The Somatic Connection  |   March 2015
Pelvic Manipulation Benefits Women With Primary Dysmenorrhea
Author Affiliations
  • Lee Kenyon, OMS III
    Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Northwest, Lebanon, Oregon
  • Hollis H. King, DO, PhD
    University of California, San Diego School of Medicine
Article Information
The Somatic Connection   |   March 2015
Pelvic Manipulation Benefits Women With Primary Dysmenorrhea
The Journal of the American Osteopathic Association, March 2015, Vol. 115, 169-170. doi:
The Journal of the American Osteopathic Association, March 2015, Vol. 115, 169-170. doi:
Molins-Cubero S, Rodríguez-Blanco C, Oliva-Pascual-Vaca Á, Heredia-Rizo AM, Boscá-Gandía JJ, Ricard F. Changes in pain perception after pelvis manipulation in women with primary dysmenorrhea: a randomized controlled trial [published online March 25, 2014]. Pain Med. 2014;15(9):1455-1463. doi:10.1111/pme.12404.  
Researchers from the Department of Physical Therapy at the University of Sevilla and the Madrid Osteopathic School conducted a prospective randomized double-blind controlled trial that investigated the effects of a bilateral global pelvic manipulation (GPM) technique on lumbar pelvic pain and blood catecholamine and serotonin release in patients with clinically diagnosed primary dysmenorrhea. All participants (N=40; mean age, 30 years) had “regular menstrual cycle[s] (28 ± 7 days)” and “menstrual pain of moderate or severe intensity” (defined as greater than 50 mm on a 100-mm visual analog scale [VAS]). Women who had any of the following were excluded from the study: (1) an intrauterine device, (2) secondary dysmenorrhea, (3) previous gynecologic interventions, (4) contraindications to the GPM technique, (5) recent previous manipulative therapy, and (6) fear of spinal manipulation. Previous research has suggested that pain associated with primary dysmenorrhea could be addressed with spinal manipulation of the lumbosacral spine (spinal levels L5-S1).1,2 
Participants received either a bilateral GPM technique (a semi-direct high-velocity, low-amplitude technique applied to the fifth lumbar vertebra over the first sacral vertebra and the sacroiliac joint [SIJ] with the participant in a lateral position) or a sham technique (a technique with the participant in an identical position without any tension or thrust). Both the GPM and sham therapy sessions lasted approximately 2 minutes. 
The primary outcome measures were pre- to postintervention self-perceived low back pelvic pain (measured using a VAS) and pressure pain threshold (PPT) in the SIJs (measured using a digital dynamometer). Additionally, blood was drawn from the right arm before the intervention and from the left arm 30 minutes after the intervention to analyze plasma catecholamine and serotonin levels. A significant decrease in low back pelvic pain (P=.003) and a significant increase in PPTs of the left and right SIJs (SIJ left side, P=.001; SIJ right side, P=.001) were noted within the experimental group after intervention. When the preintervention and postintervention changes were compared, significant differences for PPT in the left and right SIJ (P=.001) and serotonin plasma level (P=.045) were found between the GPM and sham therapy groups. 
Although no definitive explanation was given for the increase in serotonin levels, these findings are promising and support personal observations that osteopathic manipulative treatment reduces the aggravation and pain of dysmenorrhea. Given the short duration of this study (1 day), a longer trial is needed to determine the long-term effects of this treatment. 
   “The Somatic Connection” highlights and summarizes important contributions to the growing body of literature on the musculoskeletal system's role in health and disease. This section of The Journal of the American Osteopathic Association (JAOA) strives to chronicle the significant increase in published research on manipulative methods and treatments in the United States and the renewed interest in manual medicine internationally, especially in Europe.
   To submit scientific reports for possible inclusion in “The Somatic Connection,” readers are encouraged to contact JAOA Associate Editor Michael A. Seffinger, DO (, or JAOA Editorial Advisory Board Member Hollis H. King, DO, PhD (
Holtzman DA, Petrocco-Napuli KL, Burke JR. Prospective case series on the effects of lumbosacral manipulation on dysmenorrhea. J Manipulative Physiol Ther. 2008;31(3):237-246. doi:10.1016/j.jmpt.2008.02.005. [CrossRef] [PubMed]
Boesler D, Warner M, Alpers A, Finnerty EP, Kilmore MA. Efficacy of high-velocity low-amplitude manipulative technique in subjects with low-back pain during menstrual cramping. J Am Osteopath Assoc. 1993;93(2):203-208, 213-214. [PubMed]