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

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.

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.