Patient will receive exercise program (stretching, strengthening and active range of motion (ROM) exercise) and routine medical treatment for 12 weeks.

Patients will receive routine medical treatment only for 12 weeks.

Patients who have upper cross syndrome post unilateral modified radical mastectomy and who will receive exercise program (strengthening, active range of motion exercise, and strengthening exercises including prone scapular stabilization, shoulders shrug McKenzie exercise for neck, repeated shoulder horizontal adduction, repeated shoulder flexion, repeated shoulder extension, neck flexion McKenzie exercises) and routine medical treatment. Patients will receive 3 sessions per week for 12weeks, time of session is 45 minutes.

The Craniovertebral angle (CVA) is measured by creating an angle between a horizontal line passing through the seventh cervical (C7) vertebra and a line connecting C7 to the tragus of the ear. It is commonly used to assess forward head posture, with smaller angles indicating more severe forward head posture.

How to Measure the Craniovertebral Angle:

• Use software (KINOVEA) to draw a straight horizontal line passing through C7. Draw a second line connecting the C7 mark to the tragus of the ear. Measure the angle formed by these two lines (the acute angle).

• Normal value of CVA: more than 50 degree.
• Patients selected with CVA ranged between 30-50 degrees.

To measure the Cobb angle, identify the most tilted vertebrae at the top and bottom of a scoliosis curve on an X-ray (anteroposterior view).

Steps to Measure Cobb Angle:

1. Identify End Vertebrae: Select the highest vertebra (upper end vertebra) and lowest vertebra (lower end vertebra) in the curve that are most tilted toward the concavity.

2. Draw Parallel Lines:

   • Draw a line parallel to the superior (top) endplate of the upper vertebra.
   • Draw a line parallel to the inferior (bottom) endplate of the lower vertebra.

3. Draw Perpendicular Lines: Draw a line perpendicular (90 degrees) to each of the lines drawn in step 2.

4. Measure the Angle: The angle formed at the intersection of these two perpendicular lines is the Cobb angle.

A curve of more than or equal 10 degrees is defined as scoliosis.

The FSS is an 11-item patient-reported subjective outcome questionnaire consisting of two major categories - pain (one question) and activities of daily living (ADLs) (10 questions). Subjects will answer each question on a 10-point numeric rating scale, with a lower number always indicating worse pain or greater difficulty in function. The maximum score of 100 represents the total absence of pain and best possible function. The minimum score of 0 represents the worst possible result. Fifty points will be allocated for pain and 50 for ADLs. The final score will be calculated by multiplying the value indicated by the patient's answer to the question about pain by 5 and adding this to the half the sum of the total value recorded for ADLs.

The Functional Assessment of Cancer Therapy-Breast (FACT-B) is a widely used 37-item, self-report questionnaire designed to measure the quality of life (QoL) in breast cancer patients. It covers five domains-physical, social/family, emotional, and functional well-being, plus a Breast Cancer Subscale (BCS) addressing specific issues like body image and arm tenderness. It is a 5-point Likert scale (0-4: Not at all to Very much). Scores are summed, with negatively worded items reversed, to calculate subscales (Physical, Social, Emotional, Functional, and Breast Cancer-specific) and a total score (0-148), where higher scores indicate better quality of life.