Diaphragm-Pelvic Floor Synergy Training in Young Females With Primary Dysmenorrhea.

Effects of Diaphragm-Pelvic Floor Synergy Training on Pain and Quality of Life in Young Females With Primary Dysmenorrhea.

The research investigating the effects of Diaphragm-Pelvic Floor Synergy (DPFS) training targets primary dysmenorrhea in university-aged females. This randomized controlled trial evaluates how restoring the functional "piston" relationship between the diaphragm and pelvic floor can alleviate menstrual pain and enhance quality of life. By implementing an eight-week progressive exercise protocol, the study compares DPFS training against standard symptomatic care like TENS and heat therapy. Using the WALIDD scale and WHOQOL-BREF, the research aims to establish a non-pharmacological, evidence-based physiotherapy intervention that reduces medication reliance and academic absenteeism in South Asian clinical settings.

Study Overview

• Status: Recruiting
• Conditions: Dysmenorrhea
• Intervention / Treatment: Behavioral: Diaphragm-Pelvic Floor Synergy (DPFS) Training; Device: Transcutaneous Electrical Nerve Stimulation (TENS)

Detailed Description

The research investigates the functional relationship between the thoracic diaphragm and pelvic floor muscles, often described as a "piston" mechanism, and its role in managing primary dysmenorrhea. In healthy individuals, these muscle groups contract and relax in coordination to regulate intra-abdominal pressure and provide core stability. However, young females with primary dysmenorrhea frequently experience disrupted synergy due to shallow breathing and increased pelvic tension, which exacerbates the intensity of menstrual cramps and negatively impacts their physical and psychological well-being. To address this, a randomized controlled trial will be conducted at the Prime Institute of Health Sciences, involving 64 participants aged 18 to 25. The study compares a structured eight-week Diaphragm-Pelvic Floor Synergy (DPFS) training program against standard symptomatic care, such as TENS and heat therapy. The intervention group will perform specific exercises three times per week, progressing from supine to standing positions to challenge the core muscles under varying gravitational loads. This progression aims to recalibrate the respiratory-pelvic coordination and improve neuromuscular control.

Outcomes are measured using the WALIDD scale for pain severity and the WHOQOL-BREF for quality of life assessments. By focusing on the physiological root of core instability rather than just temporary symptom suppression, the study aims to establish an evidence-based physiotherapy protocol. This approach offers a sustainable, non-pharmacological alternative for managing menstrual pain, ultimately seeking to reduce academic absenteeism and long-term reliance on analgesics among young women in South Asian clinical settings.

• Study Type: Interventional
• Enrollment (Estimated): 64
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Summra Andleeb, MSOMPT; Phone Number: 03450510617872; Email: summer.spring90@gmail.com
• Study Contact Backup: Name: Rida Zafar, WHPT; Phone Number: 03368753273; Email: rida.zafar@riphah.edu.pk

Study Locations

• Pakistan
  • Punjab Province
    • Islamabad, Punjab Province, Pakistan, 44000
      • Recruiting
      • Prime Institute of Health Sciences, Islamabad

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. University going girls aged 18-24 years.
2. Normal weight (BMI 18.5-24.9 kg/m²) based on measured height and weight.
3. Primary dysmenorrhea: recurrent menstrual pain without pelvic pathology, present for ≥6 months, with pain intensity ≥4/10 on VAS.
4. Regular menstrual cycles (21-35 days).
5. From socioeconomically disadvantaged backgrounds (e.g., low parental education, low household income, government/public school enrolment - specify in protocol).
6. Currently enrolled in school/college.
7. Informed consent/assent obtained (with parental consent if <18 years).
8. Willing to participate in intervention and data collection.

