Based on the results of this thesis, the following evidence-based recommendations are made for sports to manage breast pain and breast injury:
(i) Female athletes across all sports, especially older athletes and those with larger breasts, should receive education on strategies to reduce mastalgia and exercise- induced breast pain during training and competition. One simple strategy that has been shown to effectively relieve up to 85% of breast pain symptoms is wearing
a properly fitted, high support bra (Hadi 2000). This is because a well-designed and fitted sports bra can reduce breast motion and, in turn, reduce breast pain compared to wearing inadequate breast support. Evidence-based educational resources are available and should be used to educate female athletes on the importance of adequate breast support and how to select and correctly fit a sports bra that caters for the movements specific to their sport (McGhee et al. 2008). (ii) It is vital that female athletes, particularly female contact football players, are
educated about the potential for breast injuries and how these injuries can negatively affect their football performance. Encouraging accurate reporting and recording of breast injuries will enable future sport-specific surveillance systems to collect valid breast injury data, which is essential for the future development and implementation of breast injury prevention strategies. It will also ensure that, where necessary, female athletes receive appropriate treatment for their breast injuries.
(iii) It is also essential to “normalise the conversation” about breast injuries amongst coaches and medical professionals working with female contact football players. Many staff expressed that they were unsure of how to talk to their players about breast injuries, and therefore it is recommended that staff receive education about breast injury risk and potential prevention strategies, as well as training on how to create an open dialogue with their players about breast injury. An example of an evidence-based resource that could be used to educate female contact football players and their coaches about breast injuries is included in Appendix E.
References
References REFERENCES
Adams BB. Dermatologic disorders of the athlete. Sports Medicine. 2002;32(5):309-21. Ader DN and Shriver CD. Cyclical mastalgia: prevalence and impact in an outpatient
breast clinic sample. Journal of the American College of Surgeons. 1997;185(5):466-70.
Australian Football League Commission. Laws of Australian Football. 2019.
<https://s.afl.com.au/staticfile/AFL%20Tenant/AFL/Files/2019%20Laws%20of
%20Australian%20Football.pdf>. Accessed 1 Jun 2019.
Australian Rugby League Commission. Rugby League Laws of the Game: International Level with Notes on the Laws and NRL Telstra Premiership Interpretations. 2019. <https://www.playrugbyleague.com/media/3114/arl-rules-book-
2019.pdf>. Accessed 1 Jun 2019.
Ball K. Use of weighted balls for improving kicking for distance. Proceedings of the 6th
World Congress on Science and Football, Antalya, Turkey, 15-20 Jan 2007.
Ball K. Biomechanical considerations of distance kicking in Australian Rules football.
Sports Biomechanics. 2008;7(1):10-23.
Bank PJM, Peper CL, Marinus J, Beek PJ, van Hilten JJ. Motor dysfunction of complex regional pain syndrome is related to impaired central processing of
proprioceptive information. The Journal of Pain. 2013;14(11):1460-74.
Bayne JD. Pro+tec protective bra. The Journal of Sports Medicine and Physical Fitness. 1968;8(1):34-5.
Black GM, Gabbett TJ, Naughton G, Cole MH, Johnston RD, Dawson B. The influence of contextual factors on running performance in female Australian football match-play. The Journal of Strength and Conditioning Research. 2017 (in press).
Bowles K-A, Steele JR, Munro B. What are the breast support choices of Australian women during physical activity? British Journal of Sports Medicine.
2008;42(8):670-3.
Boyd N, Martin L, Chavez S, Gunasekara A, Salleh A, Melnichouk O, Yaffe M,
Friedenreich C, Minkin S, Bronskill M. Breast-tissue composition and other risk factors for breast cancer in young women: a cross-sectional study. The Lancet
Bridgman C, Scurr J, White J, Hedger W, Galbraith H. Three-dimensional kinematics of the breast during a two-step star jump. Journal of Applied Biomechanics.
2010;26(4):465-72.
Brown N, White J, Brasher A, Scurr J. An investigation into breast support and sports bra use in female runners of the 2012 London Marathon. Journal of Sports
Sciences. 2014a;32(9):801-9.
Brown N, White J, Brasher A, Scurr J. The experience of breast pain (mastalgia) in female runners of the 2012 London Marathon and its effect on exercise behaviour. British Journal of Sports Medicine. 2014b;48(4):320-5.
