Scapular Stabilization Exercises Combined With Thoracic Mobilization in Breast Feeding Mothers With Upper Back Pain

This assessor-blinded, randomized clinical trial will be conducted at the University of Lahore Teaching Hospital, Lahore. Seventy breastfeeding mothers will be recruited using purposive sampling and randomly allocated by lottery method to two equal groups of 35 participants. Eligible participants will be women aged 18-35 years who are within three months after childbirth, exclusively breastfeeding, and experiencing breastfeeding-related upper-back pain rated between 4 and 7 on the Numeric Pain Rating Scale.

Before treatment, participants in both groups will receive a standardized warm-up consisting of a moist hot pack applied to the cervical and upper-thoracic regions, followed by gentle stretching. Group A will receive scapular stabilization exercises combined with thoracic mobilization. The exercise programme will include scapular retraction and depression, serratus anterior punches, wall slides, and prone horizontal abduction with scapular setting. Thoracic mobilization will be performed by a trained physiotherapist to improve thoracic extension and segmental mobility and reduce stiffness. Group B will receive the same scapular stabilization exercise programme without thoracic mobilization. Exercise difficulty will be progressively increased by adding repetitions and resistance.

The interventions will be delivered three times per week for eight weeks. Each exercise session will last approximately 30-35 minutes, with an additional 10-15 minutes of thoracic mobilization for Group A. The outcome assessor will remain unaware of participants' group assignments.

The primary outcome will be pain intensity, assessed using the 11-point Numeric Pain Rating Scale. Secondary outcomes will include functional ability measured using the Patient-Specific Functional Scale and spinal range of motion measured in degrees using a digital inclinometer. Assessments will be completed at baseline, Week 4, and Week 8.

Data will be analyzed using descriptive and inferential statistics. Data distribution will be assessed before analysis. Changes over time and differences between groups will be examined using repeated-measures analysis of variance, with post-hoc pairwise comparisons where appropriate. Statistical significance will be set at p≤0.05.

Inclusion criteria

• Women in the early postpartum period (0-3 months following childbirth) (Ratajczak & Górnowicz, 2024).
• Women who were exclusively breastfeeding and experiencing upper back pain associated with breastfeeding activities within the first 3 months postpartum (Ojukwu et al., 2025).
• Participants reporting moderate upper back pain, defined as a score of 4-7 on the Numeric Pain Rating Scale (NPRS) at the time of recruitment (Bharti et al., 2024).

Exclusion criteria

• History of cervical spine trauma, surgery, or fracture (Yan et al., 2023).
• Presence of neurological disorders, cervical radiculopathy, myelopathy, or musculoskeletal conditions unrelated to breastfeeding that could influence neck pain, cervical mobility, or functional performance (Yonus et al., 2025).
• Diagnosed systemic illnesses or medical conditions that may contraindicate exercise participation, such as rheumatoid arthritis, ankylosing spondylitis, osteoporosis, uncontrolled hypertension, cardiovascular disease, or other inflammatory or metabolic disorders affecting the musculoskeletal system (Womsi et al., 2025).
• Concurrent pain in other body regions (e.g., shoulder, thoracic spine, upper back, or upper extremity pain) that could interfere with exercise participation or influence outcome measurements (Rana et al., 2024).
• Ongoing physiotherapy, rehabilitation, or medical treatment for neck pain during the study period (Ratajczak & Górnowicz, 2024).