Evaluating Efficacy of Spinal Manipulation on Primary Dysmenorrhea

  • Sharif Najafi Assistant Professor, Department of Physical Medicine and Rehabilitation, Imam Reza Hospital, School of Medicine AND Clinical Biomechanics and Ergonomics Research Center, AJA University of Medical Sciences, Tehran, Iran https://orcid.org/0000-0001-9544-4525
  • Ehsan Sanati Assistant Professor, Department of Physical Medicine and Rehabilitation, Imam Reza Hospital, School of Medicine AND Clinical Biomechanics and Ergonomics Research Center, AJA University of Medical Sciences, Tehran, Iran
  • Farid Rezaei-Moghaddam Assistant Professor, Department of Physical Medicine and Rehabilitation, Imam Reza Hospital, School of Medicine AND Clinical Biomechanics and Ergonomics Research Center, AJA University of Medical Sciences, Tehran, Iran
  • Maryam Deldar Department of Gynecology and Obstetrics, Imam Khomeini Hospital AND Research Center of Clinical Biomechanics and Ergonomics, Tehran University of Medical Sciences, Tehran, Iran
  • Hoda Jazayeri Assistant Professor, Department of Physical Medicine and Rehabilitation, Imam Reza Hospital, School of Medicine AND Clinical Biomechanics and Ergonomics Research Center, AJA University of Medical Sciences, Tehran, Iran https://orcid.org/0000-0002-1759-2706
Keywords: Dysmenorrhea; Orthopedic manipulation; Lumbosacral regions; Thoracic vertebrae

Abstract

Background: This study was performed to determine the effect of manual spinal manipulation on pain reduction in primary dysmenorrhea.

Methods: The 37 participants were randomly assigned to the intervention and control groups. All patients underwent spinal examinations on day 15 of their cycle. In addition, their lumbosacral range of motion was analyzed using a Zebris machine and their thoracolumbar range of motion was measured using a goniometer. Patients in the intervention group received spinal manipulation on day 15, 21, and 28 of their second menstruation cycle. Patients in both groups performed 6 exercises consisting of stretching and strengthening exercises which were begun on day 15 of their second cycle and stopped with menstruation onset. Follow-up was performed for 3 consecutive cycles in both groups.

Results: Of the 37 patients who entered the study, 32 patients were analyzed. The mean age of patients was 27.68 years and their pain score was generally higher than 5 out of 10. Paired t-test was used for variables with normal distribution and Wilcoxon test for those with non-normal distribution. The pain in the abdomen, pelvis, and lower back was decreased significantly in both groups, but the effect of manipulation + exercise was greater than exercise alone. This reduction in pain in the abdominal and pelvic region after the manipulation was significant in the 3 months of follow-up (P < 0.05). Manipulation caused a reduction in diclofenac use in all 3 cycles, but in the exercise group, a significant decrease was only observed in the first cycle. The reduction in the number of days with pain after menstruation was significant after manipulation.

Conclusion: Spinal manipulation seems to be a good alternative to medical therapy with much fewer complications.