Brown N, White J, Milligan A, Risius D, Ayres B, Hedger W, Scurr J. The relationship between breast size and anthropometric characteristics. American Journal of
Human Biology. 2012;24(2):158-64.
Burbage J and Cameron L. An investigation into the prevalence and impact of breast pain, bra issues and breast size on female horse riders. Journal of Sports
Sciences. 2017;35(11):1091-7.
Burnett E, White J, Scurr J. The influence of the breast on physical activity participation in females. Journal of Physical Activity and Health. 2015;12(4):588-94.
Byrne S and McLean N. Elite athletes: effects of the pressure to be thin. Journal of
Science and Medicine in Sport. 2002;5(2):80-94.
Chang L-X, Gao W-D, Yan X-L. Studies of sports bra based on biomorphic analyses of females breasts. Proceedings of the 3rd International Conference on
Bioinformatics and Biomedical Engineering, Beijing, China, 11-13 Jun 2009.
Chen X, Gho SA, Wang J, Steele JR. Effect of sports bra type and gait speed on breast discomfort, bra discomfort and perceived breast movement in Chinese women.
Ergonomics. 2016;59(1):130-42.
Clarke AC, Anson JM, Pyne DB. Game movement demands and physical profiles of junior, senior and elite male and female rugby sevens players. Journal of Sports
Sciences. 2017;35(8):727-33.
Clarke AC, Presland J, Rattray B, Pyne DB. Critical velocity as a measure of aerobic fitness in women's rugby sevens. Journal of Science and Medicine in Sport. 2014;17(1):144-8.
Clarke AC, Ryan S, Couvalias G, Dascombe BJ, Coutts AJ, Kempton T. Physical demands and technical performance in Australian Football League Women's (AFLW) competition match-play. Journal of Science and Medicine in Sport. 2018;21(7):748-52.
References
Clarsen B and Bahr R. Matching the choice of injury/illness definition to study setting, purpose and design: one size does not fit all! British Journal of Sports Medicine. 2014;48(7):510-2.
Cohen J. Statistical power analysis for the behaviors science (2nd edition). New York,
USA: Routledge. 1988.
Coltman CE, McGhee DE, Steele JR. Association between breast volume and bra size in a cohort of women with large breasts. Proceedings of the 9th Australasian
Biomechanics Conference, Wollongong, Australia, 30 Nov–20 Dec 2014.
Coltman CE, McGhee DE, Steele JR. Bra strap orientations and designs to minimise bra strap discomfort and pressure during sport and exercise in women with large breasts. Sports Medicine -Open. 2015;1:21.
Coltman CE, McGhee DE, Steele JR. Three-dimensional scanning in women with large, ptotic breasts: implications for bra cup sizing and design. Ergonomics.
2017a;60(3):439-45.
Coltman CE, Steele JR, McGhee DE. Breast volume is affected by body mass index but not age. Ergonomics. 2017b;60(11):1576-85.
Coltman CE, Steele JR, McGhee DE. Effect of aging on breast skin thickness and elasticity: implications for breast support. Skin Research and Technology. 2017c;23(3):303-11.
Coltman CE, Steele JR, McGhee DE. Effects of age and body mass index on breast characteristics: a cluster analysis. Ergonomics. 2018a;61(9):1232-45.
Coltman CE, Steele JR, McGhee DE. Which bra components contribute to incorrect bra fit in women across a range of breast sizes? Clothing and Textiles Research
Journal. 2018b;36(2):78-90.
Comstock RD, Fields SK, Knox CL. Protective equipment use among female rugby players. Clinical Journal of Sport Medicine. 2005;15(4):241-5.
Coutts AJ, Quinn J, Hocking J, Castagna C, Rampinini E. Match running performance in elite Australian Rules Football. Journal of Science and Medicine in Sport. 2010;13(5):543-8.
Cummins C, Orr R, O'Connor H, West C. Global positioning systems (GPS) and microtechnology sensors in team sports: a systematic review. Sports Medicine. 2013;43(10):1025-42.
Cunniffe B, Proctor W, Baker JS, Davies B. An evaluation of the physiological
Curry EJ, Logan C, Ackerman K, McInnis KC, Matzkin EG. Female athlete triad awareness among multispecialty physicians. Sports Medicine -Open. 2015;1(1):1-7.
Daanen H, Hong SA. Made-to-measure pattern development based on 3D whole body scans. International Journal of Clothing Science and Technology.
2008;20(1):15-25.
