Effects of Kinesiotaping With and Without Pelvic Tilts On Pain and Menstrual Distress in Females With Dysmenorrhea-Merged

EFFECTS OF KINESIOTAPING WITH AND
WITHOUT PELVIC TILTS ON PAIN AND

MENSTRUAL DISTRESS IN FEMALES WITH
DYSMENORRHEA
NameofStudent:IZZAWAHEED
Registration Number: --------------
InPartialFulfillmentofRequirementsfortheAwardof Degreeof
Master of Science in Physical Therapy (Women’s Health)
RiphahCollegeofRehabilitation&AlliedHealth
Sciences
RIPHAH
INTERNATIONAL
UNIVERSITYLAHORE
I
RIPHAH INTERNATIONALUNIVERSITY
ACADEMICPROGRESSREPORT
As on
FortheperiodfromOctober2020toJune2022
1. PersonalInformationofScholar:
Name: IzzaWaheed
RegistrationNo.:
Program: MS-WHPT
Faculty/Department:
Email: [email protected]
2. AcademicProgress:
AdmissionDate: Sep 2020

StatusofCoursework
(Credit hours
completed and
remaining):
ExpectedDateof June2022
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ResearchWork:
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each semester):
3. ResearchTopic:
Topicof Research: Effectsofkinesiotapingwithandwithoutpelvictiltsonpain and
menstrualdistressinfemaleswithdysmenorrhea
DateofApproval 5thNov, 2021
Nameof Supervisor Dr.GhulamFatima
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Supervisor(ifany):
II
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Work
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Unemployed
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title,andstatus—i.e.,
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otherwise)
Please Note: The scholars under HEC Indigenous 5000 Fellowship Program shall not
undertakeanyemploymentwhetherpaidorotherwiseatanystageduringtheircourseof study of the
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6. Overallprogress:(pleasetickonlyone)
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Verified/Certifiedby Countersignedby
Supervisor HODPhysical Therapy
Dr.GhulamFatima Prof.DrMuhammadSalmanBashir
Name: Name:
Signature: Signature:
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III
Author’sDeclaration
I,IzzaWaheedherebystatethatmyMSthesis titled,
Effects of Kinesiotaping with and without pelvic tilts on Pain and

Menstrualdistress in females with dysmenorrhea,is my own work and has not
been submitted previously by me for taking any degree from this university
RiphahInternational University, Lahore,or anywhere else in the country/world.
At any time if my statement is found to be incorrect even after my Graduation the

university has the right to withdraw my MS degree.
NameofStudent:IzzaWaheed
Date:
IV
PlagiarismUndertaking
I solemnly declare that research work present in the thesis titled “Effects of Kinesiotaping
withand without pelvic tilts on Pain and Menstrual distress in females with dysmenorrhea”
is solely my research work with no significant contribution from any other person. Small
contribution/help wherever taken has been dulyacknowledged and that complete thesis has been
written by me.
I understand the zero tolerance policy of the HEC and University Riphah
InternationalUniversity,Lahoretowardplagiarism.Therefore,IasanAuthoroftheabovetitledthesis
declare that “no portion of my thesis has been plagiarized and any material used as reference is
properly referred/cited”.
IunderstandthatifIamfoundguiltyofanyformalplagiarismintheabovetitledthesisevenafter award of
MS degree, the University reserves the rights to withdraw/revoke my MS degree and HEC and
the University has the right to publish my name on the HEC/University Website on which names
of the students are placed who submitted plagiarized thesis.
Student/AuthorSignature:
Name: Izza Waheed
V
ACKNOWLEDGEMENTS
IamoverwhelmedinallhumblenesstoexpressextremegratitudeinalldepthtotheHighestbeing, Allah
Almightywho has bestowed immense blessings on me. Allah Almightyalone is worthyof
allpraise.Heguidedmythroughouttheprojectandinstalledbrilliantideasinmymindtocomplete this
project titled “Effects of Kinesiotaping with and without pelvic tilts on Pain and Menstrual
Distress in females with dysmenorrhea”.
Second, I would like to acknowledge with extreme thanks the patronage, loving inspiration and
timely guidance which I have received from my supervisor Dr. Ghulam Fatima. I would like to
convey my heartfelt appreciation and gratefulness to her for providing me the wonderful
opportunity to work on this very project. She has been a source of constant guidance the project.
Her willingness to share her vast knowledge and constructive criticism was my source of
inspiration throughout the project.
I am highly indebted to my parents for their unconditional support emotionally and financially.
My parents owe the entire credit in myself proudly completing Masters of Science in Women
HealthPhysicalTherapy.Theybelievedinmeandmypassion.Anunshakeableandwholehearted
thankstomyparentsforinvestingzealandzestinmymindtoencounterlifehappenings.Iexpress deep
gratitude to myparents forteachingme that lifeis all about growth, happiness and struggle. I
would also like to extend my gratitude towards mysiblings for their outright support during all
times of life.
VI
DECLARATION
Dedicated to my creator, Allah Almighty & my exceptional parents

Whosetremendoussupportandcooperationledmetothecompletionof This
extremely brilliant project
VII
SIGNATURES
Title:EFFECTSOFKINESIOTAPINGWITHANDWITHOUT
PELVIC TILTS ON PAIN AND MENSTRUAL DISTRESS IN
FEMALES WITH DYSMENORRHEA
Name of Student: IZZA WAHEED
RegistrationNo:------------------------------------
1. Dr.GhulamFatima(Supervisor)
2. Dr. (Internal)
DefenseCommittee(Name&Signatures)
1. Dr. (Supervisor)
2. Dr. (External)
3. . Dr. (Internal)
VIII
SUPERVISOR’SCERTIFICATE
ItisherebycertifiedthatthesisisbasedontheresultsofworkcarriedoutbyIzzaWaheedandthat it has not

