Structured multimodal mobilization versus pilates-based motor imagery-focused pelvic floor exercises for primary dysmenorrhea: a randomized controlled trial

Abstract Primary dysmenorrhea impairs physical and emotional functioning. This prospective randomized controlled trial equally assigned 72 women aged 18–30 years to four groups: the structured multimodal mobilization group, the Pilates-based motor imagery-focused pelvic floor exercise group, the conventional treatment group, or the no-treatment control group. Active interventions comprised 24 twice-weekly sessions over 12 weeks. The primary outcome was the Short-Form McGill Pain Questionnaire (SF-MPQ) total pain score; secondary outcomes included SF-MPQ sensory and affective scores, the Visual Analog Scale (VAS), Menstrual Symptom Questionnaire, and Functional and Emotional Measure of Dysmenorrhea scores. Groups were comparable at baseline. Post-intervention pain differed significantly among groups. Structured multimodal mobilization produced the largest reduction in total pain score (15.44 ± 9.95 to 8.78 ± 6.78; mean change, -6.67 [95% confidence interval, -8.60 to -4.73]), although its post-intervention score did not significantly differ from the Pilates-based exercise group. Post hoc comparisons favored structured mobilization over Pilates-based exercise for VAS pain intensity, menstrual pain symptoms, and emotional dysmenorrhea. No adverse events occurred; all participants completed the trial. Pain scores decreased significantly within all active intervention groups, while structured multimodal mobilization showed outcome-specific advantages that require confirmation in larger multicenter trials with long-term follow-up. Trial registration: ClinicalTrials.gov NCT07314021. Registration date: December 4, 2025.