Impact of Proximal Motor Control Exercise on Scapular Muscles Activation Pattern Post Mastectomy

Patients will receive Scapular mobilization in five manners, superior glide, inferior glide, up-ward rotation, down-ward rotation, and distraction. Each mobilization will be done ten times. A thirty second break will be given between each set. Also scapular strengthening exercises composed of diagonal two (D2) flexion pattern to augment the upper, middle, lower, and serratus anterior muscles' activity level. To activate upper trapezius muscle, shoulder shrug exercise will be used. To activate serratus anterior muscle, Wall slide exercise will be used. Scapular retraction exercise for rhomboids and middle trapezius activation will be done. Strengthening exercises will be performed using weights were initiated with two sets of ten repetitions, beginning with a weight of 0.5 kg and progressed to 0.75, and1kg, it will be applied 5 days per week for 6 weeks

Patients will receive shoulder joint mobilization, posterior capsular stretching, and ROM exercises in form of Codman/pendulum exercise. To mobilize the shoulder joint, distraction of the glenohumeral joint, posterior glide and caudal glide will be performed to the patients in a supine lying position at a frequency of two to three oscillations/second for one to two minutes. Every direction was repeated three to four times. At the resting position rhythmic oscillations grade I and II will be applied. In posterior capsule stretching each stretch will be repeated ten times for 20 seconds, between each stretching a 30-second break will be given. Pendulum exercise will be demonstrated to the patient at first, then they will performed it in the forward-backward direction, side-to-side direction, and circular pattern, for two to three minutes in each direction, it will be applied 5 days per week for 6 weeks