been previously presented for Master of Science in Women’s Health Physical Therapy
Degree.Miss. Izza Waheed has done this research work under my supervision. He has fulfilled all
the requirements and is qualified to submit the accompanying thesis for the degree of Doctor of
Physical Therapy.
NameofStudent:IzzaWaheed Signature:
Date:
Supervisor’sName:Dr.GhulamFatima
Signature:
Date:
IX
ABSTRACT
Background
Dysmenorrheaisaconditiondescribedaschroniccrampingpainassociatedwithmenstrualcycle.
Dysmenorrhea is categorized as being primary (absence of pelvic pathology) and secondary
(presence of pelvic pathologies i.e. endometriosis, fibroids and ovarian cysts). Various treatment
strategies exist to cope with this treatment i.e., pharmacological interventions and exercise. Two
most commonly used treatment approaches are active stretching and application of kinesiotape.
KT is believed to alleviate symptoms of dysmenorrhea through neural and muscular stimulation.
Activestretchingofpelvicareai.e.pelvictiltsisthoughttobringpelvicregioninproperalignment and
contribute to lessen dysmenorrhea symptoms
Objective
The main aim of study was to investigate effects of KT with and without pelvic tilts on pain and
menstrual distress in females with dysmenorrhea
Methods
The study was a randomized controlled trial conducted in University of Sialkot, Kashmir road
CampusSialkot.Thestudydurationwas6months.Thestudyincluded30participants.Participants were
equally divided and randomly allocated to two groups; Group A (KT with pelvic tilts) & Group
B (KT without pelvic tilts). Pre-intervention data was collected through NPRS, WaLIDD tool &
MDQ in the first menstrual cycle. Interventions were carried for the next two consecutive
menstrual cycles. Post-intervention data was collected in the fourth menstrual cycle.
Results
NPRS score Between group analysis via Independent Samples T-test of group A and group B
shows pre-treatment p-value as 0.393 and 0.453 respectively. Both groups A and B exhibited
decreased p-value post-treatment to 0.000 and 0.002 respectively. Moreover, MDQ score Between
group analysis via Mann-Whitney Testpost-treatment of both group A and Bhadp-
value<0.05forallsymptomsi.e.pain,concentration,behavioralchanges,autonomicreactions,waterrete
ntion,negativeeffect, arousal and control
Conclusion
X
BothgroupA(KTwithpelvictilts)andgroupB(KTwithoutpelvictilts)exhibitedimprovements
XI
in NPRS and MDQ post-treatment. However, group A whose participants were given KT in
combination with pelvic tilts exhibited significantly greater improvements in NPRS and MDQ
score than group B
Keywords
Activestretching,Kinesiotape,Painfulmenstruation,Menstrualpain
XII
TABLEOF CONTENTS
Contents
EFFECTS OF KINESIOTAPING WITH AND WITHOUT PELVIC TILTS ON PAIN AND
MENSTRUALDISTRESSINFEMALESWITH DYSMENORRHEA........................................I
ACADEMICPROGRESSREPORT....................................................................................................II
AUTHOR’S DECLARATION.........................................................................................................IV
SIGNATURES................................................................................................................................VIII
SUPERVISOR’SCERTIFICATE......................................................................................................IX
ABSTRACT.......................................................................................................................................X
TABLEOF CONTENTS............................................................................................................XVII
LIST OF FIGURES……………………………………………………………………………XIV
LIST OF TABLES………………………………………………………………………………XV
LIST OF ABBREVIATIONS…………………………………………………………………..XVI
1. INTRODUCTION..................................................................................................................1
2. LITERATUREREVIEW.......................................................................................................4
3. MATERIAL&METHODS:...................................................................................................9
3.1 STUDYDESIGN..........................................................................................................................9
3.2 SETTING.....................................................................................................................................9
3.3 DURATIONOFTHESTUDY.......................................................................................................9
3.4 SAMPLESIZE.............................................................................................................................9
3.5 STUDYGROUPS......................................................................................................................10
3.6 SAMPLINGTECHNIQUE........................................................................................................10
3.7 SAMPLESELECTION..............................................................................................................10
3.7.1 INCLUSIONCRITERIA.....................................................................................................10
3.7.2 EXCLUSIONCRITERIA....................................................................................................10
3.8 RANDOMIZATIONMETHOD:...............................................................................................11
3.9 TREATMENTAPPROACH......................................................................................................11
3.9.1 Pre-interventionapproach:...................................................................................................11
3.9.2 Intervention:........................................................................................................................11
3.9.3 GroupA Interventions:........................................................................................................11
3.9.4 GroupB Interventions:.........................................................................................................12
XIII
3.9.5 Post-interventionapproach:.................................................................................................12
3.10 DATACOLLECTIONTOOL...................................................................................................13
3.10.1 NumericPainRatingScale(NPRS):.....................................................................................13
3.10.2 WaLIDDTool:...................................................................................................................13
3.10.3 MenstrualDistressQuestionnaire(MDQ):..........................................................................13
3.11 DATACOLLECTIONPROCEDURE:.....................................................................................14
3.11.1 CONSORTFLOWCHART...............................................................................................14
3.12 DATAANALYSISPROCEDURE:..........................................................................................15
4. RESULTS..............................................................................................................................16
5. DISCUSSION:.......................................................................................................................37
6. CONCLUSION.....................................................................................................................40
7. LIMITATIONSOFTHESTUDY:........................................................................................41
8. RECOMMENDATIONS:....................................................................................................42
9. REFERENCES:....................................................................................................................43
ANNEXUREI:ENGLISHCONSENTFORM..............................................................................48
ANNEXUREII:URDUCONSENTFORM...................................................................................49
ANNEXUREIII:NUMERICPAINRATING SCALE.................................................................50
ANNEXURE V:WALIDDTOOL.................................................................................................51
ANNEXUREV:MENSTRUALDISTRESSQUESTIONNAIRE(MDQ)...................................52
XIV
LISTOFFIGURES
Figure4.3SOCIOECONOMICSTATUS…………………………...18
Figure4.4MARITALSTATUS………………………………….….19
Figure4.5REGULARITYOFMENSTRUALCYCLE………….....20
Figure4.6LIFESTYLE……………………………………………...21
Figure4.7PAINLOCATION……………………………………….22
Figure4.8PAINCHARACTER…………………………………….23
Figure4.9FIRSTEXPERIENCEOFPAIN………………………...24
Figure4.10PAININITIATION…………………………………….25
Figure4.11PAINLENGTH………………………………………...26
Figure4.12OTHEREXPERIENCES………………………………27
XV
LISTOFTABLES
Table4.1TESTOF NORMALITY…………………………………………….16
Table4.2DEMOGRAPHICDETAILS…………………………………………17
Table4.13WaLIDDBETWEENGROUPANALYSIS(MANN-WHITNEY TEST)
……………………………………………………………………………28
Table 4.14 MDQ (PRE-TREATMENT) BETWEEN GROUP ANALYSIS
(MANN-WHITNEY TEST) …………………………………………………….29
Table4.15 MDQ(PRE-TREATMENT)BETWEEN GROUPANALYSIS
Table 4.16 MDQ (POST-TREATMENT) BETWEEN GROUP ANALYSIS
Table 4.17MDQ (POST-TREATMENT) BETWEEN GROUP ANALYSIS
Table4.18 NPRS BETWEEN GROUP ANALYSIS
(INDEPENDENT SAMPLES T-TEST) ……………………33
Table 4.19 WaLIDDWITHINGROUPANALYSIS
(WILCOXON SIGNED RANK TEST) ……………………34
Table 4.20NPRS WITHIN GROUP ANALYSIS (PAIRED
SAMPLE T-TEST) ………………………………………….35
Table 4.21MDQ WITHIN GROUP ANALYSIS
(WILCOXON SIGNED RANK TEST)…………………………36
XVI
LISTOFABBREVIATIONS
SERIAL ABBREVIATION DESCRIPTION
1. KT Kinesiotape
2. NPRS NumericPainRatingScale
3. MDQ MenstrualDistress
Questionnaire
4. WaLIDD Workingability,Location,
Intensity,Daysofpain,
Dysmenorrhea
5. VAS VisualAnalogueScale
XVII
Effects of kinesiotapingwithpelvictiltsonpain&menstrualdistressindysmenorrhea
1. INTRODUCTION
Dysmenorrhea is a chronic pelvic pain associated with menstrual cycle. Quite often,
dysmenorrhea is termed as cramping pain in below the umbilical region during or before
menstruation. Initial presentation of dysmenorrhea occurs at menarche and continues with
regular ovulation (1).
Theprevalenceofdysmenorrhea is as high as up to 91%in women of reproductiveagewith 2-

29% women reporting severe pain. Perceived stress is thought to aggravate the condition yet
advancing age, number of children and use of contraceptive pills inversely relates with the
condition (2). Dysmenorrhea adversely affects the physical & mental health of women
leading to absenteeism and reduced quality of life. Dysmenorrhea can either be primary or
secondary. Primary dysmenorrhea is termed as menstrual pain in the absence of pelvic
pathologyhowever,secondarydysmenorrheaindicatedpainduetofibroids,ovariancystsand
endometriosis (3).
There is some evidence that elevation or reduction in Prostaglandin levels leads to primary
dysmenorrhea. Therefore, non-steroidal anti-inflammatorydrugs (NSAIDS)arethe first line
oftreatmentoption.Thepain-relievingeffectsofNSAIDSarethoughttobeduetoinhibition of
cyclooxygenase enzyme & reduced menstrual blood volume. They also exert a direct
analgesiceffectonthecentralnervoussystem.However,Long-termuseofNSAIDShasbeen
documented to increase the risk of cardiovascular abnormalities. Therefore, alternative
treatment options such as physical activity and mild exercise have been proposed to reduce
dysmenorrhea (4).
Various treatment approaches exist to cope with dysmenorrhea. Most commonly used are
medications & Yoga. Physical therapy intervention options include TENS, IFT, hot packs,
massage,tapingand gentleexercises (5).Stretchingexerciseshave alsobeendocumented to
exert beneficial effects on pain intensity of dysmenorrhea. Stretching exercises aid to relax
musclesintension.Anumberofstretchingexerciseshavebeendocumentedinevidencesuch as
heel raise, chin touch, forward bend and much more (7).
Thereisevidencethatpelvicalignmenthasaneffectonmenstrualpainduetodysmenorrhea.
1
Kim,BaekandGoodescribedthattherewasasignificantdifferenceinpelvictorsionbetween
women with menstrual pain and women who did not have, which suggests that pelvic
alignment may have an effect on dysmenorrhea (34). This finding complies with the earlier
accountthatwithdysmenorrhea,thereisarestrictionintherangeofmotionofposteriorpelvic tilt in
relation to the legs and the spine (33). Studies have shown that women with higher
pelvictorsionhavehigherrateofdysmenorrheabecauseofspinalmalalignment,whichleads to an
imbalance in the amounts ofoxytocin and prostaglandin (34). A changein theposition of the
uterus caused by an excessive amount of prostaglandin produced could be one explanation
for the pelvic imbalance (31). Females with dysmenorrhea may be able to
minimizetheirpainiftheirspinalalignmentisrestoredtonormal.Itisthoughtthatcutaneous
sensations elicited by spinal segment motion, such as that experienced with pelvic tilts, can
cause changes in the activity of the internal organs, so alleviating dysmenorrhea (32).
One of the most commonly recommended treatment option is kinesiotaping as tape

attachmentcausesmusclecontractionandenhancedbloodcirculationtoreducepainintensity.
Kinesiotaping provides support and stability to the joints and muscles without affecting
circulationandrangeofmotion.Theelastictapehelpsthesurroundingmusculatureandother
tissuestofunctionefficientlybiomechanicallythroughtheactivationoftheneurologicaland
circulatory systems. Moreover, tape attachment blocks pain sensations via counter-irritant
effect (6).
Posterior pelvic tilts combined with tape can aid in the correction of a pelvic imbalance and
inappropriate restriction of mobility of the lumbosacral vertebrae, which is caused by
increased bodily fluids within the pelvis, as well as uterine contractions that intensify
menstruation pain.
Primary dysmenorrhea is a condition effecting life of young females frequently. Many

