Background: Myofascial Pain Syndrome (MPS) is a prevalent musculoskeletal disorder associated with trigger points, pain, and reduced quality of life. Although different physiotherapy techniques are used and studied but comparison of combined treatment regimens remains scarce.

Objective: To compare the effectiveness of Dry Needling combined with Myofascial Release versus Trigger Point Therapy combined with Stretching on pain intensity, craniovertebral angle (CVA), and health-related quality of life (SF-36) in MPS.

Methods: A three-arm randomized controlled trial was conducted at National Hospital Bahawalpur, Pakistan. Seventy-five participants (aged 20–40 years) with clinically diagnosed MPS were randomly allocated into three groups. Interventions were delivered twice weekly for four weeks (8 sessions). Outcomes included pain intensity (NPRS), CVA (digital photography with MicroDicom), and SF-36 domains, assessed at baseline, mid-intervention, and post-intervention. Data were analyzed using SPSS-26 with mixed-design ANOVA.

Results: At baseline, groups were comparable (p > .05). A significant Group × Time interaction was found for NPRS, CVA, and all SF-36 domains (p < .001). DN with MFR achieved the greatest improvements: NPRS scores improved from 8.4 to 0.5, CVA improved from 40.4° to 48.0°), and SF-36 scores approaching normative values (85–95). TrPT with Stretching showed moderate benefits, while Control demonstrated minimal improvements.

Conclusion: DN with MFR is superior to TrPT with Stretching and Control in reducing pain, correcting postural alignment, and enhancing quality of life in MPS.