Exclusion Criteria:

1. diagnosed pelvic pathologies (e.g., endometriosis, fibroids, pelvic inflammatory disease).
2. Irregular menstrual cycles (<21 days or >35 days).
3. Current or recent use of hormonal contraceptives or hormonal therapy (within last 3 months).
4. History of pelvic/abdominal surgery.
5. Pregnancy or recent childbirth (within 6 months).
6. Any diagnosed musculoskeletal, neurological, or medical condition contraindicating exercise or acupressure.
7. Current participation in another clinical trial or structured exercise/physiotherapy program for dysmenorrhea.
8. Unwillingness to provide consent/assent or comply with study procedures

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Diaphragm-Pelvic Floor Synergy (DPFS) Training; Participants in this group undergo an active neuromuscular re-education protocol. The intervention focuses on restoring the "piston-like" coordination between the thoracic diaphragm and the pelvic floor muscles. Over an 8-week period, participants perform supervised exercises three times per week that synchronize breathing with pelvic floor activation. The training is progressive, advancing through four postural stages (supine, sitting, quadruped, and standing) to challenge the core's ability to regulate intra-abdominal pressure and alleviate symptoms of primary dysmenorrhea.	Behavioral: Diaphragm-Pelvic Floor Synergy (DPFS) Training; This intervention is a supervised 8-week program consisting of 3 sessions per week. It focuses on the functional coordination of the thoracic diaphragm and pelvic floor muscles to regulate intra-abdominal pressure. The protocol involves a "piston" technique where participants perform a 4-second slow inhalation (allowing the pelvic floor to relax and descend) followed by a 6-second pursed-lip exhalation (actively contracting and elevating the pelvic floor). The training is progressive, advancing every two weeks through four postural levels: supine, sitting, quadruped, and standing.
Active Comparator: Standard Symptomatic Care; This group serves as the clinical control, receiving conventional physiotherapy typically used for menstrual pain relief. During the first three days of the menstrual cycle, participants receive passive modalities, including High-Frequency Transcutaneous Electrical Nerve Stimulation (TENS) and moist heat therapy. On non-menstrual days, the group performs supervised Progressive Muscle Relaxation (PMR) three times per week. This design ensures that the control group remains as active as the experimental group while receiving standard-of-care treatments for symptom management.	Device: Transcutaneous Electrical Nerve Stimulation (TENS); This arm receives established clinical treatments for menstrual pain. During the first three days of the menstrual cycle, participants receive 30 minutes of High-Frequency Transcutaneous Electrical Nerve Stimulation (TENS) at 100 Hz and 20 minutes of moist heat therapy. On non-menstrual days, they participate in supervised Progressive Muscle Relaxation (PMR) sessions three times per week to manage general muscle tension and stress.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Working Ability, Location, Intensity, Days of pain, and Dysmenorrhea (WALIDD) Scale	The WALIDD scale is a validated multi-dimensional tool used to assess the severity of primary dysmenorrhea. It evaluates five specific areas: work interference, anatomical location of pain, pain intensity, duration of symptoms, and the clinical grade of dysmenorrhea. Scores range from 0 to 12, where 1-4 indicates mild, 5-7 moderate, and 8-12 severe pain.	Baseline (Pre-intervention), 8 weeks (Immediate post-intervention), and 3 months (Follow-up).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
: World Health Organization Quality of Life-BREF (WHOQOL-BREF)	This is a 26-item questionnaire used to assess quality of life across four major domains: physical health, psychological health, social relationships, and environment. It measures how the intervention impacts the participants' overall well-being and daily functioning. Each item is rated on a 5-point Likert scale.	Baseline (Pre-intervention), 8 weeks (Immediate post-intervention), and 3 months (Follow-up).

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Summra Andleeb, MSOMPT, Riphah International University

Study record dates

Study Major Dates

• Study Start (Actual): August 12, 2026
• Primary Completion (Estimated): November 1, 2026
• Study Completion (Estimated): January 1, 2027

Study Registration Dates

• First Submitted: August 5, 2026
• First Submitted That Met QC Criteria: August 7, 2026
• First Posted (Actual): August 10, 2026

Study Record Updates

• Last Update Posted (Actual): August 26, 2026
• Last Update Submitted That Met QC Criteria: August 25, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Keywords: Quality of Life; Primary Dysmenorrhea; Young Females; Diaphragm-Pelvic Floor Synergy
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Pathologic Processes; Pelvic Pain; Menstruation Disturbances; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Dysmenorrhea; Therapeutics; Physical Therapy Modalities; Rehabilitation; Anesthesia and Analgesia; Electric Stimulation Therapy; Analgesia; Transcutaneous Electric Nerve Stimulation
• Other Study ID Numbers: Rida Zia Chaudhary

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No