Daanen, HAM, Ter Haar, FB. 3D whole body scanners revisited. Display. 2013;34:270- 275.
de Bernardo DH, Curtis A. Using online and paper surveys: the effectiveness of mixed- mode methodology for populations over 50. Research on Aging. 2013;35(2): 220-40.
Den Tonkelaar I, Peeters PH, Van Noord PA. Increase in breast size after menopause: prevalence and determinants. Maturitas. 2004;48(1):51-7.
Deroche T, Woodman T, Stephan Y, Brewer BW, Le Scanff C. Athletes' inclination to play through pain: a coping perspective. Anxiety, Stress, and Coping.
2011;24(5):579-87.
Dönmez G, Korkusuz F, Özçakar L, Karanfil Y, Dursun E, Kudas S, Doral MN. Injuries among recreational football players: results of a prospective cohort study.
Clinical Journal of Sport Medicine. 2018;28(3):249-54.
Drummond JL, Hostetter K, Laguna PL, Gillentine A, Del Rossi G. Self-reported comfort of collegiate athletes with injury and condition care by same-sex and opposite-sex athletic trainers. Journal of Athletic Training. 2007;42(1):106-12. Efting Dijkstra JD. Borstcorrecties: plastische chirurgie ter correctie van de borst.
Haarlem: De Toorts. 1995.
Engström B, Johansson C, Tornkvist H. Soccer injuries among elite female players. The
American Journal of Sports Medicine. 1991;19(4):372-5.
Female Athlete Issues For The Team Physician: A Consensus Statement. Current
Sports Medicine Reports. 2018;17(5):163-71.
Finch C. A new framework for research leading to sports injury prevention. Journal of
Science and Medicine in Sport. 2006;9(1-2):3-9.
Fink B, Neave N, Manning J. Second to fourth digit ratio, body mass index, waist-to-hip ratio, and waist-to-chest ratio: their relationships in heterosexual men and
References
Frideres JE, Mottinger SG, Palao JM. Collegiate coaches’ knowledge of the female athlete triad in relation to their characteristics. Central European Journal of
Sport Sciences and Medicine. 2016;16(4):55-66.
Fuller CW, Brooks JH, Cancea RJ, Hall J, Kemp SP. Contact events in rugby union and their propensity to cause injury. British Journal of Sports Medicine.
2007a;41(12):862-7.
Fuller CW, Ekstrand J, Junge A, Andersen TE, Bahr R, Dvorak J, Hägglund M,
McCrory P, Meeuwisse WH. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Scandinavian
Journal of Medicine and Science in Sports. 2006;16(2):83-92.
Fuller CW, Molloy MG, Bagate C, Bahr R, Brooks JH, Donson H, Kemp SP, McCrory P, McIntosh AS, Meeuwisse WH. Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union. British Journal
of Sports Medicine. 2007b;41(5):328-31.
Furnell A, Coleman J, Tomkinson G, Daniell N. Sizing up the ADF: The Australian warfighter anthropometry survey. Proceedings of the 3rd International Digital
Human Modelling Conference, Tokyo, Japan, 20-22 May 2014.
Gabbe B, Finch C, Wajswelner H, Bennell K. Australian football: injury profile at the community level. Journal of Science and Medicine in Sport. 2002;5(2):149-60. Gabbett TJ. Incidence of injury in junior and senior rugby league players. Sports
Medicine. 2004;34(12):849-59.
Gabbett TJ. Physiological and anthropometric characteristics of elite women rugby league players. The Journal of Strength and Conditioning Research.
2007;21(3):875-81.
Gabbett TJ, Jenkins DG, Abernethy B. Physiological and anthropometric correlates of tackling ability in junior elite and subelite rugby league players. The Journal of
Strength and Conditioning Research. 2010;24(11):2989-95.
Gabbett T, Kelly J, Pezet T. Relationship between physical fitness and playing ability in rugby league players. The Journal of Strength and Conditioning Research. 2007;21(4):1126-33.
Garraway WM, Lee AJ, Hutton SJ, Russell EB, Macleod DA. Impact of
professionalism on injuries in rugby union. British Journal of Sports Medicine. 2000;34(5):348-51.
Garrido-Chamorro R, Sirvent-Belando J, Gonzalez-Lorenzo M, Martin-Carratala M, Roche E. Correlation between body mass index and body composition in elite athletes. Journal of Sports Medicine and Physical Fitness. 2009;49(3):278-84. Gaskin, KM. Structural anatomy of the breast (Masters thesis). University of
Wollongong, Australia. 2017.
