Objective: Neck pain is a common problem. Lomplaipattakad Sanyan-4-Lang (LPP-S4L) disease is a frequent cause of neck pain in Thai traditional medicine. Thai traditional medicine recommends treating neck pain with court-type Thai traditional massage (CTTM). Meanwhile, in conventional medicine, ultrasound modality (US) is used to treat neck discomfort. However, there is no scientific evidence if CTTM has potential analgesic advantages on LPP-S4L compared to ultrasound therapy. The study aims to evaluate the efficacy of CTTM compared to US and find body elements of participants based on aspects of Thai traditional medicine.Materials and Methods: Sixty-six participants were diagnosed with LPP-S4L, with a numerical rating scale (NRS) ≥ 4. Patients were randomly assigned to one of two groups (33 per group). Participants underwent CTTM or US therapy eight times in total (twice a week). Pain intensity, pressure pain threshold, ROM, quality of life, and a body element questionnaire were used to assess patients.Results: Both treatments showed a significant reduction in pain intensity, increase in pain threshold, increase in ROM, and improvement in quality of life in patients with LPP-S4L. The current study found that CTTM is moreeffective than US in most parameters, except QoL. Moreover, a decrease in pain intensity is related body elements, which indicates the influence of CTTM, or mostly the fire element.Conclusion: We recommend employing CTTM, an alternative therapy, to treat patients with upper back pain caused by LPP-S4L disease.
 The trial was registered at thaiclinicaltrials.org (number: TCTR20211004008).