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Breastfeeding and the Shoulder

I put out a call on my Facebook page (link) asking for questions about shoulder related issues and I got a lot of really great questions.

I can only answer these questions with the limited knowledge and training that I have and thus these are by no means definitive answers, but they might help to guide your thinking. If I can point you in the direction for more information, I certainly will.

I answered the first question in my last post (link) as it was about that topic (scapular movement).

The first two questions are about child rearing shoulders and arms and I’ll address one here. Part two in two weeks.

Q: What exactly happened to my shoulders from the breast-sleeping position – that side lying position you do with a baby to nurse in bed, arm up around around them from the top. I remember my shoulder being sore with the first baby, and then forever just not quite right after that, with subsequent babies. I can’t remember how they used to feel.

I’d like to start out by saying that the years of child rearing for most of us are a limited time relatively speaking, during which we are subject to loads and positions that are not the norm during the non child-bearing years. We are not really ready for those loads because we are coming to the pregnancy and first years from a sedentary past. I will use myself as an example. I was an office worker when I got pregnant with my first child. I sat and typed all day. The baby grew as I sat for those several hours a day over the months of the pregnancy, and as a sitter, I was not really preparing my body for pregnancy and delivery and the rigors of the first year of breastfeeding and child holding. As the loads to my abdominal and pelvic floor muscles and tissues increased, my strength did not, as I was sitting passively supported by a chair for those months.

If I’d been born into a community such as a hunter-gatherer tribe, I would have been walking a lot, squatting to cook, eat and poop, generally moving in ways I can’t really conceive. (Read Move Your DNA, pages 34-36) I’d be helping the older women with their children, carrying them, playing with them, and in doing so, learning how to care for children myself.

So instead of training for the rigors of carrying and having a child by all day movement and babysitting, I entered the marathon of pregnancy, birth and breastfeeding in a state of sloth and ignorance.

I went from an underused situation to an overused situation literally overnight. I found the effort of caring for a child to be extremely taxing on my body and mind. Then I became pregnant again, and I was now dealing with a body that had several overuse injuries from asking so much of a body that was not prepared for it, compounding the problems.

This question is a positional question regarding the shoulder, where the bottom arm is positioned in a protective placement around the baby for side-lying breast feeding. The top arm is free to cradle the baby behind its back and position it to the breast.

This is not a position you would use very much if you weren’t breastfeeding, either in bed or out of it. Suddenly you are taking a shoulder that doesn’t move much beyond the height of a keyboard or steering wheel, raising it much higher, internally rotating it, loading it with your own body weight (pressing on it – which might have circulatory implications), and then being in that position for a good deal of time, perhaps 8 hours at a stretch. I stayed on one side for the most part during my co-sleeping days, as I kept the baby on the outside away from my husband who I didn’t trust not to roll on her, so I stayed on that side and simply turned more to get both breasts used equally. This meant one shoulder got this position in spades, while the other one got off pretty much scot-free.

That sets you up to have a less than healthy shoulder which is then used in this position for months or years of breastfeeding, and if you have another baby, it’s ongoing. Plus you are now using a shoulder that is compromised in all the other ways that create extra loads to a shoulder that is not used to it; lifting, carrying, holding a growing child, all the extra work that having a baby entails such as laundry and cleaning.

The position and pressure (and potential decrease in circulation) means that certain structures of the shoulder are under threat and in an environment that does not promote healing (which requires circulation).

So what to do? Should you just find another position? This could work, as a cross training strategy, but essentially you are still dealing with a shoulder that is at a poor level of health. It’s a matter of getting a job done with minimal damage to you during the length of time you need to perform it and then dealing with the aftermath, and dealing with it during the time when it is required.

You could try bolstering your hand in the meantime – this brings you out of so much internal rotation.

Isn’t my baby cute? 🙂

You can also start to increase your shoulder health safely and gradually using the corrective exercises for the shoulders in Restorative Exercise, and perhaps doing a low load side-hang a few times a day (i.e., not leaning away from the hand very much at all).

Don’t discount arm swing. Mothers typically don’t have time to walk far distances very often, and when they do walk, it’s usually pushing a carriage, or holding a billion things, including toddler’s hands or diaper bags or their own baby, and often with a baby strapped on. So you might not be swinging your arms 100s of times per day as you would with several miles of walking. That arm swing moves the shoulder gently and encourages circulation of blood and lymph. It loads the rotator cuff and shoulder ligaments with the weight of the arm.
https://www.ncbi.nlm.nih.gov/pubmed/19640879

Instinctive Sleeping and Resting Postures article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1119282/

My review of the book “Shoulder Pain? the Solution & Prevention” by John M. Kirsch: http://www.alignmentrescue.com/book-review-shoulder-pain/

 

MD John M. Kirsch’s video:

 

In Part 2 I will talk about baby carrying. Check back!

 

 

 

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