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The dreaded “M” word

What is mastitis?

 

• Defined as “inflammation of the breast”. The term is generally used in reference to the lactating breast.
• Is thought to occur when pressure within the ducts is greater than the surrounding tissue. This causes milk products to leak into surrounding tissue and the body produces a dramatic inflammatory response.
• This in turn can cause painful, red, hot and inflamed breast tissue.
• Incidence of mastitis has been reported to be as high as 1 in 3 women post partum, with the highest incidence occurring 2-3 weeks post partum. Mastitis is the most common reason to wean in the first 12 weeks post partum (Wöckel et al 2008).

Symptoms may include:

• Breast tissue feeling tender
• Increased temperature of the breast tissue
• Redness in a wedge-shaped or striped pattern on the breast tissue
• Chills, ache and flu-like symptoms, similar to a systemic illness
• The inflammation may or may not involve a bacterial infection (the only way to rule out a true infection is by doing a milk sample testing – but this step is often skipped as it takes a long time)

“A tender, hot, swollen, wedge-shaped area of breast associated with increased temperature, chills, ‘flu-like’ aching and systemic illness. The inflammation may or may not involve a bacterial infection” (Amir 2014).

Risk factors and things to avoid:

• A previous episode of mastitis
• A sudden change in number of feeds (ie. infant sleeping longer overnight, skipped feeds)
• Switching to 2^nd breast before 1^st breast is finished
• Suckling replaced by pacifiers or bottles
• Compression- including flange of expressing pump, tight bra/garment
• Positioning and attachment problems (eg. from tongue tie, nipple damage)
• Pendulous large breast tissue
• A direct blow to the breast

 

Here, at Clifton Hill Physio, we have a great team of Women’s Health Physiotherapists, including: Adriane, Issy, Kiera, Ali, Clare, Jane, Jen and Sal.

 

Our physio’s can help you with:

 

• Diagnosis and advice- including appropriate referral
• Treatment:
• Therapeutic Ultrasound can be very effective in the management and treatment of mastitis. This will likely form part of your treatment and will be explained by your physiotherapist.
• Education regarding manual handling of your breast: This must always be gentle. Respect your pain.
• Self-management techniques: Effleurage or draining massage, breast rotating/breast lifting techniques. 

• Kinesiotape can be very helpful in facilitating lymphatic drainage of swelling. Your physiotherapist will show you how to apply this if necessary.

• Positioning advice:

It is important to have a number comfortable positions to rely on for feeding.

Recumbent or ‘laid back feeding’, football hold and side lying hold.

Special extra tips:

 

• If possible try to bring you baby with you as it is helpful to have your baby feed immediately after the session.
• Develop the habit of feeling each breast after each feed to highlight any areas of tension.
• Always maintain adequate hand hygiene and breast pad hygiene.
• If it is safe to do so, Non-Steroidal Anti-Inflammatory medications (NSAIDs) may be recommended.
• It is almost always ok for your baby to continue feeding if comfortable.
• Avoid over-stimulating the breast tissue
• Ensure the duration between feeds is short enough so breasts do not feel uncomfortably full.
• Expressing must be comfortable and/ or relieving.
• Take care that the flange does not compress the breast
• Avoid wearing tight compressive garments, ie, tight bra/flange of expressing pump. Garments should not indent skin.
• Catch it early: look out for early signs to prevent the condition from becoming debilitating or a more serious health problem that might threaten yours and the baby’s well-being.

 

At Inner North Physiotherapy, we understand how distressing mastitis can be and will always try our best to book you in as early as possible.

Our physio’s will strive to fit you in within the day to help reduce your symptoms and provide you and the baby with some relief as quickly as possible.