femalesrelyonpharmacologicalinterventionstoencounterthecondition.Asheerneedexists
toidentifyalternativeapproachestomanagetheconditionofdysmenorrhea.Accordingtothe
researcher’s knowledge, preliminary evidence is available to document the effect of
kinesiotape on dysmenorrhea. This study aims to determine the effectiveness of kinesiotape
with & without pelvic tilts on pain intensity & menstrual distress in females with
dysmenorrhea.Thestudyfindingswillhelptoestablishbetternon-pharmacological
2
approachestocopewiththepain&distressin menstruation.
3
2. LITERATUREREVIEW
The effectiveness of kinesiotaping has already been described in various studies. Patel and
Dhupkar conducted an experimental study to compare the effect of only kinesiotaping and
kinesiotapig with pelvic tilts on primary dysmenorrhea. Their study included 42 nulliparous
unmarriedwomanofagegroup18-30.Subjectswererandomlydividedintwogroups.Group A
received taping alone while Group B received taping & pelvic tilt exercises. They concluded
that taping had immediate effects only while taping with pelvic tilts exerted positive effects
both immediately and in the next menstrual cycle (8).
Koo et al. conducted a case study to discover effects of kinematic taping therapy on
dysmenorrhea. A 25-year-old women with no history of allergic reactions to tape was
selected. The studyfound beneficial effects of kinematic taping therapyapplication on pain,
menstrual distress and Prostaglandins (9).
Roozbahani and Najad conducted a quasi-experimental study to compare the effects of
stretching exercises & kinesiotaping. Thirty female high school students were selected and
dividedintothreegroups.Firstgroupreceivedstretchingexerciseinterventions,secondgroup was
given kinesiotape application and third group was not given any intervention. They
concluded that kinesiotaping had better effects than stretching exercises in reducing the
cramping pain of dysmenorrhea however, stretching exercises were more useful in terms of
increase in range of motion (10).
Jerdy-S.S et al. conducted an experimental study to assess effect of one term of stretching
exercises on primary dysmenorrhea of high school girls. 179 single girls were recruited and
divided into groups. The intervention group was requested to complete session of stretching
exercises for 8 weeks. Theyconcluded that stretchingexercises arebeneficial to reduce pain
intensity, pain duration and amount of painkillers used during primary dysmenorrhea (11).
Barati et al. carried out a semi-experimental study to compare the effects of stretching
exercises and combination of massage-stretching exercises on primary dysmenorrhea. 90
students were recruited for the study and divided into three groups to practice the protocol.
According to their results, stretching exercises & massage-stretching combination is equally
effective as other noninvasive methods (12).
VaziriF.etal.conductedarandomizedclinicaltrialtocomparetheeffectsofaerobicand
4
stretchingexercisesonseverityofprimardysmenorrhea.105participantswererecruitedand
divided into three groups. One group received aerobic exercise program, second group
received stretching exercise program while third group received no exercise program. The
studydiscoveredthatbothaerobicandstretchingexerciseprogramswereequallyeffectivein
reducing the pain intensity of dysmenorrhea however, women opted for one intervention
based on their lifestyle and interest (13).
Gamit S.K et al. conducted a quasi-experimental study to demonstrate effects of stretching
exercise on primary dysmenorrhea. 30 participants diagnosed with primary dysmenorrhea
weredividedintotwo groups.Group Areceived stretchingexercise programwhile Group B
received no exercise program. The study concluded that stretching exercises are effective in
reducing the pain associated with dysmenorrhea (14).
Arshad S. et al. conducted a survery-based quasi experimental study to demonstrate and
comparetheeffectivenessoftapingtechnique &hydrotherapyonprimarydysmenorrhea.50
menstruating women were randomly divided into two groups. The study discovered that
taping technique was more effective than hydrotherapy technique in reducing the pain
intensity of primary dysmenorrhea (15).
GuruprasadP.etal.conductedanexperimentalstudytoshowtheimmediateeffectsofYoga
postures versus physiotherapyexercises with K-tapingon pain in dysmenorrhea. 30 subjects
were divided into two groups. The study concluded that yogic postures and physiotherapy
exercises with K-taping were both effective in immediate reduction of pain associated with
primary dysmenorrhea (16).
Gil-M E. et al. conducted a pilot study to demonstrate and compare the effectiveness of
kinesiotaping and auricular acupressure on primary dysmenorrhea. 114 participants were
randomlyallocatedtoakinesio-tapegroup,placebokinesio-tapegroup,auricularacupressure
group & auricular acupressure placebo group. The study concluded that both interventions
wereeffectiveinreducingthepainintensityofprimarydysmenorrheahowever,theresultsof
auricular acupressure were observed to last longer (17).
Toprak Celenay, Kavalci, Karakus and Alkan investigated the effects of kinesiotaping on
pain, anxiety, and menstrual complaints in women with primarydysmenorrhea. The authors
randomized 51 women with primarydysmenorrhea into three groups, namelykinesiotaping,
shamtaping,andcontrol,andfoundoutthatkinesiotapinghadbeneficialeffectsonthese
5
areas. Specifically, kinesiotaping application was found to have greater effects on the stated
parameters (e.g. pain intensity and anxiety levels) when compared to the control and sham
taping.Additionally,therewerelowerreportsoflowbackpain,abdominalswelling,fatigue,
nausea, insomnia, nervousness, and depression in the subjects who received kinesiotaping
than in the other two groups. The reduction in menstrual complaints was found to be greater
inthekinesiotapinggroupthaninthecontrolandshamtapinggroups.Ofthesepositiveresults
fromkinesiotaping,however,theauthorsfailedtodescribedegreesofpelvictilt,iftherewere (22).
Doğan, Eroğlu and Akbayrak comparatively examined the effects of kinesiotaping and
lifestyle changes and lifestyle changes alone on pain, body awareness, and quality of life in
women with primary dysmenorrhea, and found out that although there were positive results
seen in both groups, reduction in pain severity and improvements in body awareness and
quality of life was greater in the group that received both types of interventions. However,
there was no description of the amount of pelvic tilt mentioned (23).
Bhosale, Golhar and Shende studied the effect of kinesiotaping on pain in women with
primarydysmenorrheaandmeasuredtheoutcomeusingtheVisualAnalogueScale.Thetrial
included40womenwithprimarydysmenorrheawhoreceivedkinesiotaping,whichafforded the
subjects a significant reduction in pain. The amount of pelvic tilt was not, as well,
documented. However, the kinesioptaping was described to be applied to the subjects in the
area below the navel and above the pubic hairline (24).
Lim,ParkandBaecomparedtheeffectsofkinesiotapingandspiraltapingonmenstrualpain
andpremenstrualsyndromein34unmarriedwomenwhowererandomizedintothreegroups,
including the kinesiotaping group, spiral taping group, and control group. Both the
Kinesiotapingandspiraltapinggroupsreportedareductioninmenstrualpain,butthesubjects who
received the spiral taping described additional beneficial effects on premenstrual
syndrome.Therewasnoreportontheamountofpelvictiltuponapplicationofkinesiotaping (25).
Abdelaziz, El-Kosery, Refaye and Mohamed investigated the effect of kinesiotaping on
primary dysmenorrhea in girls and compared it against pilate exercises. The study involved
60 girls with menstrual pain and discomfort.Both groups exhibited statistically significant
improvementsintheVisualAnalogueScale,qualityoflifeenjoymentandsatisfaction,
6
Menstrual Distress Questionnaire, and Spielberger questionnaire, although the pilates group
showedastatisticallysignificantimprovementoverthekinesiotapinggroup.Bothgroupshad a
considerable drop in working ability, location, intensity, days of pain, and dysmenorrhea
(WALIDD)scoreaftertreatmentcomparedtobeforetreatment,buttherewasnostatistically
significant difference between them. Also, both groups had a significant reduction in
prostaglandin levels after treatment compared to before treatment, with the pilates group
having a greater reduction than the kinesiotaping group. The authors concluded that pilate
exercisesappeared tobemoreeffectivethankinesiotapingonprimarydysmenorrheaingirls (26).
A recent study by Boguszewski et al. investigated the effectiveness of kinesiotaping on
44womenwithmenstrualpain.Thesubjectswererandomlyassignedtokinesiotaping,inelastic
taping, and control. In all groups, pain intensitywas reduced by50%, occurring 2 to 4 hours
afterapplicationingroups1and2,andafter11hoursinthecontrolgroup.Thestudy concluded that
Kinesiotaping was effective at reducing the severity of menstrual pain andlevel ofanxiety,
and whilesham taping also produced similarly, theresults werefoundtobe weaker
therapeutically. There was no information as to the amount of pelvic tilt given (27). Pazare,
Sawant and Ingale compared the effects of kinesiotaping against isometric exercises
inthetreatmentofpaininprimarydysmenorrhea.OnVASandMDQ,boththekinesiotaping and
isometric groups showed pain reduction. Kinesiotaping, on theotherhand, was foundto
besuperiortoisometricworkoutsinapost-treatmentexamination.Therewasnoinformation on the
amount of pelvic tilt that was described (28).
Roozbahani and Mahdavinajad compared the effectiveness of stretching exercises and
kinesiotaping in menstrual pain in high school students, specificallyon their effects on back
and abdominal pain and back range of motion. This study involved an operational, quasi-
experimental, and two-stage study where 30 female high school subjects were randomized
into stretching, kinesiotaping, and control groups.The authors concluded that although
Kinesiotapinghadbetter effectsinthereductionofmenstrualpain,stretchingexerciseswere found
to be better than kinesiotaping in increasing back range of motion. There was no information
on the amount of pelvic tilt upon the application of kinesiotaping (29).
Bandara, Kularathne , Brain and Weerasekara conducted a systematic review and meta-
analysisontheeffectsoftherapeutictapinginprimarydysmenorrheaanddescribedthat
7
Kinesiotapinghadfavorableeffectsonqualityoflife,andpainintensity(30).
According to the researcher’s knowledge, individual studies have been conducted to
demonstrate the effect of kinesiotaping and pelvic tilts on dysmenorrhea. However, a
combined&comparativestudyontheseinterventionsdoesnotexistinevidence.Theaimof this
study is to explore the effects of kinesiotaping with and without pelvic tilts on pain and
menstrual distress in females with dysmenorrhea.
8
Effects of Kinesiotaping withpelvictiltsonpain&menstrualdistressindysmenorrhea
3. MATERIAL&METHODS:
3.1 STUDYDESIGN
Thestudywas arandomizedcontrolled trial.
3.2 SETTING
ThestudywasconductedinUniversityofSialkot,KashmirroadCampus,Sialkot.
3.3 DURATIONOFTHESTUDY
Thestudywascompletedinsixmonthsafterapprovalofsynopsisfrom BASR.
3.4 SAMPLESIZE
A sample size of 30 was taken for this project. Sample size was calculated
usingopen epi tool.
Sample Size for Comparing Two MeansInput Data

