10.5958/0973-5674.2019.00145.X The Effects of Kinesio Taping and Isometric Exercises on Pain in Primary Dysmenorrhea – A Comparative Study

Shamla Pazare1, Lekha Sawant2, Shweta Ingale3

1Professor (Neurosciences), 2BPTh, 3MPTh Neurosciences, CMF’s College of Physiotherapy, Chinchwad

Abstract Primary dysmenorrhea is the most common problem faced worldwide affecting majority of women. The present study is aimed to compare the effect of kinesiotaping and isometric exercises on pain in females with primary dysmenorrhea.

Materials and Method: In this randomized controlled clinical trial, 40 students females aged between 18-25 years with primary dysmenorrhea were randomly assigned to kinesiotaping and isometric exercises group. Pain intensity was measured using Visual Analogue Scale (VAS) and premenstrual symptoms were assessed using Menstrual Distress Questionnaire (MDQ- C). Data were analyzed using paired and unpaired t-test. P<0.05 was considered statistically significant.

Results: Both kinesiotaping and isometric groups showed reduction in pain on VAS and MDQ (P<0.001). However in post treatment analysis, Kinesiotaping was proved to be better than isometric exercises.

Conclusion: Kinesiotaping seems to be an effective method for reducing pain in primary dysmenorrhea.

Keywords: Isometric exercises, Kinesiotaping, Pain, Primary dysmenorrhea.

Introduction which in turn breaks down and dies. These uterine contractions continue as they squeeze the old, dead Dysmenorrhea is the occurrence of painful cramps endometrial tissue through cervix and out of the body during menstruation affecting quality of life. There through vagina. Due to these uterine contractions and are two types of dysmenorrhea namely primary and the resulting temporary oxygen deprivation to nearby secondary. Prevalence of dysmenorrhea was reported as tissues, pain or “cramps” are experienced during 84.2% in India.(1) menstruation.(2) Primary dysmenorrhea usually presents during The Premenstrual syndrome has been described as adolescence, within three years of menarche. Pain the commonest psycho-neuro-endocrine-stress related usually starts in first menstrual cycle itself. Affected disorder and is a major clinical entity affecting large women experience sharp, intermittent spasms of pain, fraction of female population. Symptoms occurring usually centred in the suprapubic area, which may during primary dysmenorrhea include at least one radiate to the back of the legs or the lower back. There of the first four symptoms like depressed mood, is no structural abnormality or pathology in Primary tension or anxiety, lower back pain, decreased activity dysmenorrhea. It occurs due to increase in prostaglandin changes in appetite. Physical symptoms include secretion resulting in increase in uterine activity thereby breast tenderness, headaches, bloating or distension of constricting the blood supply to tissue of endometrium, abdomen, and muscle pain. Other symptoms includes nausea, vomiting, diarrhoea, fatigue, nervousness and dizziness. Females are dependant on medications for Corresponding Author pain and complementary or alternative medicine include Dr. Shamla Pazare vitamins, supplements, Transcutaneous Electrical Professor (Neurosciences), CMF’s College of Nerve Stimulation (TENS), acupuncture, medicinal Physiotherapy, Chinchwad, Pune-411019 plants aromatherapy, reflexology, acupressure, massage e-mail: [email protected] therapy, and exercises.(3) 118 Indian Journal of Physiotherapy and Occupational Therapy, October-December 2019, Vol. 13, No. 4 Dysmenorrhea is the most common complaint Outcome Measures of young female disturbing their quality of life and Visual analogue scale (VAS)–is a unidimensional absenteeism from their work. Despite ongoing medical measure of pain intensity, determined by measuring advances, many women still depend on medications to the distance (mm) on 10cm line.(8) A higher score cope up with menstrual pain, which may result in drug indicates greater pain intensity. Menstruation distress addiction. A study by Sara et al showed that Isometric questionnaire (MDQ) Form C- is a standard method exercises helped in reducing Primary dysmenoorheal for measuring perimenstrual symptoms.(9) It is a 46- pain.(4) A study done byJung Hyug et al showed that item self-report inventory .Permission to access to Kinesio Taping and Hot Pack helps in premenstrual use the scale taken from author Rudolf Moos through syndrome.(13) Another study revealed that Kinesio taping MINDGARDEN by info.mindgarden.com. had significant effects on menstrual pain.(12)

