Randomised controlled trials are needed that combine activity/exercise approaches with other interventions such as psychological approaches, educational approaches and medication. The optimal combination and dosage of such approaches will need to be determined. WAD, whether acute or chronic, is a challenging and complex condition. With clear evidence emerging of a myriad of physical and psychological factors occurring to varying degrees in individual patients, it is also clear that practitioners

involved in the management of WAD need specific skills in this area. Physiotherapists are the health care providers who likely see the greatest number of patients this website with WAD, and by virtue of the health system set-up, spend the most time with these patients. Physiotherapists are well placed to take on a coordination or ‘gatekeeper’ role in the management of WAD and research into health services models that include physiotherapists in such a role is also needed. Competing interests: Nil. Acknowledgement: Michele Sterling received a fellowship from the National Health and Medical Research Council of Australia. Correspondence: Michele Sterling, Centre of National Research on Disability

and Rehabilitation Medicine (CONROD), The University of Queensland and Griffith University, Australia. Email: [email protected] Akt inhibitor “
“Primary dysmenorrhoea is defined as cramping pain Phosphoprotein phosphatase in the lower

abdomen that occurs just before or during menstruation without identifiable pelvic pathology.1 Secondary associated symptoms include nausea, vomiting, fatigue, back pain, headaches, dizziness, and diarrhoea.2 Primary dysmenorrhoea has been reported as the leading cause of recurrent absenteeism from school or work in adolescent girls and young women, and is considered to be a common disorder among women of reproductive age.3 A survey of 1266 female university students found the total prevalence of primary dysmenorrhoea to be 88%, with 45% of females having painful menstruation in each menstrual period and 43% of females having some painful menstrual periods.4 Excessive production and release of prostaglandins during menstruation by the endometrium causes hyper-contractility of the uterus, leading to uterine hypoxia and ischaemia, which are believed to cause the pain and cramps in primary dysmenorrhoea.3 Based on this understanding, pharmacological therapies for primary dysmenorrhoea focus on alleviating menstrual pain and relaxing the uterine muscles by using non-steroidal anti-inflammatory drugs (NSAIDs) or oral contraceptive pills.5 A survey of 560 female students from three medical colleges in India reported that 87% of those with dysmenorrhea also sought treatment.6 Among the women who sought treatment, 73% took analgesics and 58% had physiotherapy management, primarily heat treatment.