BACKGROUND AND PURPOSE: There is no consensus on effective treatment for scapulocostal syndrome (SCS). This study aimed to evaluate the effects of traditional Thai massage (TTM) and Thai boxing exercise (TBE) on pain intensity, pressure pain threshold (PPT), and cervical range of motion (CROM) in patients with SCS. MATERIALS AND METHODS: Seventy-eight patients with SCS were randomly equally allocated to receive either four-week TTM or TBE. Pain intensity, PPT, and CROM were measured at baseline, posttreatment, and 1-month follow-up. RESULTS: Significant improvements in pain intensity, PPT, and CROM in all directions were evident at posttreatment compared with baseline in the TTM group (p < 0.01); these improvements, except cervical extension, were observed at 1-month follow-up (p < 0.01). Compared to baseline, the TBE showed significant improvements in all outcomes except cervical flexion at posttreatment (p < 0.01); these improvements, except cervical flexion and PPT, were evident at 1-month follow-up (p < 0.001). When comparing the groups, the TTM showed significantly better scores than the TBE in terms of pain intensity, PPT, and cervical flexion and left lateral flexion at posttreatment (p < 0.05). The superior effects of TTM on these outcomes, except cervical flexion, were demonstrated at 1-month follow-up (p < 0.05). CONCLUSION: Four weeks of TTM and TBE reduced pain intensity and improved pain threshold and cervical movements at posttreatment and 1-month follow-up. TTM provided better reductions in pain intensity, pain threshold, cervical flexion, and left lateral flexion than TBE in patients with SCS.