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Therapeutic Breast Massage in Lactation | Image Courtesy of Mehmet Turgut Kirkgoz via Unsplash
Therapeutic Breast Massage in Lactation | Image Courtesy of Mehmet Turgut Kirkgoz via Unsplash

Therapeutic Breast Massage in Lactation Can Help Make Breastfeeding Less Painful

Breastfeeding is widely accepted as the normal standard for providing nutrition to newborns, however, many women who do not reach their breastfeeding goals. US national data stated that breast pain was a commonly reported reason for women weaning less than 1 month postpartum. Within that segment, 29% of women who participated in the study stated that “breastfeeding was too painful” to continue.

In the same study, 24% of women reported “breasts feel(ing) too full or engorged” as another reason to discontinue breastfeeding prior to 1 month postpartum.1 Currently, The American Academy of Pediatrics recommends exclusive breastfeeding of infants for the first six months of life. As physical therapists who treat patients with postpartum conditions, we are well positioned to make a big impact on patients with breastfeeding related pain and reduce barriers to continued breastfeeding!

Therapeutic Breast Massage in Lactation (TBML) is a specific type of manual therapy that specially trained providers can perform to relieve pain and excessive engorgement related to breastfeeding. What’s even better is that your physical therapist at Femina Physical Therapy can teach you how to perform this massage yourself to prevent more pain in the future!

First, let’s get familiar with different types of breastfeeding related conditions.

The common attribute among these conditions is that they are typically caused by milk stasis or inadequate removal of milk from the breast:

  • Engorgement: Uncomfortable swelling of the breast associated with increased milk secretion
  • Blocked Milk Ducts: Engorgement can lead to inflammation surrounding the milk duct, causing the duct to collapse and stop the flow of milk. This can sometimes form a tender lump in the breast. A milk bleb may form in the appearance of a small, white bump on the nipple.
  • Mastitis: Inflammation of the breast. It may be non-bacterial or with a bacterial infection of the breast. It is associated with a hard, red and swollen part of the breast. Systemic symptoms can be present including fever, chills and body aches. When infection is present, it must be treated by antibiotics prescribed by your provider prior to being treated in physical therapy.

Traditionally, therapeutic breast massage for the alleviation of blocked milk ducts has involved deep, painful massage strokes towards the nipple. What we now know about engorgement and blocked milk ducts is that inflammation surrounding the duct is the culprit. Our lymphatic system is responsible for moving inflammation throughout the body, and this system lives directly under the skin and gets suppressed by the use of deep pressure. By performing light massage strokes opposite to the flow of milk, we can encourage lymphatic flow to reduce inflammation, giving milk ducts room to allow for adequate flow.

Therapeutic Breast Massage in Lactation Step by Step:

Step 1: Stimulate your lymphatic system
  • Close your eyes. Take 10 long diaphragmatic breaths into your low belly. Perform 10 gentle, circular strokes at the base of the neck. Finally, perform 10 circular strokes in the armpit.
Step 2: Perform massage on the affected breast
  • With a flat palm, use broad, light sweeps starting from under the breast towards the armpit with the hand opposite to the breast you are working on. Perform this for 1-2 minutes. Use light pressure, similar to if you were petting a cat. Use enough pressure where you are moving your skin just a bit.
  • Using the same broad stroke, sweep upwards from the nipple, over the chest and neck, ending at the chin. Perform this for 1-2 minutes.
  • Follow your therapeutic breast massage by nursing your baby or by hand expressing.

Additional tips for therapeutic breast massage:

  • Perform your therapeutic breast massage prior to every time you are expressing milk if you are dealing with a blocked duct until the blockage is cleared.
  • Avoid deep and painful pressure of the breast tissue
  • Consider following up your Therapeutic Breast Massage in Lactation with some cold compress as opposed to heat to reduce inflammatory process
  • Consistent milk removal is key to improving symptoms!

