
==== Front
J Educ Health Promot
J Educ Health Promot
JEHP
J Edu Health Promot
Journal of Education and Health Promotion
2277-9531
2319-6440
Wolters Kluwer - Medknow India

JEHP-13-252
10.4103/jehp.jehp_1629_23
Case Report
Benefits of core stability exercise and relaxation technique for primary dysmenorrhea in an unmarried girl: A case report
Gopal S Radhika 1
Premkumar M 1
Kavitha S 12
Shipnu P 1
1 Institute of Physiotherapy, Srinivas University, City Campus, Pandeshwar, Mangalore, Karnataka, India
2 Department of Outpatient, Santosh of Physiotherapy, Madurai, Tamil Nadu, India
Address for correspondence: Mr. Premkumar M, Institute of Physiotherapy, Srinivas University, City Campus, Pandeshwar, Mangalore - 575 001, Karnataka, India. E-mail: 80pk2009@gmail.com
2024
29 7 2024
13 25211 10 2023
05 12 2023
Copyright: © 2024 Journal of Education and Health Promotion
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Primary dysmenorrhea denotes the onset of recurrent lower abdominal pain and uterine contractions throughout the bleeding phase of menstruation in the absence of any underlying pelvic pathology. Core stability exercise is considered a beneficial exercise program for managing several health problems. Various relaxation techniques can be used in womanhood with primary dysmenorrhea for relief of pain and improving their quality of life (QOL). The aim of this study was to learn and understand the benefits of core stabilization exercise along with relaxation techniques for primary dysmenorrhea in an unmarried girl. This single-case study was planned to analyze the effect of core stability exercise along with relaxation techniques in the management of primary dysmenorrhea symptoms. Relaxation exercises along with core stability exercises were given to subjectswith primary dysmenorrhea for 20 sessions of 30 minutes spanned for 5 weeks, four sessions a week. Along with the demographic profile, pre- and post -intervention value of pain in the visual analog scale (VAS) and Working Ability, Location, Intensity, Days of Pain, Dysmenorrhea (WaLIDD) score was obtained, recorded, and analyzed. This single-case study results showed significant improvement in the outcome of pain in the VAS and WaLIDD score after the intervention of core stability exercise along with relaxation exercise for the primary dysmenorrhea patients. Pre- and post-intervention of core stability exercise along with Mitchell’s relaxation exercises, measurements of VAS, and dysmenorrhea severity in WaLIDD scores revealed an effective reduction in pain and severity using core stability training and relaxation training in an unmarried girl diagnosed with primary dysmenorrhea.

Core stability exercise
primary dysmenorrhea
relaxation exercises
WaLIDD score
==== Body
pmcIntroduction

Dysmenorrhea, also called painful menstruation, is a cyclic lower abdominal pain and pelvic region, which also radiates to the posterior aspect of the thighs, usually occurring before or during menstruation or even throughout.[1] Menstrual cramps and pain are usually felt in the abdominal region after consistent ovulation and arise soon after attaining menarche.[2] Dysmenorrhea is considered one of the most commonly seen gynecological concerns among adolescent and adult females.[3]

Primary dysmenorrhea denotes the onset of recurrent lower abdominal pain and uterine contractions throughout the bleeding phase of menstruation in the absence of any underlying pelvic pathology.[4]

Physical activity and exercise are also found to be effective and safe interventions formanaging dysmenorrhea.[5] Many studies have given evidence of increased blood circulation, balanced hormonal changes, and the boost of endorphin levels in response to various exercise regimens, which is ultimately increasing the pain threshold of dysmenorrhea patients.[6]

Core stability exercise is considered a beneficial exercise program formanaging several health problems. Core stabilization exercise strengthens and organizes the muscles around the abdomen andthe lumbar and pelvic regions. For the reason that core stability exercise may have a prime influence on the lumbosacral structure,[78] it is hypothesized that stability training for core muscles might be an effective way to condense the warning signs of primary dysmenorrhea as well. In contrast, to our knowledge, the effects of core stability training on dysmenorrhea have not been estimated yet.

Various relaxation techniques can be used in womanhood with primary dysmenorrhea for relief of pain and improving their quality of life (QOL). In Laura Mitchell’s relaxation technique, contracting a muscle or body as a whole and relaxing can relieve stress and muscle tension.[9]

There were very limited resources available to assess the effectiveness of core stability training and relaxation techniques in managing primary dysmenorrhea in an unmarried girl and to conclude the effects of the post-training program. Thus, this case study outcome will give aview of treatment approaches tothe benefit of dysmenorrhea among unmarried girls, which will be of greater significance in the physiotherapy treatment aspects.

