Spinal manipulation for painful periods

Painful menstrual periods (dysmenorrhoea) are caused by cramps in the uterus (womb). One of the non-drug options for dysmenorrhoea is spinal manipulation (using the hands to put pressure on certain parts of the back bone). This procedure is sometimes offered by physiotherapists, osteopaths or chiropractors. As dysmenorrhoea may be caused by restricted blood flow, manipulating the lower spine could improve blood flow to the pelvic area. The review of trials found no evidence that spinal manipulation relieves dysmenorrhoea.

Authors' conclusions: 

There is no evidence to suggest that spinal manipulation is effective in the treatment of dysmenorrhoea. In the one trial reporting on adverse effects there was no greater risk of such events with spinal compared with sham manipulation.

Read the full abstract...

Dysmenorrhoea (occurrence of painful menstrual cramps of uterine origin) is a common gynaecological condition. The character of pain from musculoskeletal dysfunction can be very similar to gynaecological pain by presenting cyclicly and being altered by hormonal changes associated with menstruation. Medical treatment for dysmenorrhoea usually comprises anti-inflammatory drugs, oral contraceptives, or surgical intervention. Spinal manipulation is a non-medical intervention. It has been suggested that manipulation of the vertebrae may increase spinal mobility thus improving pelvic blood supply and facilitating pain relief.


To determine the safety and efficacy of spinal manipulative interventions for the treatment of dysmenorrhoea when compared to each other, placebo, no treatment, or other medical treatment.

Search strategy: 

In this update we searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (May 2009), CENTRAL (to second quarter, 2009), MEDLINE (1966 to May 2009), EMBASE (1980 to May 2009), CINAHL (1982 to May 2009), and PsycINFO (1806 to May 2009). Citation lists of review articles and included trials were examined.

Selection criteria: 

Any randomised controlled trials (RCTs) including spinal manipulative interventions (for example chiropractic, osteopathy, or manipulative physiotherapy) versus each other, placebo, no treatment, or another medical treatment were considered. Exclusion criteria were mild or infrequent dysmenorrhoea or dysmenorrhoea from an intrauterine device (IUD).

Data collection and analysis: 

Two trials of high velocity, low amplitude (HVLA) manipulation and one trial of the Toftness technique were included. Quality assessment and data extraction were performed independently by two review authors. No data were suitable for meta-analysis. Data were therefore reported as descriptive data. The outcome measures were pain relief or pain intensity and adverse effects.

Main results: 

Results from HVLA manipulation suggested that the technique was no more effective than sham manipulation for the treatment of dysmenorrhoea. One small trial indicated a difference in favour of HVLA manipulation however the one trial with an adequate sample size found no difference between HVLA and sham manipulation. There was no difference in adverse effects. The Toftness technique appeared more effective than sham treatment in one small trial but no conclusions could be made due to the size and other methodological limitations of the trial.