ConfidenceInterval(2-sided)95%Power 80%
Ratio of sample size (Group 2/Group 1) 1
Group 1 Group 2 Difference*
Mean2.19 3.85 -1.66
Standarddeviation 1.13 1.06
Variance 1.2769 1.1236

SamplesizeofGroup1 12
SamplesizeofGroup2 12
Totalsamplesize 24
*Differencebetweenthemeans
ResultsfromOpenEpi,Version3,opensourcecalculator—SSMean (18).
9
3.5 STUDYGROUPS
GroupA:Kinesiotapingwithpelvic tilts
GroupB:Kinesiotapingwithoutpelvic tilts
3.6 SAMPLINGTECHNIQUE
Non-probabilityconvenientsamplingtechniquewasusedtocollectdata.
3.7 SAMPLESELECTION
3.7.1 INCLUSIONCRITERIA
1. Age18-30years
2. Nulliparous
3. Regularmenstrualcycles
4. Primarydysmenorrhea(diagnosed viaWaLIDDtool)
3.7.2 EXCLUSIONCRITERIA
5. Allergictokinesiotape
6. Skindisorders
7. Uterine fibroids
8. Endometriosis
9. PolycysticOvarianSyndrome
10
3.8 RANDOMIZATIONMETHOD:
Once the above mentioned inclusion & exclusion criteria were satisfied, potential
participants were considered. They were requested to participate in the study via
informed consent. Patients were randomlyallocated to either Group A or Group B via
random number generator.
3.9 TREATMENTAPPROACH
3.9.1 Pre-interventionapproach:
The first visit was made during the first menstrual cycle of each subject. Baseline
interventions was taken using three tools. Pain status was recorded using Numeric
PainRatingScale(NPRS).Symptomsregardingmenstrualcyclewererecordedusing
WaLIDD tool and Menstrual Distress Questionnaire (MDQ). Afterwards, the
subjects werecontacted in theirsecond and third menstrual cyclefor interventions.
3.9.2 Intervention:
Thesecondvisit&thirdvisitweremadeduringthesecond&thirdmenstrualcycleofeach
subject. Interventions were applied to each groupaccordingly.
3.9.3 GroupA Interventions:
Kinesiotape was applied to patients. Patients were instructed to inhale while tape
application. Tape was applied in vertical direction from just below the navel to pubic
region, another tape was applied over the initial tape in horizontal direction with
minimal stretch. Another tape was applied over the lumbosacral region making a V-
shape. The arms of V lied over the lumbar region while the base rested over caudal
region. Taping was maintained for at least 48 hours.In addition, patients were
instructedtoperformpelvictilts.Patientswereaskedtolieinsupinepositionwithlegs bent
and toes facing forward. Afterwards, they were instructed to pull their belly inwards
whilepushingpelvistowards the ceilingand keep hipmusclestightened. This position
was maintained for 5 seconds with 3 sets of 20 repetitions. Pelvic tilts were performed
throughout the menstrual cycle.
11
3.9.4 GroupB Interventions:
Kinesiotape was applied to patients. Patients were instructed to inhale while tape
application. Tape was applied in vertical direction from just below the navel to pubic
region, another tape was applied over the initial tape in horizontal direction with
minimal stretch. Another tape was applied over the lumbosacral region making a V-
shape. The arms of V lied over the lumbar region while the base rested over caudal
region.Tapingwasmaintainedforatleast48hours.Theinterventionswereappliedfor two
consecutive menstrual cycles.
3.9.5 Post-interventionapproach:
Fourthvisitwasmadeduringfourthmenstrualcycleasafollow-uptorecordpainstatus via
Numeric Pain Rating Scale, Menstrual Distress Questionnaire & WaLIDD tool.
All participants received02 treatment sessions over a period oftwo menstrual cycles,one
treatment per cycle.
12
3.10 DATACOLLECTIONTOOL
3.10.1 NumericPainRatingScale(NPRS):
The Numeric Pain Rating Scale (NPRS) is an outcome measure that is

unidimensionalmeasureofpainintensityinadults.Itissegmentednumericversion
ofVisualAnalogueScale(VAS)inwhichrespondentsselect awholenumber from 0-10
that best reflects the intensity of their pain. (19)
3.10.2 WaLIDDTool:
WaLIDDtool was developed to diagnosedysmenorrhea and predict medical leave

in women. The tool assesses working ability, location of pain, pain intensity, days
of pain and dysmenorrhea. (20)
3.10.3 MenstrualDistressQuestionnaire(MDQ):
Menstrual Distress Questionnaire is a tool developed by Moss that measures the

severity and symptoms associated with menstruation. Kim designed a revised
version of Menstrual Distress Questionnaire to determine the type of discomfort
during menstruation wit 35 questions. (21)
13
3.11 DATACOLLECTIONPROCEDURE:
3.11.1 CONSORTFLOWCHART
14
3.12 DATAANALYSISPROCEDURE:
The data has been analyzed using SPSS for Windows software, version 21.
Statistical significance was set at P=0.05. Normality of data was checked through
Shapiro Wilk’s test. Following tests have been used:
 Descriptive Statistics: Frequency tables, pie charts, bar charts have been
used to show summary of group measurements measured overtime.
 Changes between successive visits: Change between successive visits:
Wilcoxonttestandpairedt-testhavebeenusedtoshowtheprogressoftwo groups
betweenanytwo successive visits interms of subjective and objective
measurements.
 Difference between Groups: Independent sample t test & Mann-Whitney
testhavebeenused.Thesearenon-parametricteststhatareusedtocompare two
populations at different various intervals.
15
4. RESULTS
TABLE 4.1 TEST OF NORMALITY
Shapiro-Wilk
Tool Statistic df Sig.
NPRS_1_value .929 24 .093
WaLIdD_1_vaule .773 24 .000
Table shows the result of normality test. Shapiro Wilk’s test was performed to determine the
distributionofdatainNumericPainRatingScale(NPRS)andWaLIDDtool.SincetheP-valuefor NPRS is
greater than 0.01 which means that the data is normally distributed therefore, parametric tests
wereperformed for NPRS to analyze the data. On the other hand, the P-valueforWaLIDD is less
than0.01 which means that thedatais not normallydistributed therefore, non-parametrictests were
performed to analyze the data.
16
TABLE 4.2 DEMOGRAPHIC DETAILS
Groups Minimum Maximum MeanSD
GroupA(KTtapewithpelvictilts)
Age 17 27 22.15±2.478
Weight 43 85 58.92±11.42
Height 4.11 5.70 5.21±0.41
Menarche 11 15 12.69±1.03
Avg.Durationof 3 8 5.46 ±1.66
menstrual cycle
GroupB(KTtapewithoutpelvictilts)
Age 19 24 22.18±1.60
Weight 47 80 58.54± 10.65
Height 4.11 5.70 5.12±0.46
Menarche 11 17 14.09±1.64
Avg.Durationof 5 8 6.09±1.04
menstrual cycle
In the above table, the mean age of participants in Group A was 22.15 ±2.478 with age ranging
from17-27years.MeanageofparticipantsinGroupBwas22.18±1.60withagerangingfrom19-24
years.In GroupA,meanweightofparticipantswas58.92±11.42withaweight rangeof43-85
kgs.InGroupB,mean weightofparticipantswas58.54±10.65withaweightrangeof47-80kgs. In Group
A, the mean height of participants was 5.21 ± 0.41 with minimum height being 4 feet 11 inches
while maximum height being 5 feet 70 inches. In Group B, the mean height of participants was
5.12 ± 0.46 with minimum height also being 4 feet 11 inches while maximum height being 5
feet70inches.InGroupA,themeanmenarcheofpatientswas12.69±1.03withmenarcheranging from 11-
15 years. In Group B, the mean menarche of patients was 14.09 ±1.64 with menarche
rangingfrom11-17years.InGroupA,themeanaveragedurationofmenstrualcyclewas5.46±
1.66 with the range of 3-8 days for average duration of menstrual cycle. In Group B, the mean
averagedurationofmenstrualcyclewas6.09±1.04withtherangeof5-8daysforaverageduration of
menstrual cycle
17
FIGURE 4.3 SOCIOECONOMIC STATUS
Theclusteredbarchartdepicts showsthesocioeconomicstatus ofGroup A&Group B.Out of13