Materials and Methods

An introductory class was conducted about dysmenorrhea and its symptoms for the femalestudents in the Santosh College of Physiotherapy, and the nature of the study and interventions were explained to the subjects and those willing to participate. Based on the criteria, each subject was selected for the study. Before proceeding with theintervention, written consent was obtained from the subject. Pretreatment outcome measures of the level of pain onthe visual analog scale (VAS)[8] and the severity of primary dysmenorrhea with the WaLIDD score were recorded. Selected subjects took part in a 45-minute session along with demonstrations of the importance of “planned exercise program with core stability exercise along with relaxation exercise to care primary dysmenorrhea symptoms.” The subject was encouraged to chart the exercise program for 30 minutes per session at least four times a week on a regular basis. After 5 weeks of spanning the next menstrual cycle, 20 sessions of intervention of treatment outcome measures of pain and severity of primary dysmenorrhea with the WaLIDD score[10] were recorded again. Data were documented and reported for analysis.

Case presentation

Name: M Abhirami, aged 19 years, with chief complaints of pain, severe discomfort during monthly cycles, and fatigue. (History: age of menarche: 12 years, history of menstruation: no. of days or cycles: 6 days, regular or irregular: irregular, and painful or pain free: pain in VAS—9). Onset of pain: duration of pain proceeding monthly cycle: 3 days before. Location of pain: lower back and lower abdomen, events associated with pain: emotional outbreaks, pattern of pain: aching and pin pricking, amount of bleeding: abnormal and unusual, variables: pre-intervention: rate of pain due to dysmenorrhea—9 (VAS), Dysmenorrhea Severity ScaleWorking Ability, Location, Intensity, Days of Pain, Dysmenorrhea (WaLIDD) score—9, and pain-relieving elements: hot packs, supine lying, and gentle abdominal massage. Diagnosis: primary dysmenorrhea, physiotherapy interventions: core stabilization exercises [Figure 1] and Mitchell’srelaxation exercises [Figure 2], post-intervention: rate of pain due to dysmenorrhea—3 (VAS), and Dysmenorrhea Severity Scale WaLIDDscore—4 [Table 1].

Figure 1 Core stability exercise with the Swiss Ball (Source: Author)

Figure 2 Mitchell’s relaxation exercise (Source: Author)

Table 1 Outcome measures (Source: Author)

Intervention	Pain in VAS	WaLIDD score	
Pre-intervention	9	9	
After 2 weeks (after the next immediate cycle of menstruation)	7	8	
Post-intervention (after 5 weeks—second cycle of menstruation)	3	4	

Data Analysis and Discussion

In this case study, a reduction in pain was noticed significantly in the pre–post--scores using VAS and severity of dysmenorrhea by the WaLIDDscore in this unmarried young girl. This change was noticed because of the physiological benefits of the core stability exercise and Mitchell’s relaxation techniques, which physiologically reduce the endometrial tension and eventually relax the musculature of the uterus. Core stability exercise gives the desirable strength in the uterus muscles, whereas relaxation exercise proves the psychological status of subjects and reduces emotional outbursts and tension during the menstruation period.

Outcome Measures

Pain in VAS

Dysmenorrhea Severity by WaLIDD Score

This study result showed the conceptual outcome of a previous study (Hend S Saleh et al. 2015), wherein performing exercises, such as stretching and core muscle training, effectively reduced the amount and extent of pain in primary dysmenorrhea.[89] This study reinforced the importance of relaxation exercisesin treating dysmenorrhea symptoms, which has already been mentioned in a previous study by Rasoulzadeh et al.,[9] 2007 where they stated that symptoms of primary dysmenorrhea were effectively managed using various relaxation techniques in young women.

Although core stabilization exercises and relaxation techniques are immensely beneficial in the treatment intervention of dysmenorrhea patients, this study result contributes more tothe treatment of dysmenorrhea symptoms.

Nevertheless, this study is a single-case study, which is the main limitation of the study. This study can be performed with anadvanced study design by involving more number of subjects. This concept can be extended todifferent age groups of primary dysmenorrhea subjects also. If it can be done like that, then there will be proper progression in the treatment of dysmenorrhea symptoms with good functional outcomes.

Conclusion

Pre- and post-intervention of core stability exercise along with Mitchell’s relaxation exercises, measurements of VAS, and dysmenorrhea severity in WaLIDD scores revealed an effective reduction in pain and severity using core stability training and relaxation training in an unmarried girl diagnosed with primary dysmenorrhea.

CRediT authorship contribution statement

Author a conceptualized the study, involved in formal analysis, designed methodology, wrote the original draft, and administered the project.

Author b conceptualized the study; investigated the study; wrote the original draft; wrote, reviewed, and edited the manuscript; and supervised the project.

Author c involved in formal analysis, collected data, designed methodology, and investigated the data.

Author d involved in formal analysis, collected data, designed methodology, and investigated the data.

All authors read and approved the final version of the manuscript.

Ethical committee approval

Reg.No: SCP/UG02/101/2022.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.
==== Refs
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