The Use of Osteopathic Manipulative Medicine in the Management of Recurrent Mastitis

Participants

• Number: 1
• Description: a 34-year-old woman with 6 pregnancies and 3 children, who had 5 episodes of left breast mastitis within the previous 6 months, all treated with multiple courses of antibiotics.
  She received the first diagnosis of mastitis 21 days after the last childbirth (she had no problems with the previous childbirths): after that she alternated treatments based on amoxicillin, cephalexin, trimethoprim/sulfametoxazole – which induced a skin rash – dicloxacillin, ceftriaxone, amoxicillin/potassium clavulanate in which the symptoms of redness, soreness, fever, chills and muscle pain tended to resolve during the time of treatment, only to recur a few days after its termination.

The microbial culture of her milk showed the presence of Streptococcus group A. For fear of infecting the 7-month-old baby, the patient was willing to wean him, so much so that in recent weeks she was pumping milk from the breast instead of breastfeeding directly. At the first osteopathic examination, she had completed half of the last course of antibiotics, did not have much redness or pain, had no muscle pain and was pumping her milk (30 grams at a time).

The osteopathic evaluation aimed at highlighting areas of fascial restriction, pain and low mobility. In particular, tenderness in the left breast emerged, fascial restriction towards the medial lower quadrant, restriction in the left thoracic inlet, in the left pectoral fascia, in the left armpit and in the mobility of the left thoracic diaphragm during inhalation.

Interventions and evaluations

• 2 sessions of OMT applied to the thoracic and abdominal regions, using myofascial release techniques directed to the breasts, pectoral fascia, scapula and thoracic diaphragm, Ligamentous tension balancing techniques were applied to the thoracic inlet and thoracic lymphatic pump
• The patient was taught how to perform a self-massage based on myofascial release techniques

Results

At the second osteopathic visit (1 week after the first), the patient had a sore left breast since the previous night, with a little redness and pain.
After the second visit, the patient decided with the osteopath that she would wait and see her symptoms’ development and contact her primary physician should they have worsened, with fever or other specific symptoms indicating the need for antibiotics.
After 6 months from the second visit, the patient called to report the absence of new infections: she reported having enough milk for the baby and, in fact, she had resumed breastfeeding.

At the time of writing the article, 1 year after the second osteopathic examination, the patient had not had any more episodes of mastitis and, when the child requested it, she could still breastfeed him without any problems.

Discussion

In relation to the results here described, randomized controlled trials are needed to assess whether OMT is actually useful in managing recurrent mastitis episodes in breastfeeding women.

Similar studies are particularly important because, although organizations such as the WHO indicate the need of waiting for antibiotics to be used in the event of mastitis, and to act instead through milk removal, dietary changes, applications of heat or ice and use of oral analgesics, often these interventions have minimal effects and antibiotics are eventually used.