participants in Group A, 11 participants (84.6 %) belonged to middle socioeconomic status while
both categories of low and high socioeconomic status had 1 participant (7.7%) each. In Group B,
all 11 participants (100%) belonged to middle socioeconomic status.
18
FIGURE 4.4 MARITAL STATUS
Bar chart shows the marital status of participants in both groups. In Group A, 10 participants
(76.9%) were single while 3 participants (23.1%) were married. In Group B, all 11 participants
(100%) were married.
19
FIGURE
FIGURE 4.5 4.5 REGULARITY
REGULARITY OFOF MENSTRUALCYCLE
MENSTRUAL CYCLE
The clustered bar chart expresses information regarding the regularity of menstrual cycle in both
groups. 13 participants (100%) in Group A marked ‘yes’ regarding regularity of menstrual cycle
and 11 participants (100%) in Group B also marked ‘yes’ regarding regularity of menstrual cycle.
20
FIGURE 4.6 LIFESTYLE
Theclusteredbarchartrevealsinformationregardingthelifestyleofparticipantsinbothgroups.In Group
A, 4 participants (30.8%) had sedentary lifestyle while 9 participants (69.2%) had active lifestyle.
In Group B, 4 participants (36.4%) had sedentary lifestyle while 7 participants (63.6%) had active
lifestyle.
21
FIGURE 4.7 PAIN LOCATION
The clustered bar chart provides information regarding the pain location in both groups. In Group
A, 2 participants (15.4%) experienced pain in each area of lower back, right side of abdomen &
lower abdomen+backache+left side. 3 participants (23.1%) experienced pain in lower
abdomen+backacheonly.4participants(30.8%)experiencedpaininlowerabdomenonly.InGroup B, 1
participant (9.1%) experienced pain in each area of lower abdomen and lower back. 9 participants
(81.8%) experienced pain in lower abdomen+backache.
22
FIGURE 4.8 PAIN CHARACTER

Theclusteredbarchart providesinformationregardingthepaincharacterin bothgroups. InGroup A, 2
participants (15.4%) described their pain as sharp, stinging, twisting and twisting+stinging+sharp
each. 1 participant (7.7%) described their pain as twisting+stinging & stinging+sharp each while 3
participants (23.1%) described their pain as twisting+sharp. In Group B,1participant
(9.1%)describedtheirpainasstinging,twistingandstinging+sharp.3participants (27.3%) described
their pain as sharp while 5 participants (45.5%) described their pain as twisting+sharp.
23
FIGURE 4.9 FIRST EXPERIENCE OF PAIN

The clustered bar chart provides information regarding the first experience of pain in both groups.
In Group A, 2 participants (15.4%) experienced their first pain after 1 year. 4 participants (30.8%)
relatedtheirfirstexperienceofpaintoothercategorywhile7participants(53.8%)experiencedpain since
first period. In Group B, 2 participants (18.2%) related their first experience of pain to other
category.3participants(27.3%)experiencedtheirfirstpainafter1yearwhile6participants(54.5%)
experienced pain since first period.
24
FIGURE 4.10 PAIN INITIATION

F
Theclusteredbarchartprovidesinformationregardingpaininitiationinbothgroups.InGroupA,
1 participant (7.7%) experienced pain initiation on first/second day. 5 participants (38.5%)
experienced pain before period commencement while 7 participants (53.8%) experienced pain on
firstday. InGroupB,3 participants(27.3%)experiencedpainbeforeperiodcommencementwhile 4
participants (36.4%) documented pain initiation on first day and first/second day each.
25
FIGURE 4.11 PAIN LENGTH
The clustered bar chart reveals information regarding pain length in both groups. In Group A, 2
participants (15.4%) described 1-day pain length. 3 participants (23.1%) described 2-3 days and
entireperiodpainlengtheachwhile5participants(38.5%)described1-2-daypainlength.InGroup B, 2
participants (18.2%) described 1-2day pain length. 3 participants (27.3%) described 1-day pain
length while 6 participants (54.5%) described pain length spanning over entire period.
26
FIGURE 4.12 OTHER EXPERIENCES
Theclustered barchart provides information regardingother experiences in both groups. In Group

A, 1 participant (7.7%) described loss of appetite & general tiredness as other experiences each. 2
participants(15.4%)describedinsomniaasotherexperiencewhile6participants(46.2%)described
mood swings as other experiences. In Group B, 1 participant (9.1%) described headache,
nausea/vomiting and loss of appetite as other experiences each. 3 participants (27.3%) described
general tiredness as other experience while5 participants (45.5%) described mood swings as other
experience.
27
TABLE 4.13 WaLIDD B/W GROUPS ANALYSIS (Mann-Whitney Test)
Groups N Mean Median Z score P-value

Rank
GroupA(KTtape 13 11.42 11.000 -.848 0.396
withpelvictilts)
WaLIDD_1 Group B (KT tape
(pre- withoutpelvictilts) 11 13.77 11.000 -.848 0.396
treatment)
Total
24 11.000
GroupA(KTtape 0.000
with pelvic tilts) 13 7.00 5.000 -4.183
WaLIDD_2
Group B (KT tape
(post- 11 19.00 9.000
withoutpelvictilts)
treatment)
Total
24 6.000 -4.183 0.000
Table provides information regarding between group analysis of WaLIDD scores. Independent
sampleMann-WhitneyTestwasapplied.MeanrankofWaLIDD_1(pre-treatment)forgroupAand group
B was 11.42 and 13.77 respectively. Median of WaLIDD_1 (pre-treatment) for both groups A and
B was 11.000. Z-scoreof WaLIDD_1 (pre-treatment) for both groups was -.848. P-value of
WaLIDD_1(pre-treatment)was0.396.MeanrankofWaLIDD_2(post-treatment)forgroupAand group
B was 7.00 and 19.00 respectively. Median of WaLIDD_2 (post-treatment) for group A &
groupBwas5.00&9.00respectively.Z-scoreofWaLIDD_2(post-treatment)forbothgroupswas
-4.183. P-value of WaLIDD_2 (post-treatment) for both groups was 0.000. There is a significant
differencebetweenWaLIDDscoreP-valueofpre-treatmentandpost-treatmentbeing0.396and
0.000respectivelyinbothgroups.SincetheP-valueislessthan0.05,henceitprovesthattreatment
significantly improved WaLIDD scores across both group A and group B.
28
TABLE 4.14 MDQ B/W GROUP ANALYSIS (Mann-Whitney Test, Pre-treatment Scores)
Groups N Mean Median Z P-

Rank score value
GroupA 13 14.15 4.00 -1.581 .114
MDQ1_pain GroupB 11 10.55 4.00 -1.581 .114
GroupA 13 15.08 2.00 -2.065 .039
MDQ1_ GroupB 11 9.45 2.00 -2.065 .039
concentration
MDQ1_ GroupA 13 17.31 3.00 -3.845 .000

Behavioral GroupB 11 6.82 2.00 -3.845 .000
Changes
MDQ1_autonomic GroupA 13 16.12 3.00 -2.939 .003

reactions GroupB 11 8.23 2.00 -2.939 .003
Table provides information regarding between group analysis of MDQ1 (pre-treatment) scores.
Mann-Whitney test was applied. The P-values of MDQ1_pain, MDQ1_concentration,
MDQ1_behavioralchanges,MDQ1_autonomicreaction in both groupsA and Bwere0.114, 0.039,
0.00, 0.003.
29
TABLE 4.15 MDQ B/W GROUP ANALYSIS (Mann-Whitney Test, Pre-Treatment Scores)
Groups N Mean Groups N Mean Groups
MDQ1_water GroupA 13 13.54 1.00 -.863 .388
retention GroupB 11 11.27 .00 -.863 .388
MDQ1_negative GroupA 13 16.00 3.00 -2.689 .007

effect GroupB 11 8.36 1.00 -2.689 .007
MDQ1_arousal GroupA 13 15.04 3.00 -1.972 .049

GroupB 11 9.50 1.00 -1.972 .049
MDQ1_control GroupA 13 15.35 3.00 -2.232 .026

GroupB 11 9.14 2.00 -2.232 .026
Table provides information regarding between group analysis of MDQ1 (pre-treatment) scores. Mann-
Whitney test was applied. The P-values of MDQ1_waterretention,MDQ1_negative effect,
MDQ1_arousal and MDQ1_control in both groupsA and Bwere0.388, 0.007, 0.049 and 0.26.
30
TABLE 4.16 NPRS B/W GROUP ANALYSIS (Mann-Whitney Test, Post-treatment Scores)
Groups N Mean Median Z P-

Rank score value
GroupA 13 7.73 2.00 -3.847 .000
MDQ2_pain GroupB 11 18.14 3.00 -3.847 .000
GroupA 13 11.00
MDQ2_ GroupB 11 14.27 1.00 -1.204 .002
concentration 1.00 -1.204 .002
MDQ2_ GroupA 13 12.12 1.00 -.321 .001