 

 

WHEN TO SEE YOUR GP/LACTATION CONSULTANT:

 

• If your symptoms are persisting
• If you have a nipple infection
• If you have signs of thrush
• If you require a breast ultrasound (as advised by your physiotherapist)
• If you become acutely unwell

Adriane Kabulyuk

Physiotherapist

 

References:

 WEBSITES:

The Australian Breastfeeding Association

https://www.breastfeeding.asn.au/aboutaba

The International Breastfeeding Journal

http://www.internationalbreastfeedingjournal.com/

Positioning advice:

www.biologicalnurturing.com

 

ARTICLES:

-Amir, L., (Revised March 2014). Clinical Protocol #4: Mastitis. The Academy of Breastfeeding Medicine Protocol Committee ABM.

-Cooper, M., (2015) The lactating breast for physiotherapists. Course Notes – Continence & Women’s Health Physiotherapy Australia Group, Australian Physiotherapy Association.

–Struebe, A., & Schwartz, E., (2010). The risks and benefits of infant feeding practices for women and their children.Journal of Perinatology, 30, 155-162

– Wöckel, A., Abou-Dakn, M., Beggel, A., Arck (2008). Inflammatory breast diseases during lactation: health effects on the newborn – a literature review. Mediators of Inflammation, Article ID 298760, 7 pages doi: 10,1155/2008/298760.

It’s an exciting time to be involved in woman’s sport. In fact, it makes me wish I was a teenager again with the opportunities that our young women have to pursue their dreams of becoming a professional athlete. From the rise of the Matilda’s, to the restructuring of the National Netball League, and of course the introduction of the AFLW. There are more pathways than ever for young female athletes to follow into the professional ranks.

But with this rise in popularity, we have also seen a rise in the rate of serious knee injuries in female athletes.

I am excited to be taking up a role in the AFLW for the upcoming 2019 season as one of the team physiotherapists for North Melbourne Football Club. It will be the inaugural season for North Melbourne in the AFLW. Exciting times for all involved.

The AFLW Injury Report shows that compared to their male counterparts, woman in the AFLW have a 9.2x greater risk of suffering an ACL injury. This figure sits even above the 2-5x greater risk that woman participating in all sports have of rupturing their ACL. Should we be concerned? The reasons for the increased risk in the female athlete are complex and multifactorial – from our genetics/anatomy, to hormonal considerations, to overall strength and conditioning, quality and skill of movement patterns, as well as factors such as footwear. There is much discussion and research occurring around this topic as we speak. Although the injury rates have been high in the first 2 seasons, there is plenty that can be done to reduce injury risk and enhance athletic performance. Injury Reduction Programs (IRP’s) have been shown to be an effective way to reduce the risk of injury by up to 50%!

IRP’s include different components of warm up, preparation, movement quality training, and strengthening exercises for key muscle groups. In the AFLW, teams have all developed programs for the female athletes to undertake at training and before games to help decrease their risk of injury. Professional athletes themselves are becoming more aware of the importance of participating in IRP’s. But there is still much work to be done at the grassroots and community level.

With the massive uptake of sport, especially footy, in girls at the grassroots level, it’s important we begin to educate and talk to our community level athletes about how they too can reduce their risk of injury and enhance their performance. As physio’s we want to encourage our young female athletes to take up sport, and participate fully in their passion of footy, without having an overshadowing fear of impending injury. The benefits of young people participating in sport still far outweigh the risks! The key is for young female (and male) athletes to develop good movement patterns and skills specific to their sport, progressively develop their strength and load capacity as they grow and develop, and be aware of how to prepare their bodies for training and game day with an appropriate warm up. Recovery is also a big key and should be holistic in nature. Gone are the days where recovery is just putting an ice pack on after a game. Recovery should include considerations such as appropriate sleep patterns, nutrition, training load management, general wellness, and self-management strategies.

As a physio, my passion is to not only work with elite athletes in exciting opportunities such as the AFLW, but also with community level and young athletes.

If you or an aspiring young athlete you know want to learn more about what IRP’s involve, or how to recover better, come in and see us at Inner North Physiotherapy. Remember prevention is better than cure!

Mel is part of the Research team at La Trobe University looking at injury prevention in Women’s footy.

Melissa Haberfield

Physiotherapist

 

 

Congratulations to Fitzroy Football Club on another successful season, and especially to the Men’s Senior and Reserve teams who both impressively took out VAFA Premier C Premierships on Saturday at Trevor Barker Oval!!! Both teams have enjoyed spectacular seasons.

In the senior game, Fitzroy were far too strong for Old Geelong and after 8 goals in the first quarter they continued to increase their lead, finishing 15.10.100 to 4.6.30.

The Reserves was a tight game in tough conditions. Fitzroy were able to keep Old Geelong goalless for the first half before surviving a late surge, eventually winning 4.6.42 to 4.9.33.

Team physiotherapists Billy Williams and Lizzy Barnes-Keoghan, along with all of us here, would like to congratulate all teams and thank them for their efforts during the 2018 season.

#GoRoys

The recent state government initiative is currently in full swing and voting is underway! 30 million dollars worth of funding has been invested to encourage individuals to submit project ideas to benefit their local community and our women’s health physio, Ali has submitted a project!

Ali’s project is aimed at women of all ages and backgrounds. It will involve a quarterly education seminar addressing common concerns and important areas of pelvic health in an interactive manner. The sessions follow the lifespan of women, beginning with adolescent females, through pre & post natal phases and menopause. Common concerns will be addressed for each stage of life, including normal pelvic floor health, good bladder and bowel habits and sexual function.

We know that pelvic floor dysfunction is a common concern and affects up to 1 in 3 women! Here at Clifton Hill and Inner North Physiotherapy we continue to work hard to promote education around pelvic health within our communities. These seminars will be able to reach further audiences and will be presented in a captivating and interactive fashion to inform, educate and provide solutions to these everyday problems. Ali’s project aims to empower women to liberate themselves from the ongoing stigma around pelvic health.

Please check out Ali’s project on the link below, and if you live within 5km of Thornbury register to vote and get voting! There are many excellent community initiatives so have a look through the projects and help someone make a difference! Voting closes September 18^th!

 

https://pickmyproject.vic.gov.au/rounds/pick-my-project/ideas/the-lifespan-of-a-woman-s-pelvic-health-an-education-series

 

Our staff have been busy sharing their knowledge and expertise with Doctors and other Physios.

Issy has been busy presenting on two different topics this month!

Issy was asked to present to a support group of women who suffer with Endometriosis at the Epworth Hospital in East Melbourne. Issy presented on how physiotherapy can help women with pelvic pain and endometriosis. This common and debilitating illness is something our women’s health team sees frequently. They are able to help women with pain and bladder and bowel dysfunction.

The presentation went really well with many women asking questions on how they could be helped by physiotherapy. They were all amazed to hear of the self-help strategies that they could use at home with some simple steps. It was also pleasing to see so many of them came with a friend or partner to assist in managing their condition.

In that same week Issy presented her knowledge of gut focused treatment to a large group of GPs as part of their continuing education. She discussed some case studies of patients with constipation and incontinence and was able to inform the GPs of how they could manage their patients better.

There was lots of interest from the group not only on irritable bowel syndrome but also male pelvic pain and female sexual pain. The group was most interested by how physiotherapists can teach patients to regulate their bowel and be more in-control of their own health. It was exciting to see so many GPs (about 70) come out for this event, which was run by St Vincent’s Private Hospital.

Issy and Jen have also just tutored on a course on Female sexual pain for Physiotherapists and Brendon has just run 3 busy days in Bendigo teaching Health Professionals about Graded Motor Imagery and Explain Pain.

We are always striving to share our knowledge and continue our own learning.

If you have a endometriosis related pain, bladder, bowel or sexual dysfunction, consider coming in to see one of our experienced pelvic health physiotherapists who are able to sensitively navigate a management plan or chat with your GP, help is available.