Dysmenorrhea and Physiotherapy Approaches

Let lifeblood live in normal life as survival in life in special organs in life in 11-15 age group in special organs in life in menstrual life. In this course, life can be affected, and the problems experienced in the person are living and living (1). The menstrual period in women lasts on average 28 times throughout the day and is approximately 4-6. For women, it is generally accepted as normal with a different approach while raising their children (2).
5 conditions for the start of menstruation:

  1. There should be pulsatile GnRH stimulation from the hypothalamus.
  2. It must be overstimulated by the pituitary.
  3. There should be follicles in the ovaries and these follicles may be responsive to gonadotropins.
  4. The endometrium should not respond to hormonal stimuli.
  5. Genital structures should be within normal anatomical limits for menstruation (2).

Ovarian cancer - Symptoms and causes - Mayo Clinic

Menstruation consists of 2 cycles, the ovarian and endometrial cycles:
The ovarian cycle is the physiological changes that occur in the ovaries that are repeated every 28 days on average. It takes place in 3 stages:
1. Follicular phase: It lasts for 10-14 days from the beginning of the menstrual cycle. Estrogen and progesterone levels are at their lowest. With the disintegration of the corpus luteum stimulated by FSH, the excretion of the follicles begins to increase.
2. Ovulation phase: About 12-14 from the start of menstruation. coincides with the days. It is the expulsion of maturing follicles from the ovary. Estrogen hormone reaches its highest level in the blood. If FSH is suppressed, LH comes to the stimulated level.
3. Luteal Phase: This phase lasts for 13-15 days after ovulation. In the first 3 days of ovulation, the follicle takes the name of the corpus luteum. After ovulation, high amounts of progesterone and low amounts of estrogen begin to be secreted from the corpus luteum. The most mature form of the corpus luteum corresponds to the 21st day of the menstrual cycle. This period is the time for the ovum to implant into the endometrium. If fertilization has not occurred, estrogen and progesterone levels drop and the corpus luteum deteriorates. Hormone secretion ends and menstruation takes place.
The endometrial cycle is the cycle that takes place in the endometrium. It consists of 3 stages:
1. Proliferative phase: It occurs in the follicular phase, which is the first phase of the ovarian cycle. This phase continues from the 6th day to the 14th day from the onset of menstruation. The endometrium begins to thicken under the influence of estrogen produced by the growing ovarian follicles. Glands, capillaries, and other tissues develop in the endometrium. However, the increased blood flow prepares the endometrium for the possible implantation of a fertilized egg.
2. Secretory phase: This phase of the menstrual cycle is 13-28. between the days. It continues from ovulation to the onset of menstruation. This period, which lasts for 14 days after ovulation, is also known as the premenstrual phase. Depending on the levels of progesterone produced by the ovarian corpus luteum, the blood flow to the endometrium continues to increase. This phase is under the control of the luteal phase. Fertilization occurs within 24-48 hours after ovulation. Due to progesterone stimulation, the endometrial glands become larger and secrete nutrients into the uterine cavity. These nutrients can nourish a fertilized egg until it implants.
3. Menstrual phase: If fertilization does not occur, the corpus luteum shrinks, estrogen and progesterone levels drop and stop. The upper (superficial) 9 layers of the thick endometrium are separated from the uterine wall and the endometrial tissue, fluid, and blood begin to drain and the endometrium becomes thinner. This event is called menstruation. (4)