Behavioral GroupB 11 12.95 1.00 -.321 .001
Changes
MDQ2_autonomic GroupA 13 10.96 1.00 -1.223 .000

reactions GroupB 11 14.32 1.00 -1.223 .000
Table provides information regarding between group analysis of MDQ2 (post-treatment) scores.
Mann-Whitney test was applied. The P-values of MDQ2_pain, MDQ2_concentration,
MDQ2_behavioralchanges,MDQ2_autonomicreaction
inbothgroupsAandBwere0.001,0.002,0.001,0.000. Since all P-values are less than 0.05 hence, it
proves that treatment significantly improved MDQ scores in both groups.
31
TABLE 4.17 MDQ B/W GROUP ANALYSIS (Mann-Whitney Test, Post-treatment Scores)
MDQ2_water GroupA 13 13.54 1.00 -.863 .001

retention GroupB 11 11.27 1.00 -.863 .001
MDQ2_negative GroupA 13 13.23 1.00 -.597 .000

effect GroupB 11 11.64 1.00 -.597 .000
MDQ2_arousal GroupA 13 12.19 1.00 -.245 .008

GroupB 11 12.86 1.00 -.245 .008
MDQ2_control GroupA 13 10.81 1.00 -1.362 .006

GroupB 11 14.50 1.00 -1.362 .006
Table provides information regarding between group analysis of MDQ2 (post-treatment) scores.
Mann-Whitney test was applied. The P-values of MDQ2_waterretention,MDQ2_negative
effect,MDQ2_arousalandMDQ2_controlinbothgroupsAandBwere0.001, 0.000, 0.008 and 0.006.
Since all P-values are less than 0.05 hence, it proves that treatment significantly improved MDQ
scores in both groups.
32
TABLE 4.18 NPRS WITHIN GROUP ANALYSIS (INDEPENDENT SAMPLES T-TEST)
GROUPS N NPRS1 NPRS2

(PRE-TREATMENT) (POST-TREATMENT)
Mean±Std. P-value Mean±Std. P-value
Deviation Deviation
13 6.3077 ± 3.301 0.453 2.769 ± 1.480 0.00
GROUP A
GROUP B 11 7.000 ± 1.183 0.393 3.634 ± 1.206 0.002
Table provides information regarding between group analysis of NPRS scores. Independent
Samples T-test was applied. Mean ± Std. Deviation of both groups A and B in NPRS_1 (pre-
treatment) were 6.3077 ± 3.301 and 7.000 ±1.183 respectively. The P-value of both groups A and
B in NPRS_1 (pre-treatment) was 0.453 and 0.393 respectively. Mean ± Std. Deviation of both
groups A and B in NPRS_2 (post-treatment) were 2.769 ± 1.480 and 3.634 ± 1.206 respectively.
TheP-value of both groups A and Bin NPRS_2 (post-treatment) was 0.00 and 0.002 respectively.
SincetheP-valuesforbothgroups(NPRS_2,post-treatment)arelessthan0.05hence,itprovesthat
treatment significantly improved NPRS scores of both groups.
33
TABLE 4.19 MDQ WITHIN GROUP ANALYSIS (WILCOXON SIGNED RANK TEST)
Median
GroupA(N=13) GroupB(N=11)
WaLIDD_1 7.000 8.000
WaLIDD_2 1.000 2.000
Meanrank P-value Mean P-value
rank
WaLIDD_1 28.60 .0396 23.20 .030
WaLIDD_2 13.22 0.000 11.10 0.00
Table provides information regarding within group analysis of WaLIDD score in both groups.
Wilcoxon signed rank test was applied. The median of WaLIDD_1 (pre-treatment) in both groups
A and B was 7.000 and 8.000 respectively. The mean rank value of WaLIDD_1 (pre-treatment) in
bothgroupsAandBwas28.60and23.20respectively.TheP-valueofWaLIDD_1(pre-treatment)
inbothgroupsAandBwas.0396and.030respectively.ThemedianofWaLIDD_2(pre-treatment)
inbothgroupsAandBwas1.000and2.000respectively.ThemeanrankvalueofWaLIDD_2(pre-
treatment) in both groups A and B was 13.22 and 11.10 respectively. The P-value of WaLIDD_2
(pre-treatment)inbothgroupsAandBwas0.000.SincetheP-valueislessthan0.05inbothgroups
(WaLIDD_2,post-treatment)hence,itprovesthattreatmentsignificantlyimprovedWaLIDDscores
within each group.
34
TABLE 4.20 NPRS WITHIN GROUP ANALYSIS (PAIRED SAMPLE T-TEST)
GROUPS NPRS1 NPRS2