References:

  1. Li R, Fein SB, Chen J, Grummer-Strawn LM. Why mothers stop breastfeeding: mothers’ self-reported reasons for stopping during the first year. Pediatrics. 2008;122(suppl):S69-S76.
  2. Cooper BB, Kowalsky D. Physical Therapy Intervention for Treatment of Blocked Milk Ducts in Lactating Women. Journal of women’s health physical therapy. 2015;39(3):115-126. doi:10.1097/JWH.0000000000000037
  3. Witt AM, Bolman M, Kredit S, Vanic A. Therapeutic Breast Massage in Lactation for the Management of Engorgement, Plugged Ducts, and Mastitis. Journal of Human Lactation. 2016;32(1):123-131. doi:10.1177/0890334415619439

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A personal journey and testimonial from one of my patients:

My husband and I were married for 5 years before we were able to have intercourse due to my vaginismus. There was nothing traumatic in my past but for some reason, even though I wanted sex, I mentally avoided "that area" of my body and didn't even admit to myself that there was a problem for a long time, even though I was never able to put tampons in. Once I finally opened my eyes up to the fact that I had a problem, I had a surgery that was supposed to fix the issue.

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I went to Heather after the birth of my third child. It was lucky, really, that I was referred to her, because my doctor had referred me to a surgeon for a possible hysterectomy or pelvic wall rebuild. Thankfully, I went to Heather before undergoing either surgery, she was able to fix the problem. She has studied extensively in women's health--even written a book about it--and was able to diagnose my problem, suggest a course of treatment (6 weeks), and then follow through with said treatment. By the end, as she said, I was as good as gold. Boy, was it worth it! Though uncomfortable to talk about, much less write about, it is worth getting the word out there. If you have painful intercourse, especially after birth or other trauma, the treatment may be as simple as Physical Therapy (with Heather, of course). I highly recommend her.

-- Fritzette H., 3/24/16 via Yelp!

Testimonial by Lauren B.

Femina PT (née Fusion Wellness & Physical Therapy) has been such an answer to prayer, i'm so glad I found them! I've been struggling with vaginismus my whole life, but didn't have a name for it until about 6 or 7 months ago. Even once I did have a name for it though, I didn't know where to begin in getting help. My OB/GYN had me get a set of dilators, but I couldn't even insert the smallest one by myself. Most times I tried I just ended up frustrated and in tears. I felt really alone, like I was broken and didn't have the energy to keep trying. When I got engaged a few months ago though, I realized I needed to get answers so i wasn't dreading my honeymoon.

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Before I was referred to Heather Jeffcoat I was living in a nightmare. I had been married to my husband for three years and I was suffering from Vaginismus. That all changed when I visited my OBGYN and she said she knew of someone with a great success rate. To be honest I was hesitant at first because my first doctor had already told me that all I needed to do was order dilators from the internet and I should overcome my problem. She was wrong because I had followed the book on how to use the dilators with absolutely no advancements in my condition. However, that all changed when I went in for my first visit and Heather took the time to explain my condition and how we were going to work together to overcome it.

I remember leaving her office with a glimmer of hope that I could live a normal life. As my sessions continued I began to see immediate results. With only four sessions and a strict dedication to my home programs I was cured of Vaginismus. In the beginning of this process I was made aware that my health insurance company might not cover the costs, which was disappointing but today I can say one hundred percent that it was the best money I ever spent. Now thanks to Heather I am finally enjoying my life to the fullest with my husband. Thank you Heather, I can’t begin to tell you how much I appreciate all that you have done for me. I will never forget it. Those who are suffering from these types of conditions don’t be afraid because she makes you feel so comfortable and the end result is worth it. Good luck to you all and I hope you experience the success I have.
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My last appointment with Heather was over 6 years ago but I still think of her every day. I don’t take for granted that I can easily get out of bed, care for my two active and busy young boys, run, play tennis, clean my house, or sit at a desk for several hours at a time. None of these tasks were easy for me before meeting Heather. Eight years ago my car was struck from behind by a tractor trailer that was estimated to have been speeding. I spent 3 years working with different PTs and Drs trying to heal and move on with my life. When I became pregnant and the hormone relaxin that “relaxes” all the joints of the body and the additional weight gain erased all my progress and I was suddenly in a lot of pain again. My OB sent me to Heather for one last try.

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