Today I bring your attention to an area of the body that we pay a lot of attention to during the early years of motherhood: the breasts.

Breasts are great. They make milk. They nourish our babies. They provide a nice soft cushiony surface for cuddling a little one…I’m sure you can think of some other great features.

But they can also cause problems.

From engorgement to blocked ducts, mastitis, image insecurities, thrush, painful nursing…  Indeed for first time moms, it can be a real shock!  I remember wondering if I was going to make it through my first two weeks of breastfeeding, which was excruciatingly and surprisingly painful.  Yes, breastfeeding is a whole new world deserving of its own special category health professional: the lactation consultant.

But what about physio?  What could a physio possibly have to do with breasts? Well, I’m glad you asked.

When you have bigger breasts than usual, and when you spend inordinate amounts of time nursing, and when you are sitting curled forward in a rocking chair to breastfeed…structural changes take place.  Muscles in the front of your shoulders tend to shorten. Muscles in your upper back and shoulders start to lengthen.  Muscles in your neck start to tighten from looking down at baby all the time.   You can get numbness and tingling down your arms and into your wrists and fingers.  You can develop a tendinitis of the wrist or thumb from overuse.  The stabilizing muscles of your shoulder girdle may begin to weaken.  You can get ring shifts throughout your throax.  You can get achy trigger points all over your upper body.   Your spinal alignment begins to slip into non-optimal patterns – your head moves forward, your thorax moves backwards, and because you slouch in your chair, your tailbone tucks in.  It becomes harder to breath because your rib cage doesn’t expand as much.  You begin to lose endurance and stamina for good body positioning.   You begin to change pressure gradients through your abdominal and pelvic cavity.

All these changes manifest in classic dysfunctional mommy posture.   And, might I add, pain.  It is especially challenging during baby’s first three months where you’re up a lot throughout the night, nursing for what feels like hours, when you’re too tired to adjust your positioning, and when the baby is so floppy because she is still developing head and neck control.  Trust me, I get it!

So we want to counteract this downward pull of gravity that seems to accompany motherhood.  What are some practical ways to do this?

1.       Invest in a really well fitted and supportive nursing bra.  You may need to go shopping several times during your breastfeeding tenure because  boobs change over time.  A line I recommend is found here –  Not only are they well crafted bras with clever innovations that a nursing mom would appreciate, but they also are designed to help you feel feminine and sexy.

2.       Stretch.  While you are nursing, you tend to look down a lot. This is totally normal!  After you’ve gotten the hang of things and latching is easier, you might want to spend some time stretching your neck while you nurse.  First look to your left and hold for 5 seconds, then to the right and hold for 5 seconds.  Repeat this gentle stretching 10x on each side.  Then can stretch by bringing your right ear towards the right shoulder. Hold 5 seconds, then do the left side.  Repeat 10x in each direction.  You can also do some gentle neck rolls in each direction.

3.       After you’ve put your baby down post nursing, do a couple more stretches.  Stand up, stack your thorax over your pelvis and roll your shoulders forwards, then backwards a few times.  Do more if it feels good.  Then keeping your arms straight, raise both your arms up towards your ears. Take a nice deep breath as you lift your arms.  Then lower.  Do this 5-10x.  A variation of this stretch is to look up towards the ceiling as you lift your arms.  It will give you a nice deep stretch right in-between your shoulder blades.

4.       Sitting aligned in your nursing chair is also important.  Get a nursing pillow, towels, cushions, a foot stool, or a back roll and experiment (when baby is not screaming for food) with comfortable positioning.  Play around until you find a spot where you are not slouching, where your lower back is supported, and where your arms are supported so you don’t have to continuously lift them during nursing.   The idea is to bring the baby to you using comfortable supports, rather than your body to the baby.

5.       Another idea is to simply not sit when nursing.   Nursing while lying down takes all the strain off your body and gets you out gravity’s downward pull.   You should talk to an international board certified lactation consultant or breastfeeding support group such as La Leche League about other creative positions for effective nursing.

Which brings me to the last idea you can try – breast  and chest massage.

Breast massages are lovely.  They can be a bit uncomfortable at first because of tenderness, but they really make an incredible difference.   They help keep the tissues soft and pliable.  They may help with reducing stretch marks or scars.  If you have a blocked duct, massage is one of the best ways to clear it up (see note at end).  Other benefits include increased oxygen and nutrient delivery, decreased lumpiness of breast tissue, decreased lymphatic congestion, decreased tension through the chest wall, and having a baseline idea of what is “normal” for you.  If you do detect something off, you will know it’s abnormal because you are familiar with your breasts.

During a breast and chest massage, the breast tissue itself, as well as the muscles which lie underneath (the intercostals, pectorals, serratus anterior, etc), are manipulated.  You might find some painful trigger points or hypertonic areas in the muscles underneath the breasts which need to be released.  You will find it easier to breath and stand in more optimal alignment after a breast and chest massage.

You can do a self-massage or you can have your partner help.  There are also registered massage therapists who are trained to do breast massage.  Here are some pointers to get you started:

  • You will need to lie down on your back so you’re comfortable. You can also sit up supported, but that brings gravity back into the picture.
  • You will want to have a little oil or lotion for the massage.  Babies can react to scents and it can affect breastfeeding, so you will want to use something that is as pure as possible and avoid the nipple area. You may need to wipe off any excess oil post massage.
  • You should wait until after your baby is done nursing before doing a breast massage.  Also, it is normal to leak a little milk during a massage, especially if your breasts are full.
  • Remember that your breast tissue extends all the way up towards your armpits, so don’t neglect that area when doing a massage.
  • Don’t cause yourself pain. Any discomfort you feel should be tolerable.  If you push too hard, you will only cause yourself to tense up further, thus undoing any benefits of a massage.
  • If you are not nursing but are bottle feeding, you can still get all the benefits from a breast and chest massage!

I will refer you to this website for a basic breast massage technique you can try.

For the muscles which lie underneath the breast, you will need to apply a bit more pressure with your fingers and sink through the breast tissue to go deeper to the muscles.   Feel for the spaces between your ribs and glide your fingers along those spaces starting from sternum and extending out towards the side of your body.  Only go in one direction rather than rubbing back and forth.

Move from the top to the bottom  (starting just under your collar bone) working your way around the breast as much as possible.  Start with one breast, then do the next one.  You might need to spend a bit of extra time on areas that seem a bit firmer to touch or more painful.  You might be on a hypertonic muscle or a trigger point that needs to be released.

As you work the muscles of the chest wall, make sure to breathe and visualize the muscles softening and melting.  Imagine that as you breathe and expand your rib cage, that you are creating space between all your ribs and circulating the air through that space. You will be pleasantly surprised at how much lighter you feel after a breast and chest massage.

Well kids, what are you waiting for?!  Go ye forth and massage those breasts!

A note about blocked ducts:  Therapeutic Ultrasound is an effective treatment for blocked ducts.  Most physiotherapy clinics have an ultrasound machine but most therapists don’t know that they can use ultrasound to treat a blocked duct.  If you think you want to try ultrasound for a blocked duct , have your physiotherapist read these two articles for info about correct dosage. Article 1  and Article 2

So, did you try it out? How did you feel before and after? Any suggestions for how to make it even better?