Effectiveness of Post Isometric Relaxation Technique Versus Simple Stretching Exercises for Pain and Physical Activity in Young Females With Primary Dysmenorrhea in Peshawar

Khyber Medical University Peshawar

Status: Completed

Conditions: Menstrual Pain; Dysmenorrhea

Treatments: Procedure: Post-Isometric Relaxation (PIR); Procedure: Simple Stretching Exercises (SSE)

Study type: Interventional

Funder types: Other

Identifiers

NCT07052487

KMU/DIR/CTU/2025/003

Details and patient eligibility

About

This randomized controlled trial will compare the effectiveness of Post-Isometric Relaxation (PIR) versus Simple Stretching Exercises (SSE), each combined with standard physiotherapy modalities, for reducing menstrual pain and improving physical activity in young unmarried women with primary dysmenorrhea. Forty-four participants will be randomly assigned (1:1) to receive either PIR or SSE three times per week for eight weeks (24 total sessions). The study will identify which non-pharmacological intervention provides superior benefits for pain relief and daily function.

Full description

Primary dysmenorrhea is defined as menstrual cramps without underlying disease. This condition affects 50-90% of women of reproductive age and can significantly impair daily activities and quality of life. While pharmacologic treatments exist, non-drug interventions which include muscle energy techniques and stretching are under investigation for their safety and efficacy.

In this single-center, parallel-group randomized controlled trial, 44 unmarried female students aged 18-30 years with documented regular menstrual cycles and moderate to severe primary dysmenorrhea (WaLIDD score ≥5) will be enrolled. After baseline screening and informed consent, participants will be randomized (via OpenEpi) to one of two groups of post-isometric relaxation technique and simple stretching exercises.

Pain intensity (NPRS 0-10) and physical activity levels (IPAQ MET·min/week) will be assessed at baseline, 4 weeks, and 8 weeks by blinded assessors. Secondary measures include dysmenorrhea severity (WaLIDD questionnaire) and range of motion. Data will be analyzed with RM-ANOVA for within-group changes and independent-samples t-tests for between-group comparisons, after testing normality with Shapiro-Wilk. A p-value <0.05 denotes significance.

This trial will clarify which non-pharmacological intervention more effectively reduces menstrual pain and enhances activity, informing evidence-based physiotherapy protocols for primary dysmenorrhea.

Enrollment: 44 patients

Sex: Female

Ages: 18 to 30 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Female participants aged 18-30 years.
• Self-identification as female.
• Unmarried students with regular menstrual cycles (24-35 days).
• Diagnosed primary dysmenorrhea with a WaLIDD score ≥ 5.
• Able and willing to participate in thrice-weekly physiotherapy sessions for eight weeks.
• Provide written informed consent.

Exclusion criteria

• Secondary dysmenorrhea (e.g., endometriosis, pelvic inflammatory disease).
• Current use of hormonal contraceptives or any medication for menstrual pain.
• History of hip or pelvic surgery in the past year.
• Acute musculoskeletal injury or chronic pain conditions unrelated to dysmenorrhea.
• Neurological disorders affecting lower-limb muscle function.
• Contraindications to TENS or heat therapy (e.g., skin lesions, implanted electronic devices).
• Pregnancy or breastfeeding.
• Participation in another interventional trial within the past three months.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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44 participants in 2 patient groups

Post-Isometric Relaxation (PIR)

Experimental group

Description:

Participants receive Post-Isometric Relaxation targeting gluteus maximus, iliopsoas, piriformis, and hamstrings. Each session begins with 10 minutes of TENS and hot-pack application, followed by for each muscle group: a 10-second isometric contraction against the therapist's counterforce, 5-second relaxation, and 30-second passive stretch, repeated three times. Sessions occur three times per week for eight weeks (24 total sessions).

Treatment:

Procedure: Post-Isometric Relaxation (PIR)

Simple Stretching Exercises (SSE)

Active Comparator group

Description:

Participants receive four basic static stretches for the gluteus maximus, iliopsoas, piriformis, and hamstrings. Each session begins with 10 minutes of TENS and hot-pack application, followed by ten repetitions of each stretch (holding each stretch for 10 seconds). Sessions occur three times per week for eight weeks (24 total sessions).

Treatment:

Procedure: Simple Stretching Exercises (SSE)