Gefen A and Dilmoney B. Mechanics of the normal woman's breast. Technology and
Health Care. 2007;15(4):259-71.
Gehlsen G and Albohm M. Evaluation of sports bras. The Physician and
Sportsmedicine. 1980;8(10):88-97.
Gehlsen G and Stoner LJ. The female breast in sports and exercise. Sports Women. 1987;24:13-22.
Gerrard DF. The use of padding in rugby union. Sports Medicine. 1998;25(5):329-32. Gillette J. When and where women are injured in sports. The Physician and
Sportsmedicine. 1975;3(5):61-3.
Gissane C, White J, Kerr K, Jennings D. Physical collisions in professional super league rugby, the demands on different player positions. Cleveland Medical Journal. 2001;4:137-46.
Giza E, Mithöfer K, Farrell L, Zarins B, Gill T. Injuries in women’s professional soccer.
British Journal of Sports Medicine. 2005;39(4):212-6.
Graven-Nielsen T, Svensson P, Arendt-Nielsen L. Effects of experimental muscle pain on muscle activity and co-ordination during static and dynamic motor function.
Electroencephalography and Clinical Neurophysiology/Electromyography and Motor Control. 1997;105(2):156-64.
Gray AJ and Jenkins DG. Match analysis and the physiological demands of Australian football. Sports Medicine. 2010;40(4):347-60.
Greenbaum AR, Heslop T, Morris J, Dunn KW. An investigation of the suitability of bra fit in women referred for reduction mammaplasty. British Journal of Plastic
Surgery. 2003;56(3):230-6.
Greydanus DE, Patel DR, Baxter TL. The breast and sports: issues for the clinician.
Adolescent Medicine. 1998;9(3):533-550, vi-vii.
Haake S and Scurr J. A dynamic model of the breast during exercise. Sports
References
Hadi MSAA. Sports brassiere: is it a solution for mastalgia? The Breast Journal. 2000;6(6):407-9.
Hägglund M, Waldén M, Ekstrand J. Injuries among male and female elite football players. Scandinavian Journal of Medicine and Science in Sports.
2009;19(6):819-27.
Han H, Nama Y, Choi K. Comparative analysis of 3D body scan measurements and manual measurements of size Korean adult females. International Journal of
Industrial Ergonomics. 2010;40:530-540.
Haycock C, Shierman G, Gillette J. The female athlete–does her anatomy pose
problems. Proceedings of the 19th American Medical Association Conference on
the Medical Aspects of Sports. 1978.
Haycock CE. Breast support and protection in the female athlete. Paper presented at: AAHPERD Symposium Papers. 1978.
Haycock CE. How I manage breast problems in athletes. The Physician and
Sportsmedicine. 1987;15(3):89-95.
Helm MF, Helm TN, Bergfeld WF. Skin problems in the long-distance runner 2500 years after the Battle of Marathon. International Journal of Dermatology. 2012;51(3):263-270.
Hilibrand MJ, Hammoud S, Bishop M, Woods D, Fredrick RW, Dodson CC. Common injuries and ailments of the female athlete; pathophysiology, treatment and prevention. The Physician and Sportsmedicine. 2015;43(4):403-11.
Holland P, Torrance E, Funk L. Shoulder injuries in canoeing and kayaking. Clinical
Journal of Sport Medicine. 2018;28(6):524-9.
Huxley J. Rugby sevens' popularity soars following Australian women's win at Olympics. ABC News. 2016. <http://www.abc.net.au/news/2016-11-15/rugby-
sevens-popularity-soars-following-olympic-win/8024716>. Accessed 30 Nov
2018.
Jiang K and Ni Y. Research on effects on women’s breast in sports bra. Informatics and
Management Science III. 2013;206:451-6.
Jones B, Emmonds S, Hind K, Nicholson G, Rutherford Z, Till K. Physical qualities of international female rugby league players by playing position. The Journal of
Strength and Conditioning Research. 2016;30(5):1333-40.
Kroshus E, Fischer AN, Nichols JF. Assessing the awareness and behaviors of U.S. high school nurses with respect to the female athlete triad. The Journal of School
Langeveld E, Coetzee FF, Holtzhausen LJ. Epidemiology of injuries in elite south african netball players. South African Journal for Research in Sport, Physical
Education and Recreation. 2012;34(2):83-93.
