Introduction Running is a popular recreational activity worldwide, with women’s participation growing rapidly over the past decade. Compared with men, women runners are more likely to sustain a running-related injury, such as bone stress and knee injuries. Following a serious knee injury and subsequent surgery, women also experience worse knee and health-related outcomes than men. However, little is known about the intersection of female-specific health, physical, psychological and social-gendered factors with knee health in women runners with and without a history of knee surgery.Methods and analysis Building on the established ‘TRAjectory of knee heaLth in runners’ (TRAIL) prospective cohort study and designed with patient and content-expert partners, the nested TRAIL-W study will comprehensively explore the associations of multiple factors (ie, female-specific health, physical, psychological and social gendered) with knee health (symptoms and structural features), device-measured running load and running-related pain in women runners. Where appropriate, we will explore sex and/or gender differences. Alongside their scheduled TRAIL 6-monthly data collection, all active TRAIL female and male participants will be invited to complete a once-off ‘TRAIL-W survey’ and attend an additional laboratory-based assessment. The survey will include questionnaires measuring psychological, social gendered and, for women only, female-specific health factors. The laboratory assessment will measure body composition, bone mineral density and blood biomarkers. A subset of women will be invited to participate in qualitative interviews to understand women runners’ experiences of female-specific health factors and their association with running behaviour.Ethics and dissemination Findings from TRAIL-W, approved by the La Trobe University Human Ethics Committee, will address critical research gaps by describing and exploring the diverse factors that may influence women runners’ knee health.

OBJECTIVES:To investigate the frequency, characteristics and incidence rate of breast impact events (BIEs) during semi-professional women's rugby union matches using video analysis. DESIGN:Cross-sectional video analysis. METHODS:Video footage of 22 matches were analysed to identify BIEs (i.e., direct, forceful contact of a player's breast with another player, equipment or playing surface). Descriptive statistics (means, 95% CI) reported the frequency and characteristics under three categories: (i) BIE match situation; (ii) ball-carrier/tackler characteristics; and (iii) BIE outcome. Incidence rate (IR) was reported per 1000 match hours. RESULTS:The total number of BIEs was 786 (mean 35.7 per match; IR 1176/1000 h), with an average of five players sustaining multiple BIEs per match. The most common BIE match situation was tackle-related (88%, n = 688), with tackle taken to ground the most common activity (47%, n = 370). For ball-carrier/tackler characteristics, the ball-carriers more commonly sustained BIEs (72%, n = 569) and tacklers inflicted the most BIEs (69%, n = 471). Two-thirds of BIEs (64%, n = 502) resulted from contact with the ball and 32% from direct impact with another player (n = 248), mostly with their shoulder (44%, n = 110) and forearm (48%, n = 116). The most common BIE outcome was players continuing to play after impact. CONCLUSIONS:BIEs occur frequently in women's rugby union matches, commonly during tackle-related activities, with the breast commonly impacting with the ball. Further research is recommended to investigate the magnitude of force involved with BIEs and the effects of accumulated BIEs on breast tissue trauma and pain.

Background: Women’s participation in all football codes (including Australian Football [AF]) is increasing rapidly. To guide injury prevention strategies, the authors aimed to describe the current and lifetime prevalence of significant musculoskeletal injuries and concussions for women and girls playing community AF. Hypothesis: Women will have high rates of injury associated with playing AF. Study Design: Cross