The Usage of Ultrasound in the Treatment of Mastitis

The physiotherapist use a therapeutic ultrasound of an intensity between 1-2w/cm2, producing high intensity sound waves that can be transmitted into the tisue of the breast. The selected frequency and intensity will dictate the depth of penetration and will be adapted to the size of the breast and also the patient status, (acute v chronic, inflamed v blocked ducts).

The choice of creating a thermal effect in the tissues is an inidividual decision for the therapist and will also depend on the acute or chronic status of the presentation.

The sound waves cause a micro massage effect within the tissues which loosens the tissue structure and causes a breakdown of the material causing the blockage. It also stimulates the blood flow by hyperaemia and vasodilatation, through the tissue, which will assist then the transport of the material from the breast. There will also often be an excitation, milk producing tissue and the letdown often occurs during treatment.

Although a high dose of ultrasound has been shown to kill bacteria, the dosage is painful and not feasible for use on mastitis clients. Therefore, ultrasound does not replace the need for anti-biotic, if required.

Treatment Protocol

1.An acute presentation is typically treated with a pulsed ultrasound dose to minimise the thermal effect. A chronic presentation or recurrence is often treated with a higher, continuous dose that increases thermal effect and depth of penetration.

2. Treatment is ideally timed so Mum arrives with a hungry baby, that will feed immediatley after treatment. This takes advantage of the stimulation to the blockage and encourages milk flow through the treated area but also then minimises breast stimulation between feeds. However, it is not unusual for the baby to refuse to drink from the treated breast because when the milk flows from behind the blockage it is often stale and tastes 'off ' to the baby. If this occurs, the Mum is encouraged to express all the milk from this side and dispose of same (unfortunate, but only a one off).

3. Posture feeding positions are often taught for the feed following the treatment, allowing gravity to be on our side for a change.

4. Resolution usually requires 1-3 treatments only, in conjunction with the antibiotics and other techniques.We encourage you see your GP for review if this does not happen.

5. We encourage the policy of heat and massage immediately before and during feeding for maximum milk flow, but no stimulation between feeds.

 

 

References

1. Blocked Ducts and Mastitis: Vincent Ianelli 2004

2. Mastitis and Blocked ducts- Symptoms and treatment for Mastitis: Jack Newman 2005 revised E Kerberman 2008

3. An update on the Recgnition and Management of Lactational Breast Inflammation: CM Betzold, Journal of Midwifery and Women's Health 2007:52 (6) 595-605