No study was done to compare the effects of Procedure Isometric exercises and Kinesio-taping on menstrual Ethical committee approval was obtained. Subjects pain. Thus, the aim and objectives of this study were to with primary dysmenorrhea fulfilling the inclusion study compare the effects of kinesiotaping and isometric criteria were selected. Written consent was taken from exercises on pain in primary dysmenorrhea. It was the selected subjects. 40 subjects were selected on basis hypothesised that there is no significant difference (H0) of inclusion and exclusion criteria. Random allocation or a significant difference (H1) between the effectiveness was done in 2 groups using chit method namely Group of Kinesio Taping and Isometric exercises on the pain A which included 20 subjects that underwent Kinesio and premenstrual symptoms in primary dysmenorrhea. Taping and the Group B which included 20 subjects that underwent Isometric Exercises. Pre-treatment Materials and Method assessment of pain was done by taking menstrual history The study design was experimental-clinical trial of each subject and pain intensity was scored using that was conducted on 40 subjects as calculated by outcome measures, Visual analogue scale (VAS) and formula through purposive sampling in PCMC area, Menstruation distress questionnaire (MDQ) Pune for 6 months. The inclusion criteria for this study were females between age group of 18-25 years, having regular menstrual cycle with menstrual pain score on VAS minimum 5. The exclusion criteria were subjects suffering from secondary dysmenorrhea that is associated with structural abnormality like any pathology, infection (like fibroid, endometriosis and ovarian cysts etc.), complaints of low back pain due to any other pathology, any skin infection, sensitive skin or allergic to Kinesio Tape and subjects on medication to reduce dysmenorrhea. The materials used for this study were Kinesio Tape (5cm x 5m) and Scissors.(Figure 1)

Figure 2: Kinesio tape applied from below the navel to start of pubic hair

Figure 1: Materials used for the study Kinesio Tape (5cm x 5m) Scissors Indian Journal of Physiotherapy and Occupational Therapy, October-December 2019, Vol. 13, No. 4 119 post assessment of pain was done using VAS and MDQ.

Findings Analysis of the experimental data was made possible by means of statistical tests. Statistical analysis was performed by using Graph Pad instat3 and Microsoft excel. Descriptive statistics was to find out Mean, Standard Deviations for outcome variables. Paired t-test was used to analyse significant difference in pre post treatment VAS and MDQ values within the same group. Unpaired t-test was used to analyse the level of significance between the post mean values of VAS and MDQ of both the groups. Unpaired t-test was used to analyse the pre-treatment values between both the groups to check if they were comparable or not. Microsoft Excel was used to generate graphs and tables.