Lawson L. Chest/breast protectors for female athletes: cushioning properties and effect on selected physiological and performance variables (Doctoral dissertation). Oregon State University, Corvallis, USA. 1991.
Lawson L and Lorentzen D. Selected sports bras: comparisons of comfort and support.
Clothing and Textiles Research Journal. 1990;8(4):55-60.
Lee H-Y, Hong K, Kim EA. Measurement protocol of women’s nude breasts using a 3D scanning technique. Applied Ergonomics. 2004;35(4):353-9.
Liu Y-J and Thomson JG. Ideal anthropomorphic values of the female breast: correlation of pluralistic aesthetic evaluations with objective measurements.
Annals of Plastic Surgery. 2011;67(1):7-11.
Lorentzen D and Lawson L. Selected sports bras: a biomechanical analysis of breast motion while jogging. The Physician and Sportsmedicine. 1987;15(5):128-39. Losken A, Seify H, Denson DD, Paredes AA Jr, Carlson GW. Validating three-
dimensional imaging of the breast. Annals of Plastic Surgery. 2005;54:471–476 Loud KJ and Micheli LJ. Common athletic injuries in adolescent girls. Current Opinion
in Pediatrics. 2001;13(4):317-22.
Lund J. The relation between pain and muscle activity in fibromyalgia and similar conditions. Progress in Fibromyalgia and Myofascial Pain. 1993:311-27. Mailler EA and Adams BB. The wear and tear of 26.2: dermatological injuries reported
on marathon day. British Journal of Sports Medicine. 2004;38(4):498-501. Mailler-Savage EA and Adams BB. Skin manifestations of running. Journal of the
American Academy of Dermatology. 2006;55(2):290-301.
Malcom NL. “Shaking it off” and “toughing it out” socialization to pain and injury in girls’ softball. Journal of contemporary ethnography. 2006;35(5):495-525. Marshall S, Loomis D, Waller A, Bangdiwala S, Feehan M, Bird Y, Chalmers D,
Quarrie K. Effectiveness of protective equipment in a cohort of rugby players.
American Journal of Epidemiology. 1999;149(11):S14.
Mason BR, Page KA, Fallon K. An analysis of movement and discomfort of the female breast during exercise and the effects of breast support in three cases. Journal of
References
McCarthy MM, Voos JE, Nguyen JT, Callahan L, Hannafin JA. Injury profile in elite female basketball athletes at the Women's National Basketball Association combine. The American Journal of Sports Medicine. 2013;41(3):645-51. McGhee DE, Power BM, Steele JR. Does deep water running reduce exercise-induced
breast discomfort? British Journal of Sports Medicine. 2007;41(12):879-83. McGhee DE, Ramsey LG, Coltman CE, Gho SA, Steele JR. Bra band size
measurements derived from three-dimensional scans are not accurate in women with large, ptotic breasts. Ergonomics. 2018;61(3):464-472.
McGhee DE and Steele JR. How do respiratory state and measurement method affect bra size calculations? British Journal of Sports Medicine. 2006;40(12):970-4. McGhee DE and Steele JR. Breast elevation and compression decrease exercise-induced
breast discomfort. Medicine and Science in Sports and Exercise. 2010a;42(7):1333-8.
McGhee DE and Steele JR. Optimising breast support in female patients through correct bra fit. A cross-sectional study. Journal of Science and Medicine in Sport. 2010b;13(6):568-72.
McGhee DE and Steele JR. Breast volume and bra size. International Journal of
Clothing Science and Technology. 2011;23(5):351-60.
McGhee DE, Steele JR, Munro BJ. Education improves bra knowledge and fit, and level of breast support in adolescent female athletes: a cluster-randomised trial.
Journal of Physiotherapy. 2010a;56(1):19-24.
McGhee DE, Steele JR, Munro BJ. Sports Bra Fitness. Wollongong, NSW: Breast
Research Australia (BRA), Biomechanics Research Laboratory, University of Wollongong. 2008.
McGhee D, Steele J, Zealey W. Effects of high and low breast support on breast kinematics and kinetics during treadmill running. Journal of Science and
Medicine in Sport. 2010b;12:e143.
McGhee DE, Steele JR, Zealey WJ, Takacs GJ. Bra-breast forces generated in women with large breasts while standing and during treadmill running: Implications for sports bra design. Applied Ergonomics. 2013;44(1):112-8.