Even in traditional physical therapy for injuries the hot vs. cold debate still exists. Also keep in mind most of the research on this is on trauma. The two biggest concerns in an injury with edema is keeping motion and decreasing pain. Therefore treatment of decreasing edema focuses on both. So only some of the principles apply with engorgement: excess amount of fluid and pain. And like so much of what we do the answers are not cut and dry and vary with each situation. Here might be some info to help. And by all means just the tip of the iceberg. COLD reduces inflammation and reduces outward fluid filtration , but decreases pain and tissue extensibility. I would extrapolate that therefore the increase fluid of engorgement would not go out but it really helps the inflammation and pain. Bonnie- the decrease tissue extensibility is usually the reason one gives to not massage a cold breast. If something is not plyable it can snap so to speak. HEAT increases blood flow and also helps with fluid filtration, and increases tissue extensibility and but can increase inflammation. Therefore massage works well with heat but heat can make the inflammation worse. Some therapists like to use both with a 3:1 up to 5:1 minute ratio of heat to cold to address both. Or heat, then massage( and I would add then nurse), then ice. Clear as mud? Jill Andrews OTR,CHT, LLLL Louisville, CO *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html