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Wakefield-Scurr J, St John E, Bibby K, Renwick N, Smith N, Hobbs S, Brown N. Insights into breast health issues in women's rugby. Eur J Sport Sci 2024. [PMID: 38952063 DOI: 10.1002/ejsc.12128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 07/03/2024]
Abstract
World RugbyTM supports dedicated women's welfare, injury surveillance and medical/technical interventions, yet breast health has received limited attention. This article aims to provide insights into breast health issues in rugby, including breast impacts and injuries. We discuss how breast anatomy and position may be problematic in rugby. Breast volume relates to body size, which may be increasing in women's rugby, suggesting increased breast surface area and mass, potentially increasing injury risk. Breast health issues in rugby have been reported previously, with 58% of contact footballers (including rugby) experiencing breast injuries. There are damaging effects related to these breast health issues, with breast impacts often causing pain and swelling. Breast impacts may lead to haematomas, cysts and fat necrosis which can calcify over time making them difficult to distinguish from breast carcinoma, causing further investigation and anxiety. In sport, poor bra fit and insufficient support are associated with pain, skin strain and performance decrements. This article reports the potential implications of these breast health issues on performance in rugby. Recent breast-related projects supported by rugby communities may address recommendations identified in the literature for robust breast injury classifications, updated injury surveillance systems and prospective data collection on breast injury prevalence, severity and impact in rugby. These data should inform breast injury care pathways and intervention research, including evidence-based bra design. Understanding the implications of breast impacts on tissue properties, health and wellbeing is vital. Finally, data should inform rugby-specific breast education, raising awareness of this aspect of athlete health.
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Affiliation(s)
- Joanna Wakefield-Scurr
- Research Group in Breast Health, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Edward St John
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Kilian Bibby
- Department of Physical Education and Sport Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Nichola Renwick
- Research Group in Breast Health, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Neal Smith
- Centre for Health and Applied Sport and Exercise Research, University of Chichester, Chichester, UK
| | - Samantha Hobbs
- Centre for Health and Applied Sport and Exercise Research, University of Chichester, Chichester, UK
| | - Nicola Brown
- Faculty of Sport, Technology and Health Sciences, St Mary's University Twickenham, Twickenham, UK
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Christopher SM, Donnelly G, Brockwell E, Bo K, Davenport MH, De Vivo M, Dufour S, Forner L, Mills H, Moore IS, Olson A, Deering RE. Clinical and exercise professional opinion of return-to-running readiness after childbirth: an international Delphi study and consensus statement. Br J Sports Med 2024; 58:299-312. [PMID: 38148108 DOI: 10.1136/bjsports-2023-107489] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/28/2023]
Abstract
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.
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Affiliation(s)
- Shefali Mathur Christopher
- Department of Rehabilitation Sciences, Doctor of Physical Therapy, Tufts University, Seattle, Washington, USA
- Elon University, Elon, North Carolina, USA
| | - Gráinne Donnelly
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Kari Bo
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lorenskog, Norway
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children's Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Marlize De Vivo
- Perinatal Physical Activity Research Group, School of Psychology and Life Sciences, Section of Sport, Exercise and Rehabilitation Science, Canterbury Christ Church University, Canterbury, UK
- Active Pregnancy Foundation, None, UK
| | - Sinead Dufour
- The World of my Baby (WOMB), Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Lori Forner
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Hayley Mills
- Perinatal Physical Activity Research Group, School of Psychology and Life Sciences, Section of Sport, Exercise and Rehabilitation Science, Canterbury Christ Church University, Canterbury, UK
| | - Isabel S Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Rita E Deering
- Department of Physical Therapy, Carroll University, Waukesha, Wisconsin, USA
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Fong HB, Nelson AK, McGhee D, Ford KR, Powell DW. Increasing Breast Support is Associated With a Distal-to-Proximal Redistribution of Joint Negative Work During a Double-Limb Landing Task. J Appl Biomech 2024; 40:14-20. [PMID: 37917960 DOI: 10.1123/jab.2022-0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 07/28/2023] [Accepted: 08/21/2023] [Indexed: 11/04/2023]
Abstract
Female athletes exhibit greater rates of anterior cruciate ligament injury compared with male athletes. Biomechanical factors are suggested to contribute to sex differences in injury rates. No previous investigation has evaluated the role of breast support on landing biomechanics. This study investigates the effect of breast support on joint negative work and joint contributions to total negative work during landing. Thirty-five female athletes performed 5 landing trials in 3 breast support conditions. Lower-extremity joint negative work and relative joint contributions to total negative work were calculated. Univariate analyses of variance were used to determine the effect of breast support on negative joint work values. Increasing levels of breast support were associated with lower ankle negative work (P < .001) and ankle relative contributions (P < .001) and increases in hip negative work (P = .008) and hip relative contributions (P < .001). No changes were observed in total negative work (P = .759), knee negative work (P = .059), or knee contributions to negative work (P = .094). These data demonstrate that the level of breast support affects lower-extremity biomechanics. The distal-to-proximal shift in negative joint work and relative joint contributions may be indicative of a more protective landing strategy for anterior cruciate ligament injuries.
