When you do feel that way it is really important to empty your breasts fully - even if you can't locate the blockage.
The usual process is hot pack/feed baby/pump/hand express/cold pack - because usually the blockage will be the very last bit to clear.
And taking ibuprofen reduces the swelling and makes clearing the blockage easier - in addition to helping with the pain.
The physio treatment works really well, but does require you to know where the blockage is - they actually work on the particular area of the duct involved. You don't need a specialist women's health physio, but you do need one that has experience in duct-zapping.
When you get really engorged, some of the stuff in your milk enters back into your blood, and provokes an immune response so you feel yuk - even before the infection that is characteristic of full-on mastitis. And at that point unblocking the duct can still fix the problem. But really simply, if the antibiotics fix it then it is mastitis.
I'm not sure that they know how it works - it's very very localized heating, and it also works to reduce swelling in injuries - which is why the physios have it.
The soreness/ redness occurs in different places, but I do wonder if there's a connection to a big massive lump of tissue in my right boob. I've had an ultrasound and it was all normal breast tissue so I'm guessing damaged milk ducts probably from wearing ill fitting bras all my life.
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