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Menstrual problems are minor, about 75% minor, and similar events that are major for health and society. Menstrual cycle, first repetition of menarche, anovulatory producers are small. Like height, weight, and body fat continue to increase in 1-2 years, the cycles become regular in 2-3 years. Menstrual, from women to women, from schools, from people who care about work and social life, and because of their reasons for falling from life and workload at school. There is a lot of information being exchanged about this situation right now about shopping for lots of things. The content of menstruation problems before birth, premenstrual syndrome, and dysfunctional uterine bills are mentioned (2).
It’s the spontaneity of dealing with a reproductive woman. Amenorrhea is a symptom rather than a disease. Placement in 2 to be primary and secondary. The “lining amenorrhea” is as long as 16 men in the figure. If it is a cycle of menstruation for more than 3 months, which is menstrual, it is called “If it is a cycle of menstruation”. The distinction between primary and secondary amenorrhea is not very clear. However, primary amenorrhea is mostly normal when it results from normal union (2).
Premenstrual Syndrome
The woman who trades is also the one who spoils the trade. Premenstrual dysphoric scholarship (PMDB), which is a formula for PMS, is judged by serious emotional examination. In this system, menstrual bleeding can be passed. In the luteal appearance of the menstrual cycle, this clinic quickly in symptoms with the onset of menstruation. to be compassionate; 150 or more symptoms were not associated with premenstrual syndrome. The most frequent examinations are abdominal distension, chest pains, stomachache, and pound bloat as body measurements; In thought and behavior, it is anger/irritability, anxiety, avoidance of class, libido meals, concentration, depression (2), and normalcy.
Dysfunctional Uterine Bleeding
It consists of games called “abnormal menstruation”, 21 of which are seven longer, agenda or games. Any pathology that explains this is called “Dysfunctional Uterine Bleeding (DUB)” if it is in a systemic disease or endocrine pathological condition, and if it is the frequent or anovulatory vagina. ID is most commonly seen in the reproductive period 29 due to vaginal bleeding and the first appearance of adolescence is encountered. (2nd)
Uterine bleeding related to dysfunction
Oligomenorrhea: 45 long-term menstruation studies or less cycle history than the first book from menarche.
Menorrhagia (hypermenorrhea): Regular menstrual cycles of 80 ml and more, or 7 initial days.
Hypomenorrhea: instructions for use, system systems.
Menometrorrhagia: enumerated, frequent and prolonged use
Metrorrhagia: old irregulars (2).


In dysmenorrhea abnormal, “dys” means difficult, painful, “meno” means month, and “rhea”. As menstrual pain, daily dysmenorrhea is a gynecological problem with a rate of 50-91% in women and adolescent girls of all ages and races. Dysmenorrhea is their reproduction as they grow in age, race, and economic growth. The World Health Organization has described it as the most important cause of chronic pain. Dysmenorrhea is such that it will be present, manifesting as a few hours before or after menstruation and lasting 24-48 hours. The pain is mostly seen in the form of cramps in the lower abdomen and lumbar region. Lower abdominal pain is described as pain in the lower back or commonly in education. In dysmenorrhoea, the severity of the pain is so much that it disrupts the educational experience. This increased training in dysmenorrhea education with work accident and discontinuation reasons. (4) Coping with dysmenorrhea may also include constipation or diarrhea, squeezing, vomiting, and emotional problems. (one)

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Primary Dysmenorrhea

At the bottom of the practice is pathology menstruation and delivered abdominal pain and attraction. (1) It generally starts internally at the age of 25 and for 6-12 months after menarche. Menstrual pain comes right after or a few hours before the menstrual period and lasts for 48-72 hours. Pain is primarily the suprapubic center. The pain may radiate from the back or inner thigh but may be experienced in the knee or thigh. (2) Risks that can change early age include family type, early age women (less than 20 years old), age 12 years, menstrual uses, duration of menstruation, duration of the menstrual cycle, pelvic inflammatory, sexually weak, and nulliparity. Smaller behavioral risk is having a body index (BMI) greater than 20, smoking (vase design consisting of nicotine), small size, and weight. (4)

Secondary Dysmenorrhea
It is seen between the ages of 30-45. In secondary dysmenorrhea, a different pain pattern is observed than inlining dysmenorrhea, in addition to abdominal bloating, pelvic heaviness, and backrest. An aching pain comes from the top of the menstrual cycle and increases progressively through the intraperitoneal phase. The onset of pain in this way is referred to as “congestive dysmenorrhea” or “spasmodic” pain in primary dysmenorrhea. The pain lasts longer in 2-3 men or may continue to strut. In the pathology of secondary dysmenorrhea, pain due to an organic cause, these organic causes are endometriosis, miosis, myoma uteri, endometrial polyp, internal genital organ congestion, traumas, Gynecol stenosis, traumas, Gynecol uterus anomalies. The character of the pain shows according to the pelvic type. The pain has the appearance of a blunt character in endometriosis and inflammation of the pelvis. According to the practice conditions below, dyspareunia can be seen in practices such as menstruation practices and postcoital practices. (3) Although it is seen in seders in some of the adolescents, the prevalence of girls from young ages is pleasing below. Secondary dysmenorrhea in adolescents is most often due to endometriosis. (2nd)


