Inclusion criteria:
1- History of first stroke
2- At least three months have passed since the stroke
2- A Mini-Mental State Exam score above 24 points
3- No history of shoulder pain before the stroke
4- No medication used for shoulder pain in the last two weeks or no injection (botox, steroid, local anesthetic) in the past three months
5- Stability hemodynamics to tolerate rehabilitation
6- Patients aged 30–60
7- Hypertonicity in the upper extremity (modified Ashworth scale ≥2)
8- Detection of referred pain patterns by palpation of MTrPs
9- Active MTrP in the upper trapezius, subscapularis, supraspinatus, infraspinatus, teres minor, pectoralis major, and biceps brachii muscles