Therapeutic Ultrasound for Engorgement, Blocked Ducts and Mastitis During Breastfeeding

Therapeutic Ultrasound for Engorgement, Blocked Ducts and Mastitis During Breastfeeding

We would like to acknowledge information from The Australian Breastfeeding Association which has local branches in each state. Lactation consultants are experts in all things breastfeeding and can give advice on how to prevent the occurrence of engorgement, blocked ducts and mastitis.  They may also be your first port of call for treatment. 

Physiotherapists have a particular role in providing therapeutic ultrasound treatment to manage the actual blockage causing problems.

What is Breast Engorgement?

This is a common occurrence when a feed is missed or delayed usually in the earlier days of breast feeding when a routine is not yet established.  When this occurs, the breast becomes hard and tight.

The main treatment for this is to continue feeding often and allow plenty of time for the breast to empty fully.  It is also important to ensure that the correct attachment has occurred.

Warmth can be applied to the breast before, light massage during (and it is important that the massage is light and therefore does not traumatise the delicate breast tissue), and cold compress to the breast afterwards.  

Please note, that it is important that the massage is very light and therefore does not traumatise the delicate breast tissue.  Breast massage is more like gentle stroking in the direction of the nipple.

What is a Blocked Duct?

Blocked ducts may occur due to ineffective clearing of the milk due to lots of possible causes.  Some of these include; excessive pressure on the breast from the bra, positioning, holding the breast too firmly to feed, hurried or missed feeds and being overtired and stressed.  

The blocked duct will form a hard lump, redness, swelling and pain.  Treatment includes removing the pressure of the bra, feeding regularly, giving a light stroking massage or applying heat than cold as per engorgement. Rest is also recommended, possibly expressing after feeding to clear the breast, and ensuring correct attachment.

What is Mastitis?

Mastitis refers to an infection in the breast.  If there are any nipple cracks, make sure to wash your hands before handling the breast.  An infection may set in after a duct becomes blocked.  Symptoms of this may include fever, pain and flu-like symptoms.  If you experience any of these, you should make an appointment to see your GP. 

In summary, if you experience signs of engorgement or blocked duct you may experience relief by applying the following treatments:

  • Apply warmth before the feed and a cool pack after the feed.
  • Make sure you feed regularly. The Australian Breastfeeding Association Victorian Branch recommends starting your feed with the affected breast.  If it is too painful, start on the other side, then when the letdown occurs, switch back to the affected side which might now be less painful.
  • The Australian Breastfeeding Association also recommends you express if your baby doesn’t want to feed.  
  • Make sure you get plenty of rest.
  • Give your breast a very light massage in the direction of the nipple whilst feeding.
  • Ensure there is no excess pressure from your bra or handling the breast.


If an infection such as mastitis is diagnosed antibiotics will most likely be prescribed.  While antibiotics may clear the infection, they may also leave the underlying blockage uncleared.  This is where ultrasound might help.  Ultrasound may clear engorgement or blocked ducts before it progresses to mastitis.

What is Therapeutic Ultrasound?

Therapeutic ultrasound was used very widely in the past for the treatment of all sorts of pain and injury problems in the body.  Nowadays, it is still used to help overcome these breastfeeding problems.  

Most people are familiar with ultrasound imaging to look inside the body for all sorts of reasons including checking the health of your baby in the womb.  

Therapeutic ultrasound is similar but different: the ultrasound puts a sound wave into the tissue which causes a micro-massage effect. This effect sets up healing in the tissues.  The action of the ultrasound also provides a heating effect which is part of the deep therapeutic action. 

Ultrasound works quickly.  You should feel significantly better by the next day.  If however, you have had grumbling issues for more than 24 hours we would expect you to have consulted your GP to give the all-clear for you to attend.  

Even for a severe case, an ultrasound can give relief from the pain and swelling over the following 24 hours.  Further treatments may be needed but usually, 1 to 3 treatments are all that are required.  



If you would like to know more, discuss your treatment or book an appointment with one of our Physiotherapists, please don’t hesitate to reach out.

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