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🎗️ PHYSIOTHERAPY AWARENESS CAMP SCRIPT

"Move to Ease: Understanding & Managing Menstrual Pain"

A Complete Start-to-End Program Guide for Physiotherapists

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📋 CAMP OVERVIEW

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🕐 PART 1 — REGISTRATION & SETUP (15 min before start)

• Register participants with name, age, menstrual complaint (brief form)
• Set up stations: Education corner, Exercise mat area, Demo screen
• Distribute handouts: anatomy diagram, exercise sheet, myth-fact card

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🕙 PART 2 — WELCOME & ICEBREAKER (10 min)

"Good morning everyone! Welcome to our Physiotherapy Awareness Camp on Menstrual Pain. Periods are a normal part of life — yet so many girls suffer in silence. Today we break that silence. We will understand why pain happens, bust common myths, and most importantly — learn how to move our bodies to feel better. No judgment, no embarrassment. This is a safe space."

• "Who has ever used a hot water bottle for cramps?" ✋
• "Who has ever been told to just rest and bear it?" ✋

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🕙 PART 3 — AWARENESS MODULE: UNDERSTANDING MENSTRUAL PAIN (30 min)

3.1 What is Menstrual Pain (Dysmenorrhea)?

"Primary dysmenorrhea is what most teenagers and young women experience. The pain is real, it has a physical cause, and it is treatable."

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3.2 WHY Does it Hurt? (The Physiology — Simplified)

1. Before your period, the uterus produces chemicals called prostaglandins
2. Prostaglandins cause the uterus to contract strongly to shed its lining
3. These contractions squeeze blood vessels, reducing oxygen to uterine muscle
4. Ischemia (lack of oxygen) = PAIN — similar to a muscle cramp
5. Omega-6 derived prostaglandins (PGE2) are elevated in women with dysmenorrhea
6. Low omega-3 fatty acid intake is linked to higher dysmenorrhea severity

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3.3 MYTH BUSTING SESSION (Interactive — 10 min)

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3.4 Red Flags — When to See a Doctor

• Pain that starts BEFORE age 25 and gets progressively worse
• Pain that does not respond to over-the-counter medication
• Pain outside the menstrual period
• Associated with heavy bleeding, painful intercourse, or infertility

These patterns may indicate endometriosis, fibroids, or adenomyosis — conditions requiring medical management including hormonal therapy or surgery. — Harrison's Principles of Internal Medicine 22E (2025)

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🕙 PART 4 — PHYSIOTHERAPY MANAGEMENT MODULE (40 min)

4.1 Why Physiotherapy?

• Reducing muscle spasm in the uterus, low back, pelvic floor
• Improving circulation to pelvic organs
• Releasing endorphins — the body's natural painkillers
• Reducing prostaglandin sensitivity through regular aerobic activity
• Correcting posture and relieving referred low back pain

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4.2 HEAT THERAPY (Demonstration — 5 min)

• Apply a warm pack to the lower abdomen for 15–20 minutes
• Temperature: comfortably warm, not burning
• Mechanism: vasodilation, muscle relaxation, pain gate modulation
• Evidence: local heat application is specifically cited as beneficial in Harrison's 22nd Edition
• Can be combined with gentle massage in circular motions

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🧘 PART 5 — EXERCISE PROGRAM (CORE SECTION — 60 min)

HOW EXERCISE HELPS

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▶️ WARM-UP (5–7 min)

• Lie on back, knees bent
• Inhale through nose → let belly rise (not chest)
• Exhale slowly through pursed lips
• 10 breaths
• Purpose: Activates parasympathetic system, reduces pain perception, relaxes pelvic floor

• Seated, 5 circles each direction
• Purpose: Release upper body tension (common during dysmenorrhea)

• Seated or standing — gently tilt pelvis forward/backward and side to side
• 10 repetitions
• Purpose: Warms pelvic girdle and increases body awareness

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▶️ MAIN EXERCISE PROGRAM

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🔵 EXERCISE 1 — Supine Knee-to-Chest (Child's Pose Variant)

• Bring both knees to chest
• Wrap arms around knees
• Gently rock side to side
• Hold 30–60 seconds, repeat 3×

• Stretches the low back and sacroiliac joint
• Decompresses lumbar spine
• Relieves referred menstrual low back pain
• Promotes relaxation of pelvic floor musculature

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🔵 EXERCISE 2 — Cat-Cow Stretch (Spinal Mobilization)

• CAT: Round your back upward toward ceiling, tuck chin + pelvis (exhale)
• COW: Drop belly toward floor, lift head and tailbone (inhale)
• Alternate rhythmically, 10–15 repetitions

• Mobilizes the thoracolumbar and sacral spine
• Relieves uterine referred pain through L1-S4 nerve pathways
• Increases circulation to pelvic organs
• A classic physiotherapy spinal mobilization exercise

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🔵 EXERCISE 3 — Child's Pose (Balasana)

• Sit back on heels
• Reach arms forward on floor
• Forehead rests on mat
• Hold 1–2 minutes with deep breathing

• Gently stretches the uterine ligaments
• Reduces pressure on pelvic organs
• Promotes abdominal relaxation
• Yoga-based — specifically mentioned alongside exercise as helpful for dysmenorrhea in Harrison's 22E

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🔵 EXERCISE 4 — Pelvic Tilt (Posterior Pelvic Tilt)

• Flatten your lower back against the mat (posterior tilt)
• Hold 5–10 seconds, then release
• 10–15 repetitions

• Activates transversus abdominis and pelvic floor gently
• Reduces lumbar hyperlordosis that increases menstrual pain
• Improves blood flow to lower pelvic region

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🔵 EXERCISE 5 — Bridge Pose (Glute Bridge)

