What does physical therapy have to do with blocked milk ducts? I’ve spoken to a number of physical therapy friends about this topic, and I’m frequently met with skepticism. I get it, this is not something we talk about in PT school, and it’s not something pregnant women are often told either. With that said, my goal as a physical therapist is to help manage my patients’ pain and make them as independent, active, and comfortable as possible. Physical therapy can effectively manage blocked milk ducts. I’m here to tell you how we can do this, but let’s start with what blocked ducts are and how they happen.
What are milk ducts?
I’ll begin with the basics. Milk ducts, also called lactiferous ducts, are tubes that carry milk from the glandular tissue, where it’s made, to the nipple. A duct can become clogged if any of these canals become compressed, which can happen as a result of tight clothing, bras, or excess adipose tissue causing increased force on the duct. Additional risk factors may include an overabundant milk supply and not emptying the breast following each feeding. Women are at the highest risk for developing a clogged duct within the first four weeks following pregnancy, with 60% of cases occurring during this time.
While tenderness while breastfeeding is normal, clogged ducts are more painful. Women with clogged ducts will report discomfort wearing their regular clothing as well as increased pain when breastfeeding or during palpation of the breast. Once clogged, a duct will feel like a hard, palpable mass in the breast; while this may raise some red flags, keep in mind this mass typically arises quickly (over the course of hours or days). Breast cancer is still a concern, but the rapid appearance of symptoms is an important differentiating factor.
Mastitis is another important concern you want to keep in mind. While blocked milk ducts typically resolve within 24-48 hours, if they don’t, women are at risk for developing a potentially dangerous infection called mastitis. While clogged milk ducts feel painful to the touch, mastitis presents with additional symptoms, some of which are systemic. Mastitis’ onset is typically sudden, with women reporting flu-like symptoms appearing within hours. The breast tissue may become red, inflamed, and hot to the touch. Women experiencing mastitis may also report fever, body aches, malaise, and chills. This is a medical condition that needs medical treatment. If your patient is experiencing these symptoms, advise her to call her physician as soon as possible.
How can physical therapy treat blocked milk ducts?
Fortunately, much can be done to prevent clogged ducts, mastitis, and further complications. Physical therapists are in an excellent position to help, so let’s talk about how, exactly, we can provide that help.
A lot of the help that PTs can provide is education. Here are some things you want to tell your breastfeeding patients for prevention:
- You want to ensure proper latching. For best results, consult an experienced lactation consultant.
- Allow your baby to completely empty one breast before switching to the next. Alternate which side you begin feeding on.
- If you smoke, consider quitting as this is an additional risk factor.
- Switch positions you breastfeed in to ensure optimal emptying.
If you are seeing a patient already experiencing clogged ducts, you can educate them on additional techniques for managing the blockage as well as pain.
- While it may be tempting to stop breastfeeding on the side you are experiencing the blockage and thus the pain, do not stop. In fact, start nursing on the side of the blockage. The baby nursing on the affected side is an important step in keeping the milk moving and clearing the blockage.
- Consult your physician regarding lecithin, a phospholipid supplement thought to reduce the likelihood of clogs.
- Completely empty your breast milk each time you feed. If the baby does not eat enough to empty your breasts completely, use a pump following feeding.
- Heat is your best friend. Using moist heat for up to 15 minutes can help release the blockage, reduce pain, and improve drainage. Do this before feeding to open up the ducts. A hot shower will have the same beneficial effects.
- Self-massaging the affected breast beginning on the proximal portion of the breast and moving distally can help clear a blockage and express milk. You can do this while breastfeeding or while in the shower.
- Lastly, Cabbage! Research findings indicate that boiled and cooled cabbage leaves applied to the affected breast can reduce pain and inflammation. Apply it to the affected area for about 20 minutes, three to four times per day.
If all of this isn’t enough, there are techniques you can try in your clinic. These techniques include moist heat, manual therapy in the direction you want to promote drainage, and therapeutic ultrasound.
I know ultrasound is a contentious topic in physical therapy, and I know the evidence supporting this technique for this population is relatively inconclusive, but studies that have been conducted on the subject are typically of small sample size and are not exceedingly thorough. This combined with the fact that clogs often resolve on their own, it’s hard to say exactly how excited we should be about ultrasound for this population. That said, performing an ultrasound won’t harm your patient and research has shown that it can be effective in reducing clogs faster. Without any alternatives available to us and with ultrasound typically being something sought out after all other treatments have been unsuccessful, I firmly believe it’s worth a shot.
If you’re interested in reading more, a recent 2015 article published in The Journal of Women’s Health Physical Therapy by Cooper and Kowalsky reviews a number of the topics I’ve discussed throughout this article!1
Clogged ducts are painful and can be debilitating, but as physical therapists there are many techniques in our wheelhouse that can help ease the pain. You don’t have to be a pelvic floor or women’s health specialist to help these people, and if these simple suggestions don’t yield the results your patient needs, refer them out to a local lactation consultant! They just need to know help exists.
- Cooper, B. B., & Kowalsky, D. S. (2015). Physical Therapy Intervention for Treatment of Blocked Milk Ducts in Lactating Women. Journal of Women’s Health Physical Therapy, 39(3), 115-126.