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

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.

Inclusion criteria

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

Exclusion criteria

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