Mastitis Physiotherapy.
Therapeutic Ultrasound for Mastitis on Brisbane's Southside
What is mastitis — and what does current evidence say about it?
The understanding of mastitis has changed significantly in recent years. Breastfeeding experts used to think of mastitis, blocked ducts, abscesses and milk blisters as separate problems. Newer research suggests these are all stages of inflammation — the body's response to a threat. The Academy of Breastfeeding Medicine (ABM) revised their clinical protocol in 2022 (Protocol #36: The Mastitis Spectrum) to reflect this updated understanding, and La Leche League International has updated their guidance accordingly.
What once was thought of as a "plugged" duct is actually a series of tiny ducts that have become inflamed and narrowed, hindering milk flow. Milk blebs, slowed milk flow, blocked ducts and mastitis are therefore all part of the same inflammatory spectrum rather than distinct conditions — and importantly, this means many cases are not primarily infectious in nature, at least not at the outset.
Mastitis is not an infection when it starts. Taking unnecessary antibiotics too early may encourage resistant strains of bacteria to thrive and may make you more likely to have recurrent mastitis or an abscess in the future. This is an important message for breastfeeding parents: the presence of breast pain, redness and warmth does not automatically mean antibiotics are needed, and physiotherapy treatment is often the most appropriate first response.
What are the symptoms?
You may notice a large area of your breast that feels lumpy, swollen, hot and painful. The skin over that area may look red or darker than usual. You may get a high temperature or feel unwell like you have the flu, sometimes having a headache and tender muscles. These are all symptoms of breast inflammation within the mastitis spectrum.
When should I see a GP?
If you develop a fever above 38.5°C, feel severely unwell, notice a fluctuant swelling suggesting abscess formation, or your symptoms are not improving after 12 to 24 hours of appropriate management, see your GP promptly. Infective mastitis — where bacteria have established a true infection — requires antibiotic treatment in addition to physiotherapy. A breast abscess requires medical drainage. Your physiotherapist and GP work as complementary parts of your care, not in place of each other.
What does current evidence recommend for treatment?
Based on ABM Protocol #36 and La Leche League guidance, the priorities for managing breast inflammation and mastitis are:
Continue breastfeeding. It is important for your baby to continue breastfeeding from the affected side to help prevent the inflammation from worsening and creating an abscess. Stopping feeds or pump sessions from the affected breast allows milk stasis to worsen. Breastfeeding from the affected side is safe for the baby.
Ensure effective milk removal. At times, mastitis is the result of difficulties with positioning and/or latch that impact how efficiently your baby takes milk from your breast. A La Leche League Leader or lactation consultant can help identify and address latch and positioning issues that may be contributing.
What to avoid. Avoid trying to "empty" the breast through extra pumping or breastfeeding which increases milk production, and avoid using Epsom salts, warm compresses, olive oil, castor oil, or other oils on the skin of the breast or nipple. These approaches — once widely recommended — are not supported by current evidence and may worsen inflammation.
How can physiotherapy help?
Therapeutic ultrasound is the primary physiotherapy intervention for mastitis and blocked ducts, and it is well supported by evidence and clinical experience. Therapeutic ultrasound is a non-invasive treatment that uses high-frequency sound waves to promote healing and reduce inflammation. In the context of mastitis, therapeutic ultrasound applied to the affected breast tissue reduces localised inflammation, promotes tissue healing, and assists with restoring normal milk flow through the narrowed and inflamed ducts — without the risks associated with vigorous massage or attempts to physically "clear" a blockage.
During your session at Articulate Physiotherapy, our physiotherapists will assess your condition to ensure that therapeutic ultrasound is appropriate for your case. If suitable, a gel is applied to your skin and the ultrasound probe is moved gently over the affected area. Each treatment session typically lasts between five and fifteen minutes depending on your specific needs. Treatment may be more frequent initially — possibly daily — to provide relief and promote healing.
Gentle lymphatic drainage techniques, breast positioning advice, and education on feeding positions that optimise milk removal from the affected area complement the therapeutic ultrasound treatment. For women with recurrent mastitis, identifying the contributing factors — latch, feeding frequency, tight clothing, positioning — is as important as treating the acute episode.
Our physiotherapists are experienced in working collaboratively with lactation consultants and GPs to ensure your care is well coordinated. We also work closely with the team at our Mums and Bubs Postnatal Pilates program, where breastfeeding support and postnatal wellbeing go hand in hand.