Until recently, the pathophysiology of dysmenorrhea was stated to be caused by emotional and psychological problems such as anxiety, emotional instability, false views on menstruation and sexuality, and imitating the mother’s feelings about menstruation in medical and gynecological sources. However, experimental and clinical studies have identified a physiological cause of dysmenorrhea (Proctor and Farquhar 2006). Various theories have been proposed over the years regarding the cause of primary dysmenorrhea. (3) These theories;
Obstruction Theory: Hippocrates believed that cervical obstruction and stagnation of menstrual blood were responsible for painful menstruation. Women who have not given birth experience more dysmenorrhea than women who have given birth. The frequency of dysmenorrhea decreases with the increase in giving birth (Deligeoroglou 2000). (3)

Myometrial activities: Recent studies have shown that primary dysmenorrhea is associated with increased myometrial activity. The type of dysrhythmic uterine contractions has been shown as an example of dysmenorrhea. High to lower is reported to cause intrauterine pain. It cannot be said that it cannot be created, to be mentioned more. Uterine ischemia is required as the primary cause of dysmenorrhea (Baysal 2004; Deligeoroglou 2000). (3)

Neuromuscular growth: They have advanced neuromuscular education as a cause of student dysmenorrhea. It may explain the decreased menstrual pain after neuromuscular activity in birth change after maturity (Deligeoroglou 2000). (3)

Hormonal effect: Primary dysmenorrhea does not disappear until the ovulatory session (6-12 months after menarche). Due to the presence of progesterone in the luteal phase in ovulatory cycles, it is known to occur only in ovulatory cycles. Adolescents with this increasing menarche do not experience pain in their first application. Menstrual pain is not seen in anovulatory patients (Baygeoroglou 2000). (3)

Prostaglandins: Menstrual cramps occur due to uterine contractions. Myometrial contractions are frequent in my period. The contractions make blood circulation difficult in the uterus. It is seen that this excess contraction in the myometrium is the one produced by the endometrial and from the endometrial shedding. Prostaglandins stimulate myometrial contractions and ischemia. In the appearance of too much dysmenorrhea, prostaglandin is high in the menstrual fluid and this high level continues in the first 2 days of menstruation. Myometrial ischemia due to excessive vasospasm causes severe pain12 (Arısan 1991; Baysal 2004; Beck 1992; Çepni 2005; Dawood 1995; Deligeor 2000; Jolin and Rapkin 2004; Proctor and Farquhar 2006). (3)

Vasopressin: It has been used in the role of vasopressin. Plasmastrations in the presence of menstruation are thought to be caused by dysmenorrhea as this practice exam. However, this effect does not include PGF synthesis. These results suggest alternative proposals for vasopressin to induce excessive focus on the myometrium or uterine contraction (Baysal 2004; Deligeoroglou 2000). (3)

Psychological Factors: Emphasis has been placed on events related to the etiology of primary dysmenorrhea. The beginning of his life and his life is looked at with the eye of how certain it is. The most recent education is related to other emotional stress in premenstrual aspects of adolescent dysmenorrhea. Commonly, it is the development of exercise for dysmenorrhea (Baysal 2004; Deligeoroglou 2000). (3)


Medical Treatment Methods

Medical treatment of dysmenorrhea aims to improve pain and symptoms by reducing or affecting the physiological events behind menstrual pain (such as prostaglandin production). (1) The most commonly used drug group in the treatment of primary dysmenorrhea is prostaglandin synthesis inhibitors (ibuprofen, naproxen group, non-steroidal anti-inflammatory drugs). This group of drugs reduces the effects of prostaglandins by binding to prostaglandin receptors. Non-steroidal anti-inflammatory drugs (NSAIDs) reduce the severity of uterine contractions by lowering the endometrial prostaglandin level. In individuals who can predict the onset of menstruation, the use of these drugs 1-2 days before the onset of menstruation has a positive effect of 67-95%. (2nd)

