The aim of the study is to investigate effect of high-power pain threshold ultrasound versus extracorporeal shock wave on myofascial trigger points. Methods: this randomized single blinded controlled trial included a sample of 60 subjects (age 20 to 26) years old with upper trapezius myofascial trigger points. Subjects randomly allocated into 3 groups; Extracorporeal shock wave (ESWT) group (n=20) which received low level energy ESWT plus neck stretching, strengthening exercise, High Power Pain threshold Ultrasound (HPPT) group (n=20) received high power-pain threshold ultrasound with intensity range from 0.5 to 2 Watt/cm² plus neck stretching, strengthening exercise and control group (n=20) received neck stretching, strengthening exercise, Arabic Neck Disability Index and Pressure algometer was used to measure neck functional disability (ANDI) and Pressure pain threshold (PPT). Results: within group study showed statistically significant improvement in ANDI and PPT in both ESWT group and HPPT group as p value was (P<0.0001), While between group analysis comparison demonstrated a statistically significant improvement in ESWT group compared to the HPPT group regarding the value of NDI and PPT (P<0.000). Conclusion: in young adult with upper trapezius myofascial trigger points, ESWT plus exercise produce better improvement in ANDI and PPT compared to HPPT Ultrasound