The purpose of the study is to determine the effect of Thera-band exercises versus Swiss ball exercises on postural stability in unilateral post mastectomy lymphedema.
Patients are females.
Patient with post mastectomy unilateral lymphedema.
Their age will range from (30-50) years.
Patients will be given their informed consent.
Musculoskeletal disorders that will impair performance during training and tests.
Uncontrolled cardiovascular or pulmonary diseases.
Neurological and renal disorders.
Metabolic or vascular disease with a neurological component such as diabetes.
Parallel
Thera-Band exercises
Other interventionParticipants in the first experimental group performed a Thera-Band exercise program 3 sessions weekly, for 8 weeks with progressive resistance, divided into four 2-week phases. Each 60-minute session included a 10-min warm-up (walking, jogging, and calisthenics), 45-min Thera-Band exercises, and 5-min cool-down. Phase 1 focused on major muscle groups (e.g., shoulder press, biceps curl). Phase 2 included trunk and leg-focused moves (e.g., reverse flies, lunge). Phase 3 added advanced resistance (e.g., chest press, deadlift). Phase 4 targeted core and lower body (e.g., diagonal chop, squat). Exercises changed every phase to progressively strengthen different muscle groups.
Swiss ball exercises
Other interventionParticipants in the second experimental group performed Swiss ball exercises 3 sessions weekly, for 8 weeks. Exercises included warm-up (15-5 mins), core Swiss ball training (progressing from 1 to 4 sets), and cool-down. Each session focused on abdominal, back, leg, trunk, and balance training using varied exercises performed for 30 seconds with rest. Exercise intensity ranged from 80-95% of max effort, increasing weekly. The Swiss ball size was selected based on patient height to ensure proper posture. Sessions gradually increased in duration and difficulty, ending with breathing and stretching for recovery.
Traditional physical therapy program
Other interventionParticipants in both experimental groups performed a traditional physical therapy program in the form of complex decongestive physical therapy(CDPT), including (manual lymphatic drainage, compression, exercise and skin care) and balance training, 3 sessions weekly, for 8 weeks.
Center of Pressure (COP)
The Wii Balance Board (WBB) will be used to measure the Center of Pressure (COP), which represents the point location of the vertical ground reaction force vector. This outcome reflects the user's weight distribution and is a key indicator of balance and postural control. COP will be assessed in both the mediolateral (X-axis: left-right) and anteroposterior (Y-axis: front-back) directions, allowing evaluation of postural sway and dynamic weight shifting during balance tasks.
Total Force (Weight)
Total vertical ground reaction force will be calculated by summing the readings from all four pressure sensors on the WBB. This measure provides an estimate of the user's body weight and enables monitoring of force fluctuations during dynamic or static postural tasks, serving as an indirect marker of load-bearing and movement initiation or compensation patterns.
Load Distribution
The WBB will quantify the distribution of body weight across the left vs. right and front vs. back regions of the platform. This load distribution outcome helps identify asymmetries in stance or postural alignment, which can be critical in populations with balance deficits or musculoskeletal impairments. The measure allows for detailed analysis of postural strategy and weight-bearing preference.
Limb volume measurement
Limb volume will be measured using the truncated cone method with circumferential measurements taken at 10-cm intervals (at 0, 10, 20, 30, and 40 cm from the ulnar styloid). The patient will be seated with the limb supported horizontally on a bedside table. A 1-cm retractable fiberglass tape will be used, and an adhesive measuring strip from axilla to wrist will ensure consistency. Segment volume will be calculated using the formula: V = h × (C1² + C1×C2 + C2²) / (12π), where C1 and C2 are the circumferences and h is the 10 cm distance between them.
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