Hormonal therapy

1. Ovulation-suppressing drugs: Oral contraceptives are used in cases where anti-prostaglandin therapy is not considered sufficient. These drugs suppress ovulation, thicken the endometrial layer, reduce the amount of menstrual blood and prostaglandin secretion production, intrauterine pressure, and uterine cramping. (one)

2. Progestin use: It is used to suppress ovulation. It prevents endometrial atrophy. (one)

3. Levonorgestrel intrauterine system: With this method, an intrauterine device is placed. This device releases progestin locally into the uterine cavity. Although it does not suppress ovulation, it acts locally on the atrophic and inactive endometrium. (one)

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Surgical treatment

Surgical methods are the last option used in the treatment of dysmenorrhea and are used in cases of menstrual pain that do not go away despite medical and other treatments. Laparoscopy, hysterectomy, presacral neurectomy, and laparoscopic uterosacral nerve ablation are surgical methods used in appropriate cases. (2nd)



Education for education, plan, education-related educational and educational activities. In addition to exercises, muscle strengthening, and improving endurance, you can increase growth after the administration of inflammatory cytokines. It is also believed that exercise stimulates endorphins to have analgesics by increasing pelvic blood. Studies show that exercise performed on average 1-2 times within 30-120 minutes reduces menstrual symptoms and pain caused by dysmenorrhea. The educational uses used in dysmenorrhea education are vehicle training, aerobics, isometrics, and pilates. Studies are showing that the prevalence of PD will also decrease with exercise. In one experiment, those who practiced actively (3 per week) tried fewer times than sedentary subjects. Araújo et al. Pilates exercises, including 16 activities applied on the ground and centrally in 10 women with PD, were investigated, and they were found in PD-related and pain. Ortiz et al. Results for approximately appropriate physiotherapies PD correctly evaluated, as shown in the prediction of dysmenorrhea when repeated jogging as strengthening, stretching, and row preparations. In a comprehensive measure to be reviewed in education in 2010, it can provide measurable, adequately detailed, and limited sample-specific estimates of exercise about dysmenorrhea. (4)


The greatest effect of heat is vasodilation. With vasodilation, leukocytes and antibodies come from the application, enabling it to produce wastes and waste. The effect on the use of heat will be used for control, the use of endorphins, the use of muscle spasm. thermotherapy; The hot pack can be considered curable with hot water or a chemical reaction. (2) Dysmenorrhea treatment is used as thermotherapy. It has been observed that heat applications, especially applied to the waist, reduce pain. However, its success is based on dairy products. With this design, the application is comparable to the application of ibuprofen, and the medicine used in the dysmenorrhea technique is quite powerful. (one)

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Transcutaneous Electrical Stimulation (TENS)

Using appropriate texts on the skin for pain education, electrical signals at cultivated frequencies and grown plants are under the impact of three different mechanisms of TENS in pain in primary dysmenorrhea. by turning off the signals of connected, afferent pains originating from the spinal cord (presynaptic inhibition); correct applications of the second descending nerve fibers endogenous morphine (postsynaptic inhibition); Finally, skin stimulation with TENS increases pain quality by increasing pain quality during the local vasodilation period in the same dermatomal region. Intrauterine controls are expressed somewhat on the uterine contractile activity of TENS therapy. Proctor and tried high-frequency TENS have been quite effective over TENS because they use pain. 2009 effectively reported for the treatment of PD in high-frequency TENS in an investigational system of TENS. (4)

Interference Current

Interferential (EFA) are low-voltage currents in non-pharmacological and current-free currents, which are not known to reduce pain and edema in muscle problems, increase blood appearance, and muscle increase in some urogynecological problems such as tissue and stress incontinence. By activating a massage on current selection training, the display of endorphins, which are school-age sports, stimulates. The chain relaxes the muscles and samples the children’s knitting. Pain orientation is based on the principle of control. It also reduces edema by increasing it with blood. At the same time, it makes it easier for metabolites that cause pain in traffic. (4) A TENS and interference primer cannot be applied to the brigade and tried ones. His two electrotherapy methods, which were applied in 32 cases, are effective in pain. However, no difference was noticed. (one)

