Mastitis and nipple damage are two really common issues for lactating mothers, especially in the early days and weeks. Almost always (especially if these issues are recurrent), a lactation consultant will help get to the bottom of these issues.
However, there is an important puzzle piece that is often involved alongside lactation therapy - some physiotherapists use electrophysical agents to help with settling inflammation, decreasing pain and/or speeding up wound healing. It's possible to treat mastitis and nipple damage with therapeutic ultrasound and low level laser therapy - treatment options that a lot of women have never heard of.
What therapeutic ultrasound actually treats
Mastitis literally means 'inflammation of the breast', often presenting as an area of breast tissue that is hard, sore, hot and/or red. Alongside these signs, mastitis can also mean less milk production by the affected breast. This is where the colloquial term for mastitis, 'blocked duct', comes from - but it's important to understand that it's not 'blocked' because of a hard lump of milk that needs to be pushed through or 'massaged out'. It's 'blocked' because of the inflammation of the surrounding breast tissue compressing down on it.
Therefore, all aspects involved in the treatment of mastitis need to focus on an 'anti-inflammatory approach'. This might include ice, anti-inflammatory medication, and advice from a lactation consultant about how to continue to feed and encourage good milk supply without accidentally causing an overproduction of milk (and therefore more inflammation).
This is what therapeutic ultrasound does - the ultrasound head covered in gel goes back and forth over the affected area, giving gentle sound wave therapy to the area to encourage efficient resolution of the inflammation. This then secondarily should ease pain, soften the area and improve drainage of the milk.
What low level laser therapy actually treats
Nipple damage - cracked, blistered or broken skin on the nipple - is another really common issue in the early weeks, and it's one of the most common reasons mums consider stopping breastfeeding altogether. Sometimes it occurs because of damage as the newborn is learning to attach and suck, but it's often multifactorial and can happen secondary to issues with positioning, nipple shape, tongue tie, dermatitis, thrush or bacterial infection. This is why a proper assessment is worthwhile before jumping straight to treatment, and ongoing nipple pain or damage should always be assessed by a lactation consultant.
Physiotherapy done alongside management with a lactation consultant can be a really handy addition. Low level laser therapy (also called cold laser) is a completely painless treatment that uses light energy, rather than heat, directly on damaged tissue. At a cellular level, it's thought to support the skin's own repair process, settle local inflammation, and reduce the bacterial load on the area - which matters because broken skin is an easy entry point for infection. Because there's no heat involved, there's no discomfort; the probe is simply held against the skin for a few minutes. The patient and the therapist need to wear protective glasses, and it's worth noting that the baby cannot be in the room at the same time, due to the potential for damage to the eyes.
Research specifically looking at low level laser therapy for nipple pain and damage has found it can meaningfully ease pain and support the skin's healing, when it's used alongside good positioning and latch support. As with a lot of research in this space, studies are still working out the ideal dose and timing - but the existing evidence is promising enough that it's become a standard tool in breast physiotherapy.
Working together
The most useful aspect of having physiotherapy and IBCLC support side by side is that quicker symptom resolution is more likely. You get the lactation expertise to look at latch, supply and overall management of how you feed and express - and the concurrent physical treatment from the physiotherapists to manage pain and inflammation.
If you think physio might help, our team can see breast physio patients at FitRight Women's Health in Applecross six days a week. We prioritise these patients, and wherever possible we offer same or next-day appointments when laser or ultrasound treatment is needed.