Result Figure 3: Kinesio tape applied on low back Table 1: Showing pre and post treatment values of Subjects in group A underwent taping a total of Group A and Group B on VAS and MDQ six times twice a week for about three weeks starting Pre Post from 14 days before menstruation until its end. For this Outcome Group Treatment Treatment p Value group, a piece of Kinesio tape, with corners cut in round, Measures (Mean ±SD) (Mean ±SD) 5 cm in width and 7–8 cm in length was applied right VAS A(Kinesio 7.7900 5.8000 <0.00018* from below the navel and reached to where the pubic Taping) ±1.0398 ±1.10596 hair began(Figure2), and another piece of tape 10 cm B(Isometric 8.3050 7.1500 in length was applied to make a cross shape with the Exercises) ±0.92763 ±1.30243 0.0002* first piece. Another piece of tape was applied to low back (Figure 3). Subjects in group B performed isometric p value 0.106 0.018* exercises since the third day of their menstrual cycle MDQ A 85.7000 74.2500 <0.0001* 5 days a week, two sessions a day, and 10 times per ±23.94533 ±23.32578 session for 8 weeks. B 94.4000 88.2400 <0.0001* ±21.92907 ±23.3005 The protocol of Isometric Exercises were 1) Sleeping p value 0.238 0.0768* in supine position, facing feet to each other, pressing feet on each other, holding for 5 sec, and relaxing.2) Sleeping Table 1 shows pre and post treatment VAS values in supine position, putting feet crossed and pressing of group A (p value<0.0001), extremely significant and them on each other, holding for 5sec, and relaxing.3) of group B (p value=0.0002),significant. The post mean Sleeping in supine position, bending knees and thighs, value between group A and group B (p value=0.018), putting a pillow between two knees, pressing knees to considered extremely significant on pain using VAS. each other, holding for 5secs, and relaxing.4)Going Difference of group A was more than group B, which back to the third position, putting hand below waist showed that the intensity of pain reduced more in and pressing waist to the ground, holding for 5sec, and kinesiotaping. The pre and post treatment MDQ values relaxing.5)Sleeping in supine position, bending knees of group A (p value<0.0001),extremely significant and and thighs and trying to raise head and neck above the of group B (p value<0.0001) were extremely significant. ground level, holding for 5sec, and relaxing.6)Sleeping The post mean value between group A and B (p value= in supine position, bending knees and thighs and trying 0.076) were extremely significant on pain using MDQ. to move head and neck toward the right thigh, holding Difference of group A is more than group B, which shows for 5sec, and relaxing. After Completion of interventions intensity of pain was reduced more in kinesiotaping. 120 Indian Journal of Physiotherapy and Occupational Therapy, October-December 2019, Vol. 13, No. 4 Discussion constant cutaneous afferent stimulation through the skin and decreasing pain through neurological Primary Dysmenorrhoea causes significant pain and discomfort in majority of females. The increase in uterine suppression. It helps in realigning fascial tissue (7) production and release of prostaglandins at menstruation function by normalising muscle tension. All these gives rise to abnormal uterine activity, causing uterine factors contribute in reducing pain. hypoxia and pain. Prostaglandins such as prostaglandin E2 and cyclic endoperoxides hypersensitise pain fibers Limitations and Scope of the Study in the pelvis and uterus. A reduction in prostacyclin may There is limited opportunity for long term follow-up enhance uterine activity and vasoconstriction, which as well as there are large number of questions in menstrual gives rise hypoxia and pain. distress questionnaire which might have caused subjects not to properly answer the items. Further studies could The first objective of this study was to study the effect involve kinesiotaping with other intervention for better of Kinesio-taping on menstrual pain. Kinesio taping effect is used for treating various musculoskeletal problems, created by Dr. Kenso Kase in 1970’s. It is based on use Conclusion of special elastic strips, which mimics the density and elasticity of human skin. It is an auxiliary treatment Considering the results of this study shows that that maximizes natural recovery ability and corrects the Kinesio Taping is more effective on pain in primary balance of the human body by adjusting electromagnetic dysmenorrhea as compared to Isometric Exercise. This flows on the skin, indirectly stimulating muscles or study indicates the benefits of kinesiotaping on pain in organs right under the skin using non chemically-treated primary dysmenorrhea which can be applied in severe tape. When the muscle is inflamed, the space between pain, for immediate effect. skin and muscle is constricted and outflow of lymphatic Conflict of Interest: Nil fluid is compromised. Kinesiotaping normalizes muscular function, increases lymphatic and vascular Source of Funding: Self flow resulting in expansion of skin interstitial space. Ethical Clearance: Taken from ethical committee. Kinesio tape applied to the lower abdomen would have stimulated the tactile fibres in the skin suppressing the References pain sensitizing action of prostaglandin in the spinal 1. Mool Raj Kural et al Menstrual characteristics and cord, thereby reducing menstrual pain. Kinesiotaping prevalence of dysmenorrhea in college going girls applied, helps in reducing tension of pelvic area and Journal of Family Medicine and Primary Care,2015 thus reducing the compression by uterine contractions. Jul-Sep; 4(3): 426–431. Application of kinesiotape increases the blood supply to the area applied by vasomotor reflex, causing vasodilation 2. Mantle J, Textbook: Physiotherapy in obstetrics and gynaecology 2nd edition Elsevier Health Sciences of arteriole. Kinesiotaping helps in facilitating bleeding and excretion of wastes containing prostaglandin 3. Alaettin Unsal et al Prevalence of dysmenorrhea which causes contraction.(10) and its effect on quality of life among a group of female university students Upsala Journal of The second objective of this study was to study the Medical Sciences 2010 May; 115(2): 138–145. effect of Isometric exercises on menstrual pain. Isometric 4. Sara Azima et al Effect of Isometric Exercises on exercises strengthens pelvic muscles, facilitating Primary Dysmenorrhea: A Randomized Controlled bleeding, and facilitates excretion of wastes containing Clinical Trial [GMJ. 2015; 4(1):26-32] prostaglandin which causes contraction. Isometric 5. E Alvin, P & F Litt, I. (1982). Current status of exercises activate constant muscles which are of A-delta etiology and management of dysmenorrhea in type and C fibres and reduce pain via inhibitory effects on dolescents. 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