References

1. Spears LG. A narrative review of medical, chiropractic, and alternative health practices in the treatment of primary dysmenorrhea. J Chiropr Med 2005; 4(2): 76-88.
2. Proctor M, Farquhar C. Diagnosis and management of dysmenorrhoea. BMJ 2006; 332(7550): 1134-8.
3. Proctor ML, Hing W, Johnson TC, Murphy PA. Spinal manipulation for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev 2006; (3): CD002119.
4. Mayo Clinic. Menstrual Cramps [Online]. [cited 2018 Apr 14]; Available from: URL: https://www.mayoclinic.org/diseases-conditions/menstrual-cramps/symptoms-causes/syc-20374938
5. Proctor ML, Farquhar CM. Dysmenorrhoea. BMJ Clin Evid 2007; 2007: 0813.
6. Kokjohn K, Schmid DM, Triano JJ, Brennan PC. The effect of spinal manipulation on pain and prostaglandin levels in women with primary dysmenorrhea. J Manipulative Physiol Ther 1992; 15(5): 279-85.
7. Boesler D, Warner M, Alpers A, Finnerty EP, Kilmore MA. Efficacy of high-velocity low-amplitude manipulative technique in subjects with low-back pain during menstrual cramping. J Am Osteopath Assoc 1993; 93(2): 203-4.
8. Parkinson J, Lau J, Kalirah S, Gleberzon BJ. Attitudes of clinicians at the Canadian Memorial Chiropractic College towards the chiropractic management of non-musculoskeletal conditions. J Can Chiropr Assoc 2011; 55(2): 107-19.
9. Peterson DH, Bergmann TF. Chiropractic Technique: Principles and Procedures. 2nd ed. St. Louis, MO: Mosby; 2002. p. 39-96.
10. Thomason PR, Fisher BL, Carpenter PA, Fike GL. Effectiveness of spinal manipulative therapy in treatment of primary dysmenorrhea: A pilot study. J Manipulative Physiol Ther 1979; 2: 140-5.
11. Wiles MR, Diakow P. Chiropractic and visceral disease. J Can Chiropr Assoc 1982; 26(2): 65-8.
12. Wiles M. Gynecology and obstetrics in chiropractic. J Can Chiropr Assoc 1980; 24(4): 163-6.
13. Hitchcock ME. The manipulative approach to the management of primary dysmenorrhea. J Am Osteopath Assoc 1976; 75(10): 909-18.
14. Lundeberg T, Bondesson L, Lundstrom V. Relief of primary dysmenorrhea by transcutaneous electrical nerve stimulation. Acta Obstet Gynecol Scand 1985; 64(6): 491-7.
15. Fraser IS, McCarron G. Ibuprofen is a useful treatment for primary dysmenorrhoea. Aust N Z J Obstet Gynaecol 1987; 27(3): 244-7.
16. Jaeschke R, Singer J, Guyatt GH. A comparison of seven-point and visual analogue scales. Data from a randomized trial. Control Clin Trials 1990; 11(1): 43-51.
17. Triano JJ, McGregor M, Cramer GD, Emde DL. A comparison of outcome measures for use with back pain patients: Results of a feasibility study. J Manipulative Physiol Ther 1993; 16(2): 67-73.
18. Triano JJ, McGregor M, Hondras MA, Brennan PC. Manipulative therapy versus education programs in chronic low back pain. Spine (Phila Pa 1976) 1995; 20(8): 948-55.
19. Holtzman DA, Petrocco-Napuli KL, Burke JR. Prospective case series on the effects of lumbosacral manipulation on dysmenorrhea. J Manipulative Physiol Ther 2008; 31(3): 237-46.
20. Hondras MA, Long CR, Brennan PC. Spinal manipulative therapy versus a low force mimic maneuver for women with primary dysmenorrhea: A randomized, observer-blinded, clinical trial. Pain 1999; 81(1-2): 105-14.
21. Snyder BJ, Zhang J. Toftness system of chiropractic adjusting on pain syndromes: a pilot study in a multicenter setting. J Chiropr Med 2007; 6(1): 15-9.
22. Saleh HS, Mowafy HE, El Hameid AA. Stretching or core strength-ening exercises for managing primary dysmenorrhea. J Women's Health Care 2016; 5(1): 295.
23. Abbaspour Z, Rostami M, Najjar S. The effect of exercise on primary dysmenorrhea. Res Health Sci Width1 2004; 4(2): 26-31.
24. Onur O, Gumus I, Derbent A, Kaygusuz I, Simvali S, Urun E, et al. Impact of home-based exercise on quality of life of women with primary dysmenorrhoea. S Afr J Obstet Gynaecol 2012; 18(1): 15-8.
25. Noorbakhsh M, Alijani E, Kohandel M, Mehdizade Tourzani Z, Mirfeizi M, Hojjat S. The effect of physical activity on primary dysmenorrhea of female university students. World Appl Sci J 2012; 17(10): 1246-52.
26. Kim MJ, Baek IH, Goo BO. The relationship between pelvic alignment and dysmenorrhea. J Phys Ther Sci 2016; 28(3): 757-60.
Published
2019-12-05
Section
Original Article(s)