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Affiliation(s)
- Hailey B Fong
- Musculoskeletal Analysis Laboratory, College of Health Studies, The University of Memphis, Memphis, TN, USA
| | - Alexis K Nelson
- Musculoskeletal Analysis Laboratory, College of Health Studies, The University of Memphis, Memphis, TN, USA
| | - Deirdre McGhee
- Biomechanics Research Laboratory, School of Medicine, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW, Australia
| | - Kevin R Ford
- Biomechanics and Physiology Laboratory, High Point University, High Point, NC, USA
| | - Douglas W Powell
- Musculoskeletal Analysis Laboratory, College of Health Studies, The University of Memphis, Memphis, TN, USA
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Powell DW, Fong HB, Nelson AK. Increasing breast support is associated with altered knee joint stiffness and contributing knee joint biomechanics during treadmill running. Front Sports Act Living 2023; 5:1113952. [PMID: 37152112 PMCID: PMC10160436 DOI: 10.3389/fspor.2023.1113952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/20/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Greater breast support has been associated with improved running performance as measured by oxygen cost and running economy. Several candidate mechanisms have been proposed to underlie breast support-related improvements in running performance including increased knee joint stiffness. Greater knee joint stiffness has been associated with improved running performance (speed and metabolic cost), though the influence of breast support on knee joint stiffness has not been previously investigated. Therefore, the purpose of this study was to investigate the influence of increasing breast support on knee joint stiffness and its constituent components during treadmill running. Methods Thirteen recreational runners performed a 3-min running bout at their preferred running velocity in each of three breast support conditions: bare chested (CON), low support (LOW) and high support (HIGH) sports bras. Three-dimensional kinematics and ground reaction forces were collected simultaneously using a 10-camera motion capture system (240 Hz, Qualisys Inc.) and instrumented treadmill (1,200 Hz, Bertec Inc.). Visual3D (C-Motion Inc.) was used to calculate knee joint excursions, moments, powers and work while custom software (MATLAB) was used to calculate knee joint stiffness and breast displacements during the stance phase of running in each experimental condition. A series of 1 × 3 repeated measures analysis of covariance with post-hoc t-tests was used to evaluate the effect of breast support on knee joint biomechanics during treadmill running. Results Increasing levels of breast support were associated with greater knee joint stiffness (p = 0.002) as a result of smaller knee flexion excursions (p < 0.001). Increases in knee extension power (p = 0.010) were observed with increasing levels of breast support while no differences were observed in knee extension moments (p = 0.202) or work (p = 0.104). Conclusion Greater breast support is associated with increased knee joint stiffness resulting from smaller joint excursions. These findings may provide insight into the biomechanical mechanisms underlying previously reported improvements in running performance including reduced oxygen consumption and greater running economy.
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Affiliation(s)
- Douglas W. Powell
- Breast Biomechanics Research Center, College of Health Sciences, University of Memphis, Memphis, TN, United States
- Department of Orthopedic Surgery & Biomedical Engineering, University of Tennessee Health Science Center, Memphis, TN, United States
- Correspondence: Douglas W. Powell
| | - Hailey B. Fong
- Breast Biomechanics Research Center, College of Health Sciences, University of Memphis, Memphis, TN, United States
| | - Alexis K. Nelson
- Department of Biomedical Sciences, University of Tennessee Health Science Center, Memphis, TN, United States
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