritis) * Signs or symptoms of neuropathic pain or cervical radiculopathy * Conditions contraindicating massage therapy (e.g., skin infection, open wounds, bleeding disorders, active inflammation) * Receipt of manual therapy, massage, dry needling, injections, or similar treatments targeting the affected region within the preceding 1 month * Pregnancy or breastfeeding * History of acute trauma, fracture, or surgical intervention involving the neck or shoulder region