Relaxation Techniques

Sympathetic to controlling stress from pain, experiencing or encountering a threatening situation, has a passion to collide with that event to experience. In the situation, in the case of pain, the stress of death prolongs and more different problems occur. No place in nature originates from the pain point. However, there is a process in which the stress of pain lasts or ends. In this course, intervening, in any event, cannot have a sufficient impact to direct the transformation into information and system. When people gain the ability to control this parasympathetic activity, they begin to manage stress and/or pain. Relaxation therapy, such as stress, chronic pain, general and mood, review and can be successful, can be implemented in a place that is within reach and can be effective in getting you in control of control here, easy to implement, manage and monitor orientation. For general well-being by helping you fight this pain and providing the pain from the front. Studies show that when you’re lacking in bedding and sleep, cramps, fatigue, and muscles run out of blood. It can be used under conditions suitable for Primary Applicability. The applications used in the literature, suitable for the tools being applied, are Jacobson’s and Laura Mitchell’s Physiological Physiological Relaxation Training.


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Jacobson’s Progressive Relaxation Training consists of key components of muscle relaxation, respiratory training, anxiety management, and stress reduction programs. This training is focused on the application of stretching and relaxing techniques to systemically tense muscle groups. This training requires a systematic series of isometric contractions followed by slow progressive relaxation throughout the body. By learning to distinguish between tension and relaxation in the muscles, the practitioner learns that they can almost eliminate muscle contractions and experience a deep sense of relaxation. When necessary, coping skills are gained with the help of visual images. During the training, approximately one minute is spent for each limb and an average of 16 muscle groups are worked. It continues from caudal to cervical and progresses one by one in muscle groups. Tension is maintained for 5-7 seconds, but care is taken not to cramp the limb in the tense position. Although studies investigating the effect of Jacobson’s Progressive Relaxation Training on dysmenorrhea gave positive results, there are not enough randomized controlled studies (4).

The Alexander Technique is a psychophysical retraining process. Retraining allows muscles to work more economically by changing disadvantageous posture habits and learning alternative postures. Posture plays a central role in this approach. Phrases such as “spine lengthening” and “forward and upward” illustrate the basic principles of the Alexander Technique. The main message of this technique is that if the posture is correct, the body and mind will also relax. It helps to eliminate body stress by emphasizing balance. There is no study investigating the effect of this treatment on dysmenorrhea (4).

Laura Mitchell’s Simple Physiological Relaxation Training was introduced in 1963 by physiotherapist Laura Mitchell, who has extensive training and practical experience in obstetrics. She stated that by moving the joints and stretching the skin, the proprioceptive structures and pressure receptors in the skin are transferred to the higher centers of the brain. Mitchell’s approach is based on the physiological principle of reciprocal inhibition of muscles. Applicants are instructed to contract the antagonist muscles against the tense muscle groups and then stop them. Then they are asked to inform the therapist about the new position in their body and the change in their position. Mutual relaxation of tense muscles is achieved by the contraction of antagonists, an event controlled by the central nervous system. So when a group of muscles working on a joint is working, relaxation of the opposite group is imperative, and this technique involves intense diaphragmatic breathing and a series of sequential isotonic contractions. Mitchell’s Relaxation Technique aims to correct an imbalance in the nervous system by initiating a phenomenon known as the “relaxation response”. This response is due to the release of hormones that have a diffuse effect on the cardiorespiratory system. The relaxation response has the potential to alter diastolic and systolic blood pressure, oxygen consumption, heart rate, or respiratory rate. The Mitchell Technique’s insistence that breathing is slow and easy and not involving breathing has made it preferred by those working in the obstetrics field. Mitchell’s Relaxation Method can be adapted in prenatal, natal, and postnatal education and the treatment of many conditions such as osteoarthritis of the spine, hypertension, insomnia, and psychiatric disorders. As the name suggests, it is a relatively simple technique, requires less concentration, can be learned in a short period, and intensive training can be provided at home. This method is fast and most of the “changes” can be made without problems. However, scientific evaluation of the method is limited. (4)