(PRE-TREATMENT) (POST-TREATMENT)
Mean±Std. Mean P-value Mean±Std. Mean P-value
Deviation rank Deviation rank
GROUP A 6.3077 ± 3.301 29.64 0.20 2.769 ± 1.480 15.02 0.00
(N=13)
GROUP B 7.000 ± 1.183 25.3 0.35 3.634 ± 1.206 13.31 0.01
(N=11)
Table provides information regarding within group analysis of NPRS score in both groups. Paired
t-testwasapplied.ThemeanofNPRS_1(pre-treatment)inbothgroupsAandBwas6.3077±3.301 and
7.000 ± 1.183 respectively. Themean rank value of NPRS_1 (pre-treatment) in both groups A and
B was 29.64 and 25.3 respectively. The P-value of NPRS_1 (pre-treatment) in both groups A
andBwas0.20and0.35 respectively.ThemeanofNPRS_2(post-treatment)inbothgroupsAand B was
2.7692 ± 1.480 and 3.636 ± 1.206 respectively. The mean rank value of NPRS_2 (pre-
treatment)inbothgroupsAandBwas15.02and13.31respectively.TheP-valueofNPRS_2(post-
treatment)inbothgroupsAandBwas0.000and0.01respectively.SincetheP-valueislessthan
0.05inbothgroups(NPRS_2,post-treatment)hence,itprovesthattreatmentsignificantlyimproved
NPRS scores within each group.
35
TABLE 4.21 MDQ WITHIN GROUP ANALYSIS
Median
GroupA(N=13) GroupB (N=11)
MDQ1_pain 4.00 2.00
MDQ1_concentration 2.00 2.00
MDQ1_behavioralchanges 3.00 1.00
MDQ1_autonomicreaction 3.00 1.00
MDQ1_waterretention 5.00 5.00
MDQ1_negativeeffect 2.00 1.00
MDQ1_arousal 2.50 1.00
MDQ1_control 3.00 3.00
Meanrank P-value Mean P-value
rank
MDQ2_pain 10.0 0.00 10.0 0.00
MDQ2_concentration 10.5 0.001 10.2 0.00
MDQ2_behavioralchanges 0.00 0.00 0.00 0.00
MDQ2_autonomicreaction 7.00 0.00 4.00 0.00
MDQ2_waterretention 5.00 0.00 5.00 0.00
MDQ2_negativeeffect 8.50 0.00 7.50 0.00
MDQ2_arousal 9.50 0.00 9.50 0.00
MDQ2_control 6.00 0.00 5.00 0.01
TableprovidesinformationregardingwithingroupanalysisofMDQscoresinbothgroupsAand
B. The P-value of MDQ2_pain, MDQ2_concentration, MDQ2_behavioral changes,
MDQ2_autonomicreactions,MDQ2_waterretention, MDQ2_negativeeffect, MDQ2_arousal and
MDQ2_controlinbothgroupsAandBwere0.00,0.001and0.00,0.00,0.00,0.00,0.00,0.00,0.00 and 0.01
respectively. Since the P-values are less than 0.05 in both groups hence, it proves that treatment
significantly improved P-values of MDQ within each group.
36
5. DISCUSSION:
This study aims to compare the effects of kinesiotaping on menstrual distress and pain severity in
women aged 18 to 30 with primary dysmenorrhea when pelvic tilts and kinesiotaping are used
through assessment of the severity of menstrual pain scale through the Numeric Pain Rating Scale
(NPRS) and Menstrual Distress Questionnaire (MDQ) before and following the intervention. The
study’s findings will contribute to developing more effective non-pharmacological coping
mechanisms for menstrual pain and distress.
One of the most typical gynecological issues is primary dysmenorrhea. It is so common that even
when their everyday activities are curtailed, females still neglect to disclose it to their primary
physicians. Female adolescents have a great deal of misunderstanding and misconceptions about
the treatment of dysmenorrhea since they are not informed about the condition or the available
treatments (36). Self-medication is a prevalent practice among adolescents with dysmenorrhea,
and albeit very few seek medical attention (41). Dysmenorrhea might make it harder for them to
go about their regular life.
According to studies, dysmenorrhea interferes with women's social and academic lives. Due to the
physical and social impairment caused by dysmenorrhea, which affects adolescent females,
sickness, absenteeism, and perceived quality of life losses are common (37). In the United States,
dysmenorrhea has been considered to be the leading cause of time missed from work and school.
Dysmenorrhea and menstrual cycle function both affect depression and/or anxiety
symptoms.Dysmenorrhea'sdetrimentalpsychologicalimpactonpsychologicalstatusmay substantially
impact women's quality of life (46).
Dysmenorrhea is more common in young and nulliparous women, and this has been observed.
Indian women reach menarche between the ages of 16 and 17, and they give birth between 18 and
35. The age range of 18 to 30 is the one in which the majority of ladies with dysmenorrhea fall.
Taping is currently being explored as a treatment option for dysmenorrhea, alongside home
remedies and traditional physiotherapeutic methods. Previous research has attempted to determine
how tape affects dysmenorrheal discomfort. Being a non-invasive procedure, taping appears to
have more compliance.
The results observed in this present study confirm the results, at least based on menstrual pain
perception, found in a previous trial about the effectiveness of kinesiotaping in conjunction with
37
pelvic tilting exercises applied to subjects with characteristics similar to the present study (6).
Patel and Dhupkar indicated that kinesiotaping with pelvic tilting effectively managed menstrual
pain symptoms immediately after application, and the effects seemed to carry over the subsequent
menstrual cycles. In that study, measurements of menstrual pain were evaluated using the Visual
Analogue Scale, and the descriptions of menstrual pain were assessed using the Menstrual
Symptom Questionnaire, in which subjects of that study demonstrated no significant effects pre-
treatment and immediately after the intervention. The VAS appears to be more confusing than
other assessment techniques, making it more prone to misunderstandings. The NPRS was
employed in the current investigation because it has demonstrated strong correlations with other
pain-assessment measures in several studies (55). Its practicability and high compliance have also
been established (56).
On the other hand, a widely used tool for assessing cyclical perimenstrual symptoms is the MDQ.
Premenstrual and menstrual symptoms are evaluated and treated using it. It describes the kinds
and degrees of symptoms women encounter at each stage of the menstrual cycle, which can help
researchers and medical professionals pinpoint the impact of therapeutic measures. While the
MDQ can discriminate between cyclical and noncyclical changes in arousal, mood, and behaviour
(58), the MSQ distinguishes between spasmodic and congestive dysmenorrhea (57).
The use of kinesiotaping alone as an effective treatment for primary dysmenorrhea has already
been described. It has demonstrated positive results in reducing pain, anxiety levels, and some
menstrual complaints in women with primary dysmenorrhea (52). This finding was seen when
kinesiotaping was compared with sham taping and a control group. In a separate study,
kinesiotaping significantly reduced pain and drug intake in patients suffering from primary
dysmenorrhea. However, the changes noted in the use of auricular acupressure tended to last
longer (54). It also effectively reduced menstrual complaints when applied across the abdominal
area of women with painful menstruation (27). Kinesiotaping also demonstrated better effects
when compared with stretching exercises in reducing pain associated with primary dysmenorrhea
(9).
A study evaluated the effects of kinesiotaping on menstrual distress, pain and prostaglandin using
its effects on the VAS and MDQ (59). All of these parameters were reduced after the intervention.
However, the study was conducted on the only lone subject.
38
In the present study, both groups reported improvement in menstrual pain perception, as indicated
in table 4.16. For group A, an NPRS changes from the mean standard deviation of 6.31 ± 3.30 to
2.77 ± 1.48 with a change of p-value from 0.45 to 0.00. Because the tape is a treatment that
directly stimulates muscles and fascia beneath the skin, it maximizes the body’s inherent healing
capacity. It corrects the equilibrium of the human body. There are three benefits of kinesiotaping:
restoration of normal muscle performance by providing assistance to weak muscles, reduction of
inflammation and pain by enhancing lymphatic and blood circulation, and improve joint range of
motion by correcting muscle fiber, myofascial, and joint misalignment (48, 49). The effects of
taping have also been attributed to increased neurofacilitation and a potential connection between
the motor unit firing of the relevant myotome and the cutaneous afferents in the area where the
tape has been applied (50). Another argument for the effectiveness of taping is the mechanical
constraint that is felt after application(39). By physically stimulating cutaneous afferents, tape
causes continual relaxation and contraction of the muscles, lowering muscular tone and reducing
discomfort (39,45). To normalize diminished muscle strength, muscularconvulsions, and tension
through homeostasis and to induce muscular equilibrium with the environment by enhancing
lymphatic circulation, taping decreases the symptoms of dysmenorrhea (35).
Strong uterine contractions, a disruption in the blood flow, and the release of the hormone
prostaglandin are the main contributors to the discomfort experienced during dysmenorrhea. A
highly innervated area of the uterus is put under pressure due to the discomfort, which is thought
to be caused by ischemia of the uterine muscles that are contracting vigorously or by hypertonicity
of the uterine isthmus. In addition, prostaglandins induce myometrial contractility, which, if too
great, results in uterine ischemia and pain (34, 40, 46). The counter-irritant effect of taping, based
on the gate control theory, describes how mechanoreceptors (A-beta fibre) are stimulated at the
site of tape application, reducing nearby menstruation pain. Additionally, tape stimulates the skin,
increasing blood flow. This rise in blood pressure results from the spine's vasomotor reflex, which
lowers the concentration of chemicals that cause pain, such as histamine and prostaglandin, in the
bloodstream, reducing discomfort.
Similar to Group A, In table 4.16 Group B's pre-treatment pain score was 7.000 ± 1.183 and
decreased to 3.634 ± 1.206 after therapy. Group B demonstrated a lower degree of pain relief than
group A. The increased impact of the pelvic tilting exercise in group A may cause this outcome.
The uterine lining experiences hormonal changes due to exercise (43). Endorphins are released
during exercise, preventing any potential reductions in endorphin levels during the luteal period.
These, in turn, increase the body's pain tolerance (47). According to studies, exercise increases
39
uterine blood flow and metabolism, reducing dysmenorrhea symptoms (44). They function as a
generalanalgesicforinstantaneouspainalleviation.Asaresult,itappearsthatwomenwhoexercise
experiencelessdysmenorrhea.Exercise-inducedreductionsinsympatheticoveractivityareanother
factor in alleviating dysmenorrheal symptoms (44).
Within-group analysis for groups A and B, pain perception was significantly reduced, with a more
significant reduction in pain in Group A. Likewise, both groups improved in their MDQ scores in
all areas assessed, with no statistically significant difference between the two groups. These
findings appeared similar to those seen in a study that evaluated the effects of taping and hot packs
on the premenstrual syndrome, where the change in MDQ scores was statistically significant (53).
In that trial, MDQ scores favoured more the group that received both kinesiotaping and hot pack
than just hot pack alone, particularly for pain perception. The study compared the effects of
kinesiotaping alone, hot packs, and kinesiotaping with hot packs.
In this present study, such findings maybe attributed to the basis for the improvements seen in
NPRS in the intergroup analysis. There are several causes for this. First, the lumbar spine could be
less stressed due to posterior pelvic tilts, which would reduce sympathetic activity and relieve
pain. Second, the interspinous ligaments are less stressed because of the posterior pelvic tilt
reduction in lumbar lordosis. Third, the erector spinae may be relaxing post-isometrically, which
would lessen pain. The fact that these activities were continued throughout the research period
may have resulted in the conditioning of these muscles, improving their functionality and lowering
pain during the next menstrual cycle. Finally, the combination of posterior pelvic tilts and tape
may have an additive effect on correcting the alignment of the spine, which may explain why there
was improved pain relief in this group.
Becauseoftheirimproperspinalalignment,studieshaverevealed that women with higher levels of
pelvic torsion experience dysmenorrhea at a higher incidence. As a result, there is an imbalance in
the levels of the chemicals prostaglandin and oxytocin (34). Incorrect movement of the
lumbosacral vertebrae caused by increased bodily fluids in the pelvis, an imbalance of the pelvis,
and contraction of the uterus that worsens menstrual discomfort can all be corrected with posterior
pelvic tilts and tape when used in conjunction. The shifting position of the uterus caused by an
excessive amount of prostaglandin secreted during pregnancy may be a cause of the pelvic
imbalance (42). It is hypothesized that discomfort could be diminished in women with
dysmenorrhea if their spinal alignment reverted to normal. It is hypothesized that spinal segment
mobility, which happens with pelvictilts, might trigger cutaneous sensations, can alter the activity
of the internal organs, and can therefore relieve dysmenorrhea (Kim, Baek and Goo, 2016).
40
The pain experienced during dysmenorrhea, referred from the abdomen, may be brought on by
tension in or inflammation of the pelvic peritoneum, the release of the hormone prostaglandin, and
a forceful contraction of the uterine musculature (34). Because the low back and lower abdomen
share dermatomes, an intervention in one of these areas may impact the other. Therefore, taping
the abdomen may also stimulate the low back muscles, enhancing the effects of taping and
posterior pelvic tilt exercises. Exercises involving the pelvic tilt are especially beneficial in
reducing lumbar pain, and tape combined with pelvic tilting exercises is a successful way to treat
low back pain in pregnant women. Similar findings were made in the current investigation, which
shows that posterior pelvic tilts and taping can both lessen dysmenorrheal pain. Due to its ability
to reduce muscular tension and improve blood flow in the area where it is applied, taping is
effective for both the congestive and spasmodic types of primary dysmenorrhea (39). Following
the use of tape, this physiological alteration may have an impact on muscle and myofascial
functions. The activation of cutaneous mechanoreceptors at the taped area caused by taping may
impact how pain is perceived.
41
6. CONCLUSION
The study concludes that both group A (Kinesiotape with pelvic tilts) and group B (Kinesiotape
without pelvic tilts) improved in terms of Numeric Pain Rating Scale (NPRS) and Menstrual
DistressQuestionnaire(MDQ)post-treatment.However,greaterimprovementswereseeninGroup
AwhoseparticipantsweregivenKinesiotapingincombinationwithpelvictilts.Therefore,wereject the
null hypothesis and accept the alternate hypothesis which states that “Kinesiotape with pelvic tilts
is more effective than kinesiotape without pelvic tilts on pain intensity and menstrual distress in
females with dysmenorrhea and vice versa”.
42
7. LIMITATIONSOFTHESTUDY:
Thestudyhad certainlimitations:
1. Smallsamplesize
2. Shorterdurationofstudy
3. Inclusionofprimarydysmenorrheaalone
43
8. RECOMMENDATIONS:
4. The study recommends researchers to conduct randomized controlled trials with larger
sample sizes in future to investigate the combined effect of Kinesiotape with other physio
therapeutic interventions to provide evidence-based strategies in order to cope with the
condition of both types of dysmenorrhea.
5. The study recommends patients of dysmenorrhea to practice pelvic tilts throughout

menstrual cycle to combat the symptoms of dysmenorrhea. Moreover, patients should also
apply kinesiotape as per study directions and maintain for at least 48 hours after the initiation
of menstrual cycle.
6. The study recommends Physical Therapist in practice to include combined intervention

strategy of kinesiotape and pelvic tilts to reap benefits of both in primary dysmenorrhea
patients. Moreover, Physical Therapists should devise evidence-based coping interventions
for secondary dysmenorrhea as well.
44
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dysmenorrhea in adolescent girls. Biomedical Human Kinetics. 2012;4(1):127-32.
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50
60.
ANNEXUREI:ENGLISHCONSENTFORM
Thestudyyouare abouttoparticipateisarandomized controltrialsurveytitledas;
“EFFECTS OF KINESIOTAPING WITH & WITHOUT PELVIC

TILTSONPAIN&MENSTRUALDISTRESSINFEMALESWITH
DYSMENORRHEA”
The study has no potential harm to participants. All data collected from you will be
coded in order to protect your identity, and should not be disclosed to anyone.
Following the study there will be no way to connect your name with your data. Your
answers to the questions will not affect the quality of education given to you. Any
additionalinformationaboutthestudyresultswillbeprovidedto youat itsconclusion, upon
your request.
Youarefreetowithdrawfromthestudyatanytime.Youagreetoparticipate,indicating that
you have read and understood the nature of the study, and that all your inquiries
concerning the activities have been answered to your satisfaction.
NAME………………. SIGNATURE………………
DATE ……………….
51
‫‪Effects of Kinesiotaping withpelvictiltsonpain&menstrualdistressindysmenorrhea‬‬
‫‪ANNEXUREII:URDUCONSENTFORM‬‬
‫کرتیہوںکہ‬
‫تصدیقکرتا‪/‬‬ ‫میں‬
‫محترمعزاوحید‬
‫نے‬
‫اپنیتحقیق‬
‫‪(EFFECTSOFKINESIOTAPINGWITH&WITHOUTPELVIC‬‬
‫‪TILTS ON PAIN & MENSTRUAL DISTRESS IN FEMALES‬‬
‫)‪WITH DYSMENORRHEA‬‬
‫زیرنگرانیڈاکٹرغالمفاطمۂ‬
‫‪،‬کے متعلق بتا دیا ہے۔ مجھے اس تحقیق کی نوعیت‪ ،‬مقاصد‪،‬‬
‫احداف‪،‬توقعات‪،‬فوائداورخطراتکےمتعلقساریمعلومات‬
‫فراہمکردیگئیہیں۔‬
‫کانام‬ ‫کےدورانساریمعلوماتصیغۃرازمیںرہیںگیاور‬ ‫تحقیق‬

‫بتادیاگیا‬ ‫صرفتحقیقکےلیےاستعمالہوںاس بھی‬ ‫اور دیگرمعلومات‬
‫کامجازہوں اوریہ‬ ‫ہےکہمیںاستحقیقسےمتعلقہمریض پوچھنے‬
‫تحقیقصرفایکگی۔مجھےیہہےبلکہبحسثیتمجموعیانسانیتکامفاد‬
‫ہرقسمکےسوال تفصیالت جاننے کےبعد یستحقیق میں شخص کمفاد میں‬
‫کا قائلنہیںہوں۔استحقیقاسسےوابسطہہے۔تمام پرکوئی‬ ‫نہیں‬
‫رضامندیسےاس‬ ‫پابندینہیںہوشاملہونےیانہہونےپرکسی اور‬
‫‪ ,‬بقائمی حوش‬‫سےکسیبھیوقتعلیحدہہونےپرمجھ گی۔ میں خودبذاتِ‬
‫وحواس‬
‫عملمیںشاملہوتی‪ /‬ہوتا ہوں۔‬ ‫تحقیقات‬
‫ی‬
‫دستخطمحقق‬
‫دستخطشرکتکار‬
‫تاریخ‬
‫‪52‬‬
ANNEXUREIII:NUMERICPAINRATING SCALE
53
Annexureiv:WALIDDTOOL
54
ANNEXUREV:MENSTRUALDISTRESSQUESTIONNAIRE(MDQ)
55
56
57
58

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EFFECTS OF KINESIOTAPING WITH AND

WITHOUT PELVIC TILTS ON PAIN AND

AdmissionDate: Sep 2020

Topicof Research: Effectsofkinesiotapingwithandwithoutpelvictiltsonpain and

Dated: Signature ofScholar:

Poor Satisfactory Good VeryGood Excellent

Effects of Kinesiotaping with and without pelvic tilts on Pain and

At any time if my statement is found to be incorrect even after my Graduation the

Dedicated to my creator, Allah Almighty & my exceptional parents

Name of Student: IZZA WAHEED

ItisherebycertifiedthatthesisisbasedontheresultsofworkcarriedoutbyIzzaWaheedandthat it has not

SERIAL ABBREVIATION DESCRIPTION

Theprevalenceofdysmenorrhea is as high as up to 91%in women of reproductiveagewith 2-

One of the most commonly recommended treatment option is kinesiotaping as tape

Primary dysmenorrhea is a condition effecting life of young females frequently. Many

Sample Size for Comparing Two MeansInput Data

Mean2.19 3.85 -1.66

Standarddeviation 1.13 1.06

Variance 1.2769 1.1236

3.9.3 GroupA Interventions:

3.9.4 GroupB Interventions:

The Numeric Pain Rating Scale (NPRS) is an outcome measure that is

WaLIDDtool was developed to diagnosedysmenorrhea and predict medical leave

Menstrual Distress Questionnaire is a tool developed by Moss that measures the

TABLE 4.1 TEST OF NORMALITY

TABLE 4.2 DEMOGRAPHIC DETAILS

Groups Minimum Maximum MeanSD

FIGURE 4.3 SOCIOECONOMIC STATUS

Theclusteredbarchartdepicts showsthesocioeconomicstatus ofGroup A&Group B.Out of13

FIGURE 4.4 MARITAL STATUS

FIGURE 4.6 LIFESTYLE

FIGURE 4.7 PAIN LOCATION

FIGURE 4.8 PAIN CHARACTER

FIGURE 4.9 FIRST EXPERIENCE OF PAIN

FIGURE 4.10 PAIN INITIATION

FIGURE 4.11 PAIN LENGTH

FIGURE 4.12 OTHER EXPERIENCES

Theclustered barchart provides information regardingother experiences in both groups. In Group

TABLE 4.13 WaLIDD B/W GROUPS ANALYSIS (Mann-Whitney Test)

Groups N Mean Median Z score P-value

Groups N Mean Median Z P-

MDQ1_ GroupA 13 17.31 3.00 -3.845 .000

MDQ1_autonomic GroupA 13 16.12 3.00 -2.939 .003

MDQ1_negative GroupA 13 16.00 3.00 -2.689 .007

MDQ1_arousal GroupA 13 15.04 3.00 -1.972 .049

MDQ1_control GroupA 13 15.35 3.00 -2.232 .026

Groups N Mean Median Z P-

MDQ2_ GroupA 13 12.12 1.00 -.321 .001

MDQ2_autonomic GroupA 13 10.96 1.00 -1.223 .000

MDQ2_water GroupA 13 13.54 1.00 -.863 .001

MDQ2_negative GroupA 13 13.23 1.00 -.597 .000

MDQ2_arousal GroupA 13 12.19 1.00 -.245 .008

MDQ2_control GroupA 13 10.81 1.00 -1.362 .006

TABLE 4.18 NPRS WITHIN GROUP ANALYSIS (INDEPENDENT SAMPLES T-TEST)

GROUPS N NPRS1 NPRS2

TABLE 4.20 NPRS WITHIN GROUP ANALYSIS (PAIRED SAMPLE T-TEST)

GROUPS NPRS1 NPRS2

TABLE 4.21 MDQ WITHIN GROUP ANALYSIS

5. The study recommends patients of dysmenorrhea to practice pelvic tilts throughout