Post-mastectomy lymphedema is one of the most common chronic complications that significantly impacts patients' quality of life following breast cancer surgery. postural stability is maintained through the intricate integration of muscular forces, sensory input from mechanoreceptors, and biomechanical feedback. closed kinetic chain (CKC) exercises play a crucial role in enhancing musculoskeletal stability by countering gravitational forces during both rest and movement. weight shifting and balance are fundamental components of functional movement. Proprioceptive training, which focuses on improving body awareness and balance, is essential for developing trunk control

Sixty patients who have unilateral post mastectomy lymphedema will participate in this study. Their ages will range from 40 to 60 years. The patients will be subdivided randomly into four equal groups.

1.1.a- Group A (n= 15) (CKC group): This group will include 15 patients who will receive closed kinetic chain exercises, in addition to complex decongestive therapy (CDT) for the treatment of lymphedema. CDT includes (skin care, manual lymphatic drainage, compression bandages, compression garments and exercises). The total exercise time will be 30 minutes, three times per week for eight weeks.

1.1.b- Group B (n= 15) (WS group): This group will include 15 patients who will receive weight shifting exercises, in addition to complex decongestive therapy (CDT) for the treatment of lymphedema. The total exercise time will be 30 minutes, three times per week for eight weeks.

1.1.c- Group C (n= 15) (Combined group): This group will include 15 patients who will receive closed kinetic chain and Weight shifting exercises, in addition to complex decongestive therapy (CDT) for the treatment of lymphedema. The total exercise time will be 60 minutes; 30 minutes of CKC and 30 minutes of WS exercise three times per week for eight weeks.

1.1.d- Group D (n= 15) (control group): This group will include 15 patients who will receive complex decongestive therapy (CDT) for the treatment of lymphedema. CDT includes (skin care, manual lymphatic drainage, compression bandages, compression garments and exercises).

Inclusion Criteria:

Women who had a history of BCRS with upper limb lymphedema. • Age range of 40-60 years.

• The body mass index (BMI) is less than 30 Kg/m2.

• Consciousness and ability to communicate orally or in writing.

• Treatment by unilateral mastectomy with lymph node dissection.

• No obvious abnormal spine morphology or postural abnormalities visible to the naked eye.

• All participants had moderate lymphedema according to the lymphedema severity assessment.

Exclusion Criteria:

Patients with metastases. • Differences between lower limb length.

• Having acute or chronic vestibular, neurological, and orthopedic diseases.

• Surgery related to spine causing limitation of motion.

• Women with psychiatric disorders, reconstructive surgery.

• Bilateral mastectomy. Diagnosis with a neurological, skeletal, or rheumatic disorder or other disease that seriously affects body posture.

• History of bodily injury such as a spinal, shoulder, or neck injury, resulting in permanent alteration of the normal body posture prior to the unilateral mastectomy.

• Failure to complete follow-up for any reason over the course of the study.

• Peripheral polyneuropathy, cognitive dysfunction.

• Patients taking medication that affects body balance.

• Severe arthritis or orthopedic conditions in their lower extremity

• Poor conditioning, acute pain in any reason,

• Neurological disorders including visual problems.

Women who had a history of BCRS with upper limb lymphedema

Publication at international journal

January, 2027

Open access

Double blind study design. Randomization and masking were performed by an independent investigator who was not engaged in either the treatment administration or the outcome assessment