Psychotherapy and Behavioral Therapy

Psychotherapy and behavioral therapy are methods used in the treatment of dysmenorrhea. Biofeedback, hypnotherapy, and relaxation training are used in this treatment. Studies have shown that especially the behavioral characteristics passed from mother to daughter should be examined, girls do not have enough knowledge before menarche, emotional anxiety due to academic and social problems should be eliminated, and necessary behavioral changes in these subjects can be effective in the treatment of dysmenorrhea. The use of deep breathing, meditation, and imagining something beautiful techniques direct attention to other things besides pain, reducing the anxiety of individuals and providing a lesser experience of pain. In a study by Taylor, it was determined that the symptoms experienced during menstruation decreased in women who benefited from relaxation techniques for 5-20 minutes a day during the premenstrual period. (one)

Spine Manipulation

It allows to narrow usability, increase blood exchange, relax muscles, improve joint patency, shorten in a short time or increase their amplification. This pocket is widely used by physiotherapists, osteopaths, or chiropractors. While spinal manipulation in dysmenorrhea is treated with dermatomal devices to the lumbosacral area of ​​the uterus, pain is treated with comprehensive controls compared to control, while it increases the treatment that can be applied to the pelvic in the lower intervention and accelerates the excretion of metabolites and removes pain mediators. There are 5 studies of spinal manipulation pulse for the treatment of dysmenorrhea in a Cochrane practice. Although there are results regarding spinal manipulation to reduce pain in dysmenorrhea, they are not sufficient. (4)

Acupuncture and Acupressure

Acupressure is a Chinese method. We will be trained with the techniques of the anatomical and educational knowledge of the East. It is made by applying the hand to the security points of the fingers. The one used to pass over the Sanyinjiao point was disintegrated due to pressure. This point is located medial to the lower leg, 3 fingers above the medial malleolus. One of HuciMein and tried-and-tested apps can be reviewed for this app.

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Sanyinjiao point)

Acupuncture, on the other hand, is effective in the treatment of dysmenorrhea with its effect on hormones. It reduces dysmenorrhea by increasing the secretion of estradiol. In addition, to provide analgesia, the application is made between T5-L4 levels. In a review on acupuncture treatment in primary dysmenorrhea, a small-sample study found that acupuncture was more effective in relieving pain than placebo and the no-treatment group. In a study by Helms et al., weekly acupuncture was applied to cases with primary dysmenorrhea for 3 consecutive menstrual cycles and it was found that its analgesic effect was 41% higher than placebo. As a result of this study, the symptoms did not recur for 2 years in 93% of the cases in the follow-ups. However, according to the results of the reviews on this subject, although both acupuncture and acupressure applications seem to be effective in the treatment of primary dysmenorrhea, more studies are needed to reach a definite conclusion due to errors in the design of the studies and the selection of the sample group. (one)

Kinesio Taping

Implementation of the application of Kinesio tape related to dysmenorrhea; It is manual for immobility in fascial tissue and reduces pain by applying fascia correlation with myofascial oscillation (stimulation examination in proprioceptive tissue, gate control is activated to sacral nerve endings, which is the reflex area of the uterus). In addition, the use of field technique increases the removal of fascia and provides pain media and inflammatory cytokines) reduces pain. Forozeshfard et al. while applying the tape associated with menstruation, but not in the second menstruation; He applied Kinesio taping in the second first menstruation and Kinesio taping in the second menstruation. It may be due to menstruation, Kinesio taping was effective for utilizing dysfunction and pain. (4)


1) Sönmezer E. Comparison of the Effects of Connective Tissue Massage and Kinesiotaping on Pain and Quality of Life in Primary Dysmenorrhea. Hacettepe University Institute of Health Sciences. Doctoral Thesis. Ankara 2014.
2) Sycamore. G. N. Examination of Factors Affecting Menstrual Pain Intensity. Hacettepe University Institute of Health Sciences. Master Thesis. Ankara 2018.
3) They are in the heart. Hawk. N. Comparison of the Effects of High-Frequency TENS and Connective Tissue Manipulation on Primary Dysmenorrhea. Pamukkale University Health Sciences Institute. Doctoral Thesis. Delhi 2017.
4) Doğan H. The Effect of Kinesiotaping and Lifestyle Versions on Pain, Body Awareness and Quality of Life in Primary Dysmenorrhea. Hacettepe University Institute of Health Sciences. Doctoral Thesis. Ankara 2018.
5) Iron. A. Movement Requirement. Ankara University Faculty of Health Sciences. 2018.
6) Karaağaç A. Physiotherapy Practices.

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