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Help for Postural Pain After Breastfeeding
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Help for Postural Pain after Breastfeeding

International Journal of Childbirth Education. March 2009

Heather Jeffcoat, DPT

One of the most precious bonds between a mother and her new baby is sharing the closeness of nourishing her child. Whether this occurs by breast or by bottle, there is nothing that compares to holding that little baby close, looking into their eyes and taking in that sweet baby scent. Over time, with poor positioning of her infant and adaptive postures that the mother will take on, musculoskeletal pain may develop. The most common place to develop these aches and pains are in the neck, upper and mid-back regions. They can be as mild as a dull ache felt between the shoulder blades to a debilitating tension headache that can make it difficult to care for her child.

With nursing and bottle-feeding, it is important that the child be supported to minimize the requirement of the mother to round her shoulders forward, slump her back and dropping her head forward (Photo 1). There are numerous nursing pillows on the market that aid in correcting this postural dysfunction (Photo 2). Sometimes, multiple pillows may need to be used for increased comfort. There is no one correct way to hold the baby, so different positions should also be attempted in order to identify which is the most comfortable.

Even with postural support and correction, looking down at their new little love is unavoidable. This posture leads to increased strain on the posterior neck and upper back muscles while the muscles in the front of the neck and shoulders are placed in a shortened position, causing them to lose flexibility over time. These postures that have been adapted need to be counteracted in order to reduce or eliminate pain and dysfunction. An exercise routine that emphasizes restoring postural balance is key.

The following list of exercises is generally appropriate for clients who complain of postural pain related to breastfeeding. However, if the pain is severe, or does not improve with the following exercises, referral to a women's health physical therapist is in order. The patient should feel better after completing the exercise. If an increase in pain occurs, she is likely performing the exercise incorrectly or the exercise is not appropriate for the cause of her pain.

Chest openers and biceps combo stretch:

Cue the client to clasp her hands as pictured (A). Inhale, lift the shoulders down and back. Exhale, maintain that posture in the shoulders and lift the arms up (B). This stretch is intense, and should be broken down into 3 sets of 15 seconds for your client's comfort. This stretch should be performed after each feeding.

Neckstretch series:

Cue client to first tilt her ear to her shoulder as pictured (A). Then, client should rotate her head down and to the side (B). Finally, the client should tilt her up and away (C). Each position should be held for 30 seconds and repeated twice each side. Additionally, this series should be performed at least 2 times per day.

Seated rows with resistance tubing:

Cue the client to inhale and extend her spine into an upright position (A). Then, have her exhale as she pulls her arms, like she is rowing a boat (B). Perform 2 sets of 15 repetitions, 3 times a week. This exercise can also be performed without resistance.

Prone flies over birthing ball:

Position your client as above (A) and have her inhale to prepare. Then cue her to exhale as she lifts her arms up to the ceiling (B). She should begin with at least 10 repetitions and gradually work up to 30 repetitions before adding any weight. Creating a balance between strength and flexibility is key.

If a client's symptoms do not improve with the above techniques and exercises, additional intervention may be required. A women's health physical therapist can assist you with finding other potential causes of pain and provide a more directed treatment plan. If you don't know of one in your area, contact the American Physical Therapy Association Section of Women's Health at This email address is being protected from spambots. You need JavaScript enabled to view it. or (800) 999-APTA, extension 3229.

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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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My husband and I were having problems with painful intercourse. My therapist recommended that I go and get a pelvic floor evaluation from a physical therapist. Having never been treated by a physical therapist, I wondered how this really was going to help me. My husband who is a physician was very supportive and agreed that a PT evaluation would be a great idea. So i made the appointment and was blown away by what I learned. I had no idea that pelvic floor muscles could get tight and have trigger points just like any other muscle in the body. I'm a massage therapist and very familiar with tight muscles, and this new thought really amazed me. Heather's program to help relax and strengthen these muscles made such a difference. I can say that I am 100% pain free during intercourse now. Yippee! Going to the PT appointments and doing the at-home exercises was definitely a discipline, but it's 100% worth it! The rewards are amazing.

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I have been going to see Heather for a while now, and I can't tell you enough how much she has improved my quality of life. Heather specializes in issues like pelvic floor, but I see her for other orthopedic issues.

I have a lot of chronic joint pain and dysfunction issues (back, hips, neck) that require that have ongoing physical therapy maintenance. The effects of my problem joints/areas overlap and interconnect with each other in complex ways, so helping me requires really having a complete understanding of the entire skeletal and muscular system. Pain does not always appear where the problem actually is, the human body is a twisty, many-layered puzzle. I have an exercise program I do at home and I am very functional, but there are just something things I need a PT to help me out with.

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Testimonial by Julie T.

Femina PT (née Fusion Wellness & Physical Therapy) has honestly changed my life. Before receiving treatment at Femina, I was going doctor to doctor to try and find the answer to my pelvic pain. It has taken me YEARS to find someone that can help fix this. It wasn't until my gynecologist recommended your clinic that I finally felt relief. My pelvic pain is almost gone, and granted I still have a lot more to work on with Laureen (my PT), my original problem is nearly cured. I am so grateful to her.

What is even better is she gave me practical exercises to do at home that were not tedious and provided instant (and lasting) relief. Although I mainly work with Laureen, my interaction with the owner (Heather) has been great. She is very generous, kind, and committed to her business.

It hurts to know there are women out there suffering who will never know or have the opportunity to work with women like Laureen and Heather because this issue is hardly talked about and this field is so rare. I hope more doctors and physical therapists see the value in this work and can relieve more woman of their pain.

-- Julie T., 12/4/16 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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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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