Our physiotherapist Bethany Kippen and Eliane Machado both have experience in postnatal physiotherapy and mastitis management and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
The understanding of mastitis has changed significantly in recent years. Breastfeeding experts used to think of mastitis, blocked ducts, abscesses and milk blisters as separate problems. Newer research suggests these are all stages of inflammation — the body's response to a threat. The Academy of Breastfeeding Medicine (ABM) revised their clinical protocol in 2022 (Protocol #36: The Mastitis Spectrum) to reflect this updated understanding, and La Leche League International has updated their guidance accordingly.
What once was thought of as a "plugged" duct is actually a series of tiny ducts that have become inflamed and narrowed, hindering milk flow. Milk blebs, slowed milk flow, blocked ducts and mastitis are therefore all part of the same inflammatory spectrum rather than distinct conditions — and importantly, this means many cases are not primarily infectious in nature, at least not at the outset.
Mastitis is not an infection when it starts. Taking unnecessary antibiotics too early may encourage resistant strains of bacteria to thrive and may make you more likely to have recurrent mastitis or an abscess in the future. This is an important message for breastfeeding parents: the presence of breast pain, redness and warmth does not automatically mean antibiotics are needed, and physiotherapy treatment is often the most appropriate first response.
What are the symptoms?
You may notice a large area of your breast that feels lumpy, swollen, hot and painful. The skin over that area may look red or darker than usual. You may get a high temperature or feel unwell like you have the flu, sometimes having a headache and tender muscles. These are all symptoms of breast inflammation within the mastitis spectrum.
When should I see a GP?
If you develop a fever above 38.5°C, feel severely unwell, notice a fluctuant swelling suggesting abscess formation, or your symptoms are not improving after 12 to 24 hours of appropriate management, see your GP promptly. Infective mastitis — where bacteria have established a true infection — requires antibiotic treatment in addition to physiotherapy. A breast abscess requires medical drainage. Your physiotherapist and GP work as complementary parts of your care, not in place of each other.
What does current evidence recommend for treatment?
Based on ABM Protocol #36 and La Leche League guidance, the priorities for managing breast inflammation and mastitis are:
Continue breastfeeding. It is important for your baby to continue breastfeeding from the affected side to help prevent the inflammation from worsening and creating an abscess. Stopping feeds or pump sessions from the affected breast allows milk stasis to worsen. Breastfeeding from the affected side is safe for the baby.
Ensure effective milk removal. At times, mastitis is the result of difficulties with positioning and/or latch that impact how efficiently your baby takes milk from your breast. A La Leche League Leader or lactation consultant can help identify and address latch and positioning issues that may be contributing.
What to avoid. Avoid trying to "empty" the breast through extra pumping or breastfeeding which increases milk production, and avoid using Epsom salts, warm compresses, olive oil, castor oil, or other oils on the skin of the breast or nipple. These approaches — once widely recommended — are not supported by current evidence and may worsen inflammation.
How can physiotherapy help?
Therapeutic ultrasound is the primary physiotherapy intervention for mastitis and blocked ducts, and it is well supported by evidence and clinical experience. Therapeutic ultrasound is a non-invasive treatment that uses high-frequency sound waves to promote healing and reduce inflammation. In the context of mastitis, therapeutic ultrasound applied to the affected breast tissue reduces localised inflammation, promotes tissue healing, and assists with restoring normal milk flow through the narrowed and inflamed ducts — without the risks associated with vigorous massage or attempts to physically "clear" a blockage.
During your session at Articulate Physiotherapy, our physiotherapists will assess your condition to ensure that therapeutic ultrasound is appropriate for your case. If suitable, a gel is applied to your skin and the ultrasound probe is moved gently over the affected area. Each treatment session typically lasts between five and fifteen minutes depending on your specific needs. Treatment may be more frequent initially — possibly daily — to provide relief and promote healing.
Gentle lymphatic drainage techniques, breast positioning advice, and education on feeding positions that optimise milk removal from the affected area complement the therapeutic ultrasound treatment. For women with recurrent mastitis, identifying the contributing factors — latch, feeding frequency, tight clothing, positioning — is as important as treating the acute episode.
Our physiotherapists are experienced in working collaboratively with lactation consultants and GPs to ensure your care is well coordinated. We also work closely with the team at our Mums and Bubs Postnatal Pilates program, where breastfeeding support and postnatal wellbeing go hand in hand.
Our physiotherapist Bethany Kippen and Eliane Machado both have experience in postnatal physiotherapy and mastitis management and are members of the Australian Physiotherapy Association.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Who to book in with:
If you are unsure about which appointment type is right for you, please don't hesitate to get in touch with our friendly reception staff by calling 07 3706 3407 or emailing [email protected].