• Press feet into floor, squeeze glutes
• Lift hips off floor to form a straight line from knees to shoulders
• Hold 5 seconds, lower slowly
• 10–12 repetitions, 2–3 sets

• Strengthens gluteus maximus and pelvic stabilizers
• Reduces sacroiliac joint stress
• Increases pelvic blood circulation
• Activates posterior chain to reduce pelvic floor overload

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🔵 EXERCISE 6 — Supine Figure-4 Stretch (Piriformis Stretch)

• Cross right ankle over left knee (figure 4)
• Pull left thigh toward chest gently
• Hold 30–45 seconds each side

• Releases piriformis and hip external rotators (often tight during periods)
• Reduces sciatic-type referral pain during menstruation
• Decompresses sacral nerve roots

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🔵 EXERCISE 7 — Reclined Butterfly (Supta Baddha Konasana)

• Soles of feet together, knees fall out to sides
• Arms out to sides, palms up
• Breathe deeply for 2–3 minutes

• Passive hip opener — stretches adductors and groin
• Reduces internal pelvic pressure
• Deeply relaxing; reduces anxiety-associated pain amplification

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🔵 EXERCISE 8 — Aerobic Activity (Moderate Intensity)

• Brisk walking (20–30 min)
• Light jogging
• Swimming
• Cycling

• Releases endorphins (natural opioids) — the best systemic pain relief
• Regular aerobic exercise has been shown to reduce the incidence of endometriosis and dysmenorrhea severity
• Improves prostaglandin metabolism over time
• Aerobic activity from early age is associated with reduced menstrual pain burden

"A reduced incidence of endometriosis was reported in women who engaged in aerobic activity from an early age." — Berek & Novak's Gynecology

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🔵 EXERCISE 9 — Yoga Sun Salutation (Modified Surya Namaskar)

• Forward fold (Uttanasana) — stretches back, hamstrings
• Low lunge (Anjaneyasana) — hip flexor release
• Downward dog — spinal traction

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🔵 EXERCISE 10 — Pelvic Floor Relaxation (Reverse Kegel)

• Instead of squeezing (Kegel), focus on releasing and dropping the pelvic floor
• Breathe in → let the pelvic floor expand downward and outward
• Breathe out → let go completely, imagine the floor softening
• 10 cycles

• Many women with dysmenorrhea have hypertonicity (over-tightness) of the pelvic floor
• Releasing this tension directly reduces pelvic pain
• This is a key physiotherapy-specific intervention

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▶️ COOL DOWN (5–7 min)

• Lie on back, legs extended up against a wall
• Hold 3–5 minutes
• Drains venous congestion from legs and pelvis, profoundly relaxing

• Tense and release each muscle group from feet to head
• 5 minutes
• Reduces autonomic hyperactivation that amplifies pain

• Deep breathing, mindfulness of body sensations without judgment
• 3 minutes

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🕙 PART 6 — RECENT ADVANCES IN MENSTRUAL PAIN MANAGEMENT (20 min)

6.1 Nutritional Advances

6.2 Mind-Body Interventions

6.3 TENS (Transcutaneous Electrical Nerve Stimulation)

• High-frequency TENS applied to lower abdomen/sacrum
• Activates pain gate mechanism at spinal cord level
• Non-invasive, drug-free, suitable for camp demonstration
• Growing use in physiotherapy practice for dysmenorrhea

6.4 Emerging Physical Therapy Approaches

• Myofascial Release of Pelvic Floor: Treating hypertonicity in levator ani and piriformis as pain generators
• Dry Needling: Targeting trigger points in iliopsoas, abdominal wall, pelvic floor
• Biofeedback Pelvic Floor Training: Helps women visualize and learn to relax pelvic floor musculature
• Aquatic Therapy: Warm water reduces prostaglandin-driven spasm while supporting joint-free movement

6.5 Pharmacological Options (Brief Awareness)

• NSAIDs (ibuprofen, naproxen, mefenamic acid): >80% sustained response; start before onset of menses, continue 2–3 days
• Combined oral contraceptive pills / progestin-only: Reduce symptoms of dysmenorrhea effectively
• Always advise participants to consult a doctor before starting any medication

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🕙 PART 7 — Q&A PANEL (20 min)

1. "Is it normal to vomit or faint during periods?"
2. "Can exercise really replace pain medication?"
3. "What should I eat during my periods?"
4. "When should I see a gynecologist?"
5. "Does stress make cramps worse?" (Answer: Yes — cortisol amplifies prostaglandin sensitivity)

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🕙 PART 8 — TAKE-HOME HANDOUT SUMMARY

✅ YOUR 5-POINT MENSTRUAL PAIN ACTION PLAN
1. MOVE: 20–30 min aerobic exercise daily (especially days 1–3 of period)
2. STRETCH: Cat-cow, knee-to-chest, butterfly — 10 min/day
3. HEAT: Warm pack on lower abdomen for 20 min
4. EAT: Increase omega-3s (fish, flaxseeds), reduce junk food
5. BREATHE: 10 diaphragmatic breaths when pain starts
⚠️ See a doctor if pain is severe, worsening, or not responding to these measures

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🕙 PART 9 — CLOSING CEREMONY (10 min)

• Certificates of participation (optional)
• Group pledge: "I will not suffer in silence. I will move, breathe, and seek help."
• Feedback forms
• Selfie/group photo for awareness spread on social media

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📌 PHYSIOTHERAPIST'S CLINICAL NOTES

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📚 SOURCES

• Harrison's Principles of Internal Medicine, 22nd Edition (2025, McGraw Hill)
• Berek & Novak's Gynecology
• Swanson's Family Medicine Review

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