Physical Therapy for Clogged Ducts & Nipple Damage

Feeding human milk is so incredibly healthy for both baby and {m}other.

• Breastfed infants have unexpectedly low incidents of endometriosis in adult life (Tsutsumi 2000)

• Breastfeeding may have a preventative effect on urinary tract infections in both mother and infant (Coppa 1990, Hanson 2004, Marild 2004)

• Breastfed children have a lower risk of fractures in early childhood

• Women who breastfeed have no long-term bone strength deficit UNLESS they smoke (Jones 2003)

• There is a decreased risk of Rheumatoid Arthritis in postmenopausal women with a history of long-term breastfeeding

• Breastfeeding women's HDL (the good kind) cholesterol levels make up higher % so may prove to decrease the risk of coronary heart disease in later life (Dermer 1997)

• Breastfeeding is associated with a reduced risk of type II Diabetes in adults (Barclay 2008)

• Women who developed mastitis while breastfeeding had the lowest risk of Ovarian Cancer, those who breastfed and did not develop mastitis had an intermediate risk of Ovarian cancer and those who never breastfed had the highest rate of Ovarian cancer (Cramer 2013)

• A meta-analysis of 47 studies found that each year of breast-feeding was associated with a 4.3% reduction in the risk of invasive breast cancer (Stuebe & Schwarz 2010)

While we know how healthy it is for the mother-baby dyad, breastfeeding is not always easy. Nipple damage, clogged ducts, and mastitis a huge bumps in the road of the breastfeeding journey that physical therapy can help.

Mastitis occurs in 2-33% of breastfeeding mothers with the highest incidence at 2-3 weeks postpartum and occurs when there is inflammation of the mammary glands and ducts often due to hyperlactation (too much milk production often due to a longer stretch of a feed). It is likely under-reported. The inflammation causes the ducts and surrounding connective tissues to narrow causing a vicious cycle of narrowing->inflammation and inflammation->more narrowing. Another contributor to ductal narrowing is the disruption of the milk microbiome. The milk microbiome results from a complex interplay of maternal genetics, medical conditions, exposure to antibiotics, use of probiotics, regular use of breast pumps, and cesarean births. The best cure for mastitis is actually prevention.

Here are some ways to prevent clogged ducts and mastitis:

• Minimize breast pump usage and nipple shields– where possible– (because it affects the milk microbiome as well as proper emptying of the breasts)

• Many patients experience breast fullness or feel normal lactating tissue and misinterpret that as “plugging”. Lactating breasts DO feel lumpy and even painful at times

• Feed your baby on demand without trying to “empty” your breasts

• Wear a good-fitting bra that does not cut off circulation to your breast tissue

• Avoid deep massage of the breast tissue, as that can cause inflammation and ductal narrowing

• Use good hand washing to avoid introducing harmful bacteria into the milk microbiome or onto the nipples

• The moment you start to feel a clog, get an appointment to address it before it becomes mastitis

If you DO get a clogged duct, here is how physical therapy can help:

Ultrasound

Therapeutic ultrasound has been shown to reduce inflammation to help unclog the duct. It uses micro-massage, increases fluid movement around the duct, and improves pain, healing, and tissue mobility. It is pain-free, quick, simple, and non-pharmacological, does not affect breastfeeding, speeds up healing, and improves pain.

Decongestion of the chest and upper body

Think of breast tissue as a sponge. If the sponge is compressed, it can not easily fill, or empty. Poor posture, forward shoulders from feeding, and chest tightness compress the lymphatic flow from the breast back to the body like a compressed sponge. This compression - particularly in the pectoralis minor - compresses the vessels of the lymph which means that the breast tissue may experience even more engorgement (and more engorgement = more inflammation). Posture work is essential to address the proper flow of nutrients in and lymph fluid out. Lymphatic massage is also used to help remove any extra "stuck" fluid in the breast tissue. The fluid in the lymphatic system helps remove waste and toxins from the bodily tissues. Lymphatic massage is very light: the depth of petting a cat.

KINESIOTAPING

Kinesiotaping

Using therapeutic taping is another way to improve lymphatic flow to decongest the breast, aid in healing, and decrease ductal narrowing

Class IV therapeutic laser (also called photobiomodulation)

Laser is used to help accelerate the healing of cracked and damaged nipples. The therapeutic laser stimulates wound healing by increasing cell metabolism by improving the availability of ATP, reducing inflammatory pain, reducing scars, and promoting ulcer healing. It is also very quick and painless. We offer all of the above treatments at both of our locations.

Other suggestions for clogged ducts are the use of probiotics to help your milk microbiome. Strains should include Limosilactobaccillus fermentum or Ligilactobacillus salivarius. We also want to address postpartum mood and anxiety disorders. Postpartum is an incredibly stressful time and lack of stress and sleep affect your inflammation (and therefore your ductal narrowing).

Often, where there is plugging or clogging, the root issue is a feeding issue between the mother-baby dyad, and working with a lactation consultant can be immensely useful. Some of our local favorites are Nurturing Birth and Beyond, Coming Home RVA, and the VCU Lactation Clinic. To book a clogged duct PT visit, book at www.rvaholisticpt.com/book or send us a text (because we want to get you in quickly) at 8043720291. First visits are 55 minutes long and follow-ups are 15-55 depending on what you need.