An investigation into the prevalence and impact of breast pain, bra issues and breast size on female horse riders

Clinical and exercise professional opinion of return-to-running readiness after childbirth: an international Delphi study and consensus statement

Female athletes have identified a lack of guidance as a barrier to successfully returning to running postpartum, and existing guidelines are vague. Our aim was to define the current practice of determining postpartum run-readiness through a consensus survey of international clinicians and exercise professionals in postpartum exercise to assist clinicians and inform sport policy changes.A three-round Delphi approach was used to gain international consensus from clinicians and exercise professionals on run-readiness postpartum. Professionals who work with postpartum runners participated in an online survey to answer open-ended questions about the following postpartum return-to-running topics: definitions (runner and postpartum), key biopsychosocial milestones that runners need to meet, recommended screening, timeline to initiate running, support items, education topics and factors that contribute to advising against running. Consensus was defined as ≥75% participant agreement.One hundred and eighteen professionals participated in round I, 107 participated in round II (response rate 90.6%) and 95 participated in round III (response rate 80.5%). Responses indicated that, following a minimum 3-week period of rest and recovery, an individualised timeline and gradual return to running progression can be considered. Screening for medical and psychological concerns, current physical capacity, and prior training history is recommended prior to a return to running.This study proposes recommendations for the initial guidance on return-to-running postpartum, framed in the context of current research and consensus from professionals. Future research is needed to strengthen and validate specific recommendations and develop guidelines for best practice when returning-to-running after childbirth.

Understanding experience, knowledge and perceived challenges related to bra fit for sports participation: a scoping review

The breasts are reported as the fourth largest barrier to participation in physical activity (PA). This scoping review provides a comprehensive understanding of experiences, knowledge and challenges relating to bra fit and sports participation. The search strategy was adopted by the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) guidelines and multiple databases were searched. All research was in English and within the last 20 years. Exclusion criteria excluded reviews, male participants and the inability to locate or access full-text articles. The JBI critical appraisal tool assessed methodological quality. Twenty-three studies were included. Key themes from the studies are breast motion during PA, sports bra design, perceived barriers to participation in PA and education/knowledge of breast support and bra fit. Increasing breast support reduces breast movement during PA yet breast motion and bra fit are still the most common breast concerns for females. This is likely influenced by poor breast knowledge, leading to poor breast support choices. Future research should explore to what extent breast motion, knowledge and bra fit influences sport participation, and this research should include a more diverse range of adult ages, cup sizes, ethnicities and PA levels to provide a wider understanding.

A multi-phase intervention study of sports bra prescription for elite UK female athletes preparing for the Tokyo Olympics and Paralympics

Athletes report poor breast/bra knowledge, breast pain, sports bras causing lacerations and chafing, negatively affecting sports performance. No bra interventions to address these issues are reported. Working with 142 UK female athletes preparing for Tokyo Olympics/Paralympics (27 sports), this multi-phase intervention assessed breast/bra knowledge, preferences, issues via surveys and breast/bra assessments. Data were used to develop two sports bras. A total of 112 athletes were prescribed one of the new bras through individual assessments. After four weeks, wear athletes completed evaluations. Pre-intervention breast/bra knowledge was low (83% ≤average), multiple breast/bra issues were reported and most athletes wore ill-fitting, loose bras, offering limited support. Post-intervention, 63% reported improved knowledge and 97% reported their prescribed bra as better than their original bra. Eighty-seven per cent reported benefitting from this intervention, with 17% reporting improved performance. This intervention effectively assessed sports bra needs, developed and implemented solutions, which improved knowledge and potentially performance for some UK athletes.

The Physiological Requirements of and Nutritional Recommendations for Equestrian Riders

Equestrian sport is under-researched within the sport science literature, creating a possible knowledge vacuum for athletes and support personnel wishing to train and perform in an evidence-based manner. This review aims to synthesise available evidence from equitation, sport, and veterinary sciences to describe the pertinent rider physiology of equestrian disciplines. Estimates of energy expenditure and the contribution of underpinning energy systems to equestrian performance are used to provide nutrition and hydration recommendations for competition and training in equestrian disciplines. Relative energy deficiency and disordered eating are also considered. The practical challenges of the equestrian environment, including competitive, personal, and professional factors, injury and concussion, and female participation, are discussed to better highlight novelty within equestrian disciplines compared to more commonly studied sports. The evidence and recommendations are supported by example scenarios, and future research directions are outlined.

A multi-stage intervention assessing, advising and customising sports bras for elite female British athletes

Appropriate breast support is recommended in sport; however, what constitutes appropriate support is complex, individual and often sports specific, particularly in elite sport given the wear duration. This intervention educated, assessed and advised elite British female athletes on breasts and bras; those with unresolved issues engaged in bespoke bra interventions. Following educational workshops (n = 80), breast/bra surveys (n = 60), individual bra assessments (n = 37); a rower, shooter, and hockey player participated in the bespoke bra intervention. Eighty-three per cent of athletes rated their breast/bra knowledge as ≤average. Fifty-one per cent experienced breast pain, affecting performance for 29%; seven used medication and one surgery to relieve symptoms. In individual bra assessments most wore ill-fitting, unsupportive bras and wanted bra advice. Bespoke bra interventions eliminated breast pain: for the rower, improved breast position and spine rotation; for the shooter, repositioned tissue and improved performance; and for the hockey player, accommodated smart devices. Whilst bespoke bra development is challenging, most elite athlete breast/bra issues are resolved via education, advice and fitting.

Experience of Pain and Unpleasantness during Mammography Screening: A Cross-Sectional Study on the Roles of Emotional, Cognitive, and Personality Factors

BACKGROUND

Breast cancer is the most frequent cause of malignant tumors among women worldwide. Its successful prevention depends on the degree of participation in screening programs, which can be influenced by psychological factors, including fear.

METHOD

A cross-sectional study was conducted according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. Twenty-six healthy women aged 50-69 years took part in this study, all of whom were summoned for routine mammography screening and were randomly selected. Prior mammography screening, breast pain intensity, unpleasantness (visual analog scale), and psychological (catastrophizing, state anxiety, and fear of pain) and personality (neuroticism, psychoticism, and extraversion) variables were evaluated. Pain, unpleasantness, and state anxiety were further evaluated pre- and post-mammography screening.

RESULTS

During the mammography screening, pain and unpleasantness levels were higher than those observed pre- and post-screening. Residual unpleasantness remained post-screening. State anxiety was positively associated with pain, and psychoticism with unpleasantness, as reported by participants during the mammography screening.

CONCLUSIONS

Anxiety levels influence the pain experienced in association with the mammography procedure. Women subjected to mammography screenings might benefit from relaxation strategies aimed at reducing anxiety to pre-mammography levels and, by extension, pain and unpleasantness during mammography. The inclusion of these strategies in breast cancer prevention campaigns could improve the rates of mammography reattendance, and therefore, benefit cancer prevention efforts.

Static postural differences between male and female equestrian riders on a riding simulator

This study aimed to compare static posture of male and female riders on a riding simulator. Ten female and five male riders underwent a 5 min standardised exercise programme on the simulator, they were then videoed for 10 s from each the left, right, and rear views whilst stationary on the simulator. Two-dimensional kinematic analysis of the videos showed that male riders had a more neutrally positioned pelvis in the sagittal plane (median left: 6.47°, right: 5.24°) with females demonstrating a posterior pelvic tilt (L: 14.04°, R: 13.55°). Females showed significantly greater pelvic obliquity (median female: 1.99°, male: 0.73°), trunk lean (F: 1.60°, M: 0.43°), and shoulder tilt (F: 1.79°, M: 0.57°) in the frontal plane, demonstrating an overall greater postural asymmetry. Previous studies of elite riders have shown a more anteriorly rotated pelvis to be more desirable. Symmetry of riding position is favourable as it allows movements to be performed with ease and ensures even force distribution through the saddle to the horse. Male riders may therefore have a biomechanical advantage over females when it comes to maintaining a desirable riding position. This research should now be extended to study riders on the horse in motion.

Breast biomechanics, exercise induced breast pain (mastalgia), breast support condition and its impact on riding position in female equestrians

Breast biomechanics, exercise-induced breast pain (EIBP) and performance effects in female athletes are established. Wearing sports bras during exercise reduces breast movement and EIBP. Despite the prevalence of female equestrians, little investigation of breast movement during horse riding exists, yet excessive breast movement, embarrassment and EIBP are reported. Breast movement relative to the torso is linked to EIBP, associated with magnitude and direction of forces generated. Equestrians may experience novel breast and upper-body movement patterns in response to large vertical excursions of the horse. This study aimed to establish relative vertical breast displacement (RVBD), EIBP and positional changes in three support conditions: ‘no support’, ‘low support’ and ‘high support’. Thirty-eight female equestrians rode a Racewood™ Equine Simulator in each breast support condition in medium walk, medium trot (sitting) and medium canter. Trials were filmed and analysed using Quintic® Biomechanics V29. Significant reductions in RVBD (P<0.001) and EIBP (P<0.001) were identified with increased breast support in all gaits. In medium trot (sitting) a significant reduction in range of movement (ROM) of shoulder-elbow-wrist (P<0.001) was seen from low to high support. ROM of torso-vertical angles were reduced from no support to low support (P<0.001) and further by high support (P<0.001). This reduction in ROM was significantly greater in large breasted riders (cup size DD-FF) (n=21) (P<0.001) compared to small breasted (cup size AA-D) (n=17). These results suggest that appropriate breast support positively impacts EIBP and riding position in female riders possibly enhancing performance. As RVBD and reported EIBP were not wholly comparative with results in female runners, further research is warranted to establish breast movement in equestrianism in three dimensions.

Potential Impacts of Body Image Perception in Female Equestrians

Female body image (BI) has been investigated in many sports yet, in female-dominated equestrianism, there is a paucity of BI research. This study aimed to identify self-perceptions of BI, rider perceptions of judge and coach bias, relationships between BI and self-consciousness and effect of breast size. A four-part, 27 question survey (GoogleForms) was completed by female equestrians (n = 493). The second smallest BI was considered ideal for equestrianism (χ² = 352.751, P < .001) regardless of age, own BI or level of riding commitment. There was a perception judges favor riders with smaller frames (χ² = 54.2111, P < .001) and an association between riders with a larger BI feeling self-conscious when riding (χ² = 87.514, P < .001). More respondents perceived the ideal equestrian BI to be smaller than theirs (Median = -1.5, W = 7777.00, P < .001) and an association between those dissatisfied with their BI and self-consciousness when riding was seen (χ² = 83.649, P < .001). Perception of the ideal equestrian frame is smaller than many riders' own BI, and a larger BI perception negatively impacts self-confidence, potentially hindering performance and participation. Female riders with a larger frame feel they are perceived negatively by judges and further study is indicated to investigate the extent of this potential bias on subjective judging in equestrian disciplines.

Can Physical Characteristics and Sports Bra Use Predict Exercise-Induced Breast Pain in Elite Female Athletes?

OBJECTIVE

To evaluate whether a simple 4-factor model using self-reported data could be used to predict exercise-induced breast pain in elite female athletes.

DESIGN

Survey study.

SETTING

Online or hard-copy surveys completed at sporting competitions and training facilities around Australia.

PARTICIPANTS

Four hundred ninety female athletes competing nationally or internationally across 49 sports.

INDEPENDENT VARIABLES

A binomial logistic regression analysis was used to evaluate the strength of a predictive model that included 2 continuous independent variables (age and body mass index) and 2 binary independent variables (breast size and sports bra use). Odds ratios were also calculated to determine the likelihood of an athlete reporting exercise-induced breast pain in association with each of the 4 variables.

MAIN OUTCOME MEASURES

Exercise-induced breast pain was the binary dependent variable.

RESULTS

The model incorporating athlete age, breast size, body mass index, and sports bra use was found to be statistically significant, but weak, in its ability to predict exercise-induced breast pain in elite female athletes (correctly identified 66% of athletes). For every 1-year increase in age, a significant 2.6% increase in the likelihood of experiencing exercise-induced breast pain was observed. Athletes with medium-to-hypertrophic sized breasts were 5.5 times more likely to experience exercise-induced breast pain than athletes with small breasts.

CONCLUSIONS

Although the current model was not sensitive enough for use by clinicians and coaches, age and breast size were both identified as critical variables in the prediction of exercise-induced breast pain. Future research is encouraged to investigate whether incorporating additional variables such body fat percentage, bra fit, and other relevant factors can add strength to the model.

Garments and Footwear for Chronic Pain

In most human societies, wearing clothing and shoes, particularly in public settings, is commonplace and may even be legally required. Consequently, there is an abundance of clothing and footwear options for individuals of different ages, genders, body shapes and catering to different needs such as workwear and active-wear. However, many of the available options may not be viable for the millions and pain sufferers worldwide, indicating a need for adaptive apparel for the pain patient. In this perspective manuscript, we focus on the availability and efficacy of clothing designed to prevent pain in the general population as well as reduce or treat pain in pain patients. Furthermore, we put forth some considerations for the construction of adaptive garments. Such efforts and needed and could significantly improve well-being and quality of life in the pain patient.

The incidence of breast health issues and the efficacy of a sports bra fit and issue service in British Army recruits

Increasing retention of female recruits throughout Basic Training (BT) is a key priority for the British Army. The aims of this study were two-fold; (i) quantify breast health issues and sports bra usage within female British Army recruits, and (ii) assess the influence of professionally fitted sports bras on breast health and bra fit issues across 13 weeks of BT. A survey was completed by 246 female recruits that identified the incidence of breast health issues during BT. Subsequently, 33 female recruits were provided with professionally fitted sports bras during Week-1 of BT. Recruits completed a survey in Week-1 (Pre) and Week-13 (Post). There was a high incidence of bra issues during BT, which did not reduce following the implementation of professionally fitted sports bras. The authors recommend further research into the specific functional requirements of breast support relative to the demands of BT and the needs of the female recruit. Practitioner Summary: The British Army have a duty of care to ensure female recruits are equipped sufficiently for the demands of training. Despite the implementation of a sports bra fitting and issue service bra fit issues remained high. Further research into the specific functional requirements of breast support during training is recommended. Abbreviations: BT: Basic Training; ATR(W): Army Training Regiment Winchester; ATC(P): Army Training Centre Pirbright; BMI: Body Mass Index; NRS: Numeric Rating Scale; FET: Fisher's Exact Test.

Biomechanics of Breast Support for Active Women

More systematic breast biomechanics research and better translation of the research outcomes are necessary to provide information upon which to design better sports bras and to develop effective evidence-based strategies to alleviate exercise-induced breast pain for women who want to participate in physical activity in comfort.

A retrospective investigation of the impact of ‘eventing phase (dressage, show-jumping and cross-country)’ on pre-competition anxiety and self-confidence

Working in the discipline of eventing (the triathlon of equestrian sport), the present study aims to extend current literature on the use of psychological skills within equestrian sports, by understanding and identifying differences in levels of self-confidence and competitive anxiety. Each eventing phase (dressage, show-jumping and cross-country) was considered and its impact on anxiety and self-confidence analysed. Level of competition was considered a covariate and its effect on specific eventing phases and any associated influence on anxiety and self-confidence within eventing phase was analysed. An experimental, 3×3 factorial, within-subjects design was used. 57 participants (52 female and 5 male; 18 professional, 36 amateur and 3 undefined) completed the Revised Competitive Sport Anxiety Inventory 2 (CSAI-2R), a 17-item questionnaire measuring anxiety and self-confidence. Descriptive statistics identified the show-jumping phase had the largest impact on rider somatic anxiety (SA) and cognitive anxiety (CA). The cross-country phase had the highest self-confidence mean score. Spearman’s rank correlations showed both SA and CA were debilitative for all competition levels. Both SA and CA were found to be more debilitating in the show-jumping phase when self-confidence was low. MANCOVA analysis showed that eventing phase had significant effect on anxiety and self-confidence when controlling for level of competition. Dependent on the eventing phase riders are competing in, they experience different levels of arousal and self-confidence. When SA and CA are a debilitative source of anxiety, this could result in rider muscle tension which is not conducive to effective horse-rider communication. Coaches or sports psychologists should consider how to help riders manage their anxiety levels in relation to the competition phase, with the intention of enhancing self-confidence and enabling facilitative SA and CA in preparation for eventing performance.

ACR Appropriateness Criteria® Breast Pain

Breast pain is a common complaint. However, in the absence any accompanying suspicious clinical finding (eg, lump or nipple discharge), the association with malignancy is very low (0%-3.0%). When malignancy-related, breast pain tends to be focal (less than one quadrant) and persistent. Pain that is clinically insignificant (nonfocal [greater than one quadrant], diffuse, or cyclical) requires no imaging beyond what is recommended for screening. In cases of pain that is clinically significant (focal and noncyclical), imaging with mammography, digital breast tomosynthesis (DBT), and ultrasound are appropriate, depending on the patient's age. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

An investigation of bra concerns and barriers to participation in horse riding

Horse riding is a female-dominated sport where participation levels are declining. The influence of the breast on participation levels and current satisfaction with bras for this activity is unknown. This study aimed to investigate bra concerns and breast-related barriers to participation in horse riding. A 6-part, 32 question online survey was completed by 1,324 females who participated in horse riding. Descriptive and chi-squared analyses were utilised; inductive content analysis was completed to analyse qualitative responses. At least one breast-related barrier was reported by 25% of all participants. Larger-breasted riders were less satisfied (P<0.001) with their bras. 70% of riders stated that improvements needed to be made in bras to help reduce breast health issues, with support, style and fit the most common reasons cited. This study highlights the importance of addressing breast-related barriers and provides rationale for the development of equestrian-specific breast support garments and educational initiatives.