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Published Online: 15 January 2016

Comparison of Reflexology and Connective Tissue Manipulation in Participants with Primary Dysmenorrhea

Publication: The Journal of Alternative and Complementary Medicine
Volume 22, Issue Number 1


Objective: The aim of this interventional correlational study is to compare the effects of foot reflexology (FR) and connective tissue manipulation (CTM) in subjects with primary dysmenorrhea.
Design: A total of 30 participants having primary dysmenorrhea completed the study. Data, including demographics (age, body–mass index), menstrual cycle (age at menarche, menstrual cycle duration, time since menarche, bleeding duration), and menstrual pain characteristics (intensity and duration of pain, type and amount of analgesics), were recorded. Effect of dysmenorrhea on participants' concentration in lessons and in sports and social activities was assessed by using the visual analog scale. Participants rated their menstruation-related symptom intensity through the Likert-type scale. FR was applied to 15 participants for 3 days a week and CTM was performed on 15 participants for 5 days a week. Treatments were performed during one cycle, which started at the third or fourth day of menstruation and continued till the onset of next menstruation. Assessments were performed before treatment (first menstruation), then after termination of the treatment because of the next menstruation's onset (second menstruation), and ∼1 month after at the consecutive menstrual period (third menstrual cycle).
Results: Time-dependent changes in duration and intensity of pain along with analgesic amount show that both treatments provided significant improvements (p < 0.05) and no superiority existed between the groups (p > 0.05). A similar result was obtained in terms of time-dependent changes in concentration in lessons and difficulty in sports and social activities due to dysmenorrhea. Menstruation-related symptoms were found to be decreased after treatment and in the following cycle with both treatments (p < 0.05) where no difference existed between the groups (p > 0.05).
Conclusion: Both FR and CTM can be used in the treatment of primary dysmenorrhea and menstruation-related symptoms as these methods are free from the potentially adverse effects of analgesics, noninvasive, and easy to perform.

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Polat A, Çelik H, Gurates B, et al. Prevalence of primary dysmenorrhea in young adult female university students. Arch Gynecol Obstet 2009;279:527–532.
Ortiz MI. Primary dysmenorrhea among Mexican university students: Prevalence, impact and treatment. Eur J Obstet Gynecol Reprod Biol 2010;152:73–77.
French L. Dysmenorrhea. Am Fam Physician 2005;71:285.
Coco AS. Primary Dysmenorrhea. Am Fam Physician 1999;60:489–496.
Li WC, Tu CH, Chao HT, et al. High prevalence of incidental brain findings in primary dysmenorrhoea. Eur J Pain 2014.
Ju H, Jones M, Mishra G. The prevalence and risk factors of dysmenorrhea. Epidemiol Rev 2014;36:104–113.
Dmitrovic R, Peter B, Cvitkovic-Kuzmic A, et al. Severity of symptoms in primary dysmenorrhea—A Doppler study. Eur J Obstet Gynecol Reprod Biol 2003;107:191–194.
Ylikorkala O, Dawood MY. New concepts in dysmenorrhea. Am J Obstet Gynecol 1978;130:833–847.
Chan WY, Dawood MY, Fuchs F. Relief of dysmenorrhea with the prostaglandin synthetase inhibitor ibuprofen: Effect on prostaglandin levels in menstrual fluid. Am J Obstet Gynecol 1979;135:102.
Smith RP. The dynamics of nonsteroidal anti-inflammatory therapy for primary dysmenorrhea. Obstet Gynecol 1987;70:785.
Wong CL, Farquhar C, Roberts H, Proctor M. Oral contraceptive pill for primary dysmenorrhoea. Cochrane Database Syst Rev 2009;CD002120.
Tugay N, Akbayrak T, Demirtürk F, et al. Effectiveness of transcutaneous electrical nerve stimulation and interferential current in primary dysmenorrhea. Pain Med 2007;8:295–300.
Kannan P, Claydon LS. Some physiotherapy treatments may relieve menstrual pain in women with primary dysmenorrhea: A systematic review. J Physiother 2014;60:13–21.
Roberts SC, Hodgkiss C, DiBenedetto A, Lee E. Managing dysmenorrhea in young women. Nurse Pract 2012;37:47–52.
Yu A. Complementarry and alternative treatments for primary dysmenorrhea in adolesents. Nurse Pract 2014;39:1–12.
Smith CA, Zhu X, He L, Song J. Acupuncture for primary dysmenorrhoea. Cochrane Database Syst Rev 2011;CD007854.
Proctor ML, Murphy PA. Herbal and dietary therapies for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev 2001;CD002124.
Botting D. Review of literature on the effectiveness of reflexology. Complement Ther Nurs Midwifery 1997;3:123–130.
Tiran D, Chummun H. The physiological basis of reflexology and its use as a potential diagnostic tool. Complement Ther Clin Pract 2005;11:58–64.
Ernst E, Posadzki P, Lee MS. Reflexology: An update of a systematic review of randomised clinical trials. Maturitas 2011;68;116–120.
Holey E, Cook E. 2011. Evidence-Based Therapeutic Massage: A Practical Guide for Therapists, 3rd ed. Edinburgh: Churchill Livingstone, Elsevier.
Holey LA. Connective tissue manipulation: towards a scientific rationale. Physiotherapy 1995;81:730–739.
Ebner M. Connective tissue massage. Physiotherapy 1978;64:208–210.
Kaada B, Torsteinbo O. Increase of plasma beta-endorphins in connective tissue massage. Gen Pharmacol 1989;20:487–489.
Reed B, Held J. Effects of sequential connective tissue massage on autonomic nervous system of middle aged and elderly adults. Phys Ther 1988;68:1231–1234.
Holey LA, Dixon J, Selfe J. An exploratory thermo-graphic investigation of the effects of connective tissue massage on autonomic function. J Manipulative Physiol Ther 2011;34:457–462.
Valiani M, Babaei E, Heshmat R, Zare Z. Comparing the effects of reflexology methods and Ibuprofen administration on dysmenorrhea in female students of Isfahan University of Medical Sciences. Iran J Nurs Midwifery Res 2010;15(Suppl 1):371–378.
Reis CAAS, Hardy E, Sousa MH. The effectiveness of connective tissue massage in the treatment of primary dysmenorrhea among young women. Rev Bras Saúde Mater Infant Recife 2010;10:247–256.
Ansari S, Dastgheibshirazi H, Sehati F, et al. The effect of sole reflexology (Reflex Zone Therapy) on the intensity of premenstrual syndrome: A single-blinded randomized controlled trial. Jundishapur J Chronic Dis Care 2014;3:32–40.
Chesney MA, Tasto DL. The effectiveness of behavior modification with spasmodic and congestive dysmenorrhea. Behav Res Ther 1975;13:245–253.
Kim YH, Cho SH. The effect of foot reflexology on premenstrual syndrome and dysmenorrhea in female college students. Korean J Women Health Nurs 2002;8:212–221.
Wang XM. Treating type II diabetes mellitus with foot reflexotherapy. Chung-Kuo Chung His Chieh Ho Tsa Chih 1993;13:536–538.
Mak HL, Cheon WC, Wong T, et al. Randomized controlled trial of foot reflexology for patients with symptomatic idiopathic detrusor overactivity. Int Urogynecol J Pelvic Floor Dysfunct 2007;18:653–658.
Li CY, Chen SC, Li CY, et al. Randomised controlled trial of the effectiveness of using foot reflexology to improve quality of sleep amongst Taiwanese postpartum women. Midwifery 2011;27:181–186.
Holey LA, Dixon J. Connective tissue manipulation: A review of theory and clinical evidence. J Bodyw Mov Ther 2014;18:112–118.
Oleson T, Flocco W. Randomized controlled study of premenstrual symptoms treated with ear, hand, and foot reflexology. Obstet Gynecol 1993;82:906–911.
Yuan SL, Matsutani LA, Marques AP. Effectiveness of different styles of massage therapy in fibromyalgia: A systematic review and meta-analysis. Man Ther 2014.
Citak-Karakaya I, Akbayrak T, Demirtürk F, Ekici G, et al. Short and long-term results of connective tissue manipulation and combined ultrasound therapy in patients with fibromyalgia. J Manipulative Physiol Ther 2006;29:524–528.
Ekici G, Bakar Y, Akbayrak T, Yuksel I. Comparison of manual lymph drainage therapy and connective tissue massage in women with fibromyalgia: A randomized controlled trial. J Manipulative Physiol Ther 2009;32:127–133.
Brattberg G. Connective tissue massage in the treatment of fibromyalgia. Eur J Pain 1999;3:235–244.
Castro-Sánchez AM, Moreno-Lorenzo C, Matarán-Peñarrocha GA, et al. Connective tissue reflex massage for type 2 diabetic patients with peripheral arterial disease: Randomized controlled trial. Evid Based Complement Alternat Med 2011;2011:804321.
Mur E, Schmidseder J, Egger I, et al. Influence of reflex zone therapy of the feet on intestinal blood flow measured by color Doppler sonography. Forsch Komplementarmed Klass Naturheilkd 2001;8:86–89.
Sudmeier I, Bodner G, Egger I, et al. Changes of renal blood flow during organ-associated foot reflexology measured by color Doppler sonography. Forsch Komplementarmed 1999;6:129–134.
Hirata M, Kumabe K, Inoue Y. Relationship between the frequency of menstrual pain and bodyweight in female adolescents. Nihon Koshu Eisei Zasshi 2002;49:516–524.

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Published In

cover image The Journal of Alternative and Complementary Medicine
The Journal of Alternative and Complementary Medicine
Volume 22Issue Number 1January 2016
Pages: 38 - 44
PubMed: 26382885


Published online: 15 January 2016
Published in print: January 2016
Published ahead of print: 18 September 2015


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Funda Demirtürk
Department of Physiotherapy and Rehabilitation, Tokat School of Health, Gaziosmanpasa University, Tokat, Turkey.
Zümrüt Yilar Erkek
Department of Midwifery, Tokat School of Health, Gaziosmanpasa University, Tokat, Turkey.
Özgür Alparslan
Department of Midwifery, Tokat School of Health, Gaziosmanpasa University, Tokat, Turkey.
Fazlı Demirtürk
Department of Obstetrics and Gynaecology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey.
Osman Demir
Department of Biostatistics, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey.
Ahmet Inanir
Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey.


Address correspondence to:Funda Demirtürk, PhDDepartment of Physiotherapy and RehabilitationTokat School of HealthGaziosmanpasa UniversityTokat 60100Turkey
E-mail: [email protected]

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No competing financial interests exist.

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