Why I Blended Physical Therapy & Lactation
As a PT in the NICU, I was often the first person to teach parents how to get their tiny babies into skin to skin, and ultimately the person to provide support for positioning during the first latch. As such, I gained a unique understanding of how infant reflexes, their biomechanics, and their nervous systems shape a baby’s ability to latch and feed at the body.
It’s truly remarkable.
One common question people ask me is “How did you decide to blend PT and lactation?” And honestly, it’s a much longer story than this!
BUT- I can tell you that I have never been a provider who saw the reason for separate boxes… and always sought ways to blend my background as a prenatal yoga teacher and my love of helping new parents, with my perspective as a doctor of physical therapy.
From a physical therapy perspective, breastfeeding involves complex interactions between the musculoskeletal, neuromuscular, and fascial systems for both the breastfeeding body and the baby!
Understanding these intersections can help optimize body feeding mechanics, prevent dysfunction, and support long-term well-being.
1. Musculoskeletal System
The musculoskeletal system plays a key role in posture, stability, and movement for both the breastfeeding parent and the baby.
For the Parent:
Postural Strain: Prolonged feeding postures can lead to pain and dysfunction, especially in the neck, upper back, shoulders, and wrists (e.g., “nursing mother’s neck” or De Quervain’s tenosynovitis).
Ribcage & Diaphragm Mobility: A restricted thorax can limit deep breathing and alter posture, leading to tension in the upper back and shoulders.
Pelvic Floor & Core Function: Postpartum changes, including diastasis recti and pelvic floor dysfunction, impact posture and can contribute to discomfort during feeding.
For the Baby:
Torticollis & Plagiocephaly: Muscle tightness or asymmetry in the neck (SCM, suboccipitals) can affect head positioning, leading to latching difficulties and feeding preferences (e.g., favoring one breast).
Jaw & Tongue Mechanics: The temporomandibular joint (TMJ) and associated muscles (masseter, digastric, pterygoids) coordinate suck-swallow-breathe patterns. TMJ dysfunction can lead to weak latch, clicking sounds, or fatigue while feeding.
Shoulder & Chest Mobility: Birth trauma, clavicular injuries, or brachial plexus injuries can impact a baby's ability to maintain a strong latch or effectively suck.
2. Neuromuscular System
The neuromuscular system controls reflexive and voluntary movements critical for breastfeeding function.
For the Parent:
Nerve Compression Syndromes: Prolonged postures can lead to thoracic outlet syndrome, carpal tunnel syndrome, or radial nerve irritation, causing numbness, tingling, or weakness in the hands and arms.
Core Activation & Stability: Abdominal weakness or poor spinal stabilization can impact trunk support, leading to compensatory tension in the upper body.
For the Baby:
Primitive Reflexes & Oral Function:
The rooting, sucking, and swallowing reflexes are essential for early feeding coordination.
Persistence of the asymmetrical tonic neck reflex (ATNR) can lead to latching difficulties.
Neuromuscular Tone & Coordination:
Hypertonia (e.g., in cerebral palsy or tongue-tie compensation) can cause a tight, inefficient latch.
Hypotonia (e.g., in Down syndrome or prematurity) may result in poor lip seal, difficulty sustaining a latch, and excessive milk dribbling.
Cranial Nerve Function:
CN V (Trigeminal) – Controls jaw movement and sensory feedback for suckling.
CN VII (Facial) – Controls lip closure and facial tone.
CN IX & X (Glossopharyngeal & Vagus) – Involved in swallowing coordination.
CN XII (Hypoglossal) – Controls tongue movement for effective suck-swallow-breathe rhythm.
3. Fascial System
Fascia is a continuous, interconnected web that influences posture, movement, and tension throughout the body.
For the Parent:
Breast Tissue & Myofascial Tension: Restrictions in the pectoralis major/minor, intercostals, and upper abdominal fascia can impact milk ejection and lead to clogged ducts.
C-Section & Diastasis Recti Scar Tissue: Fascial restrictions post-surgery can affect breathing patterns, ribcage mobility, and posture, indirectly influencing breastfeeding mechanics.
Neck & Shoulder Fascial Connections: Tightness in the suboccipitals, scalene, and thoracic fascia can create compensation patterns that lead to discomfort while nursing.
For the Baby:
Tongue-Tie & Oral Restrictions:
The lingual, buccal, and submandibular fascia impact tongue mobility and sucking strength.
Tethered oral tissues (TOTs) restrict fascial glide, affecting cranial nerve function and leading to compensatory tension in the hyoid, jaw, and neck muscles.
Birth Trauma & Fascial Strain Patterns:
Instrumental deliveries (forceps, vacuum) or fast labors can create fascial restrictions in the head, neck, and chest.
Vagus nerve dysfunction (from cranial compression at birth) can affect gut motility, reflux, and suck-swallow-breathe coordination.
Body-Wide Fascial Influences:
Restrictions in the diaphragm, thoracic fascia, or sacrum can impact overall feeding posture and tension patterns in the baby.
Physical Therapy Approaches for Breastfeeding Optimization
A PT with the right training can assess and treat both parent and baby to improve feeding success through:
Postural training & ergonomic support (shoulder pain while chestfeeding?)
Manual therapy & myofascial release
Scar mobilization & fascial release (for post-surgical or post-birth tension)
Core & pelvic floor retraining (let’s face it, we all need this)
Neuromuscular re-education (Addressing baby’s oral function, treating torticollis, and retraining patterns that aren’t serving you or your baby!)
Conclusion
Breastfeeding is not just a mechanical act—it’s a full-body system in motion. From a PT lens, we can optimize this process by addressing musculoskeletal alignment, neuromuscular coordination, and fascial mobility in both parent and baby, ensuring feeding is efficient, comfortable, and sustainable.
* body feeding = chestfeeding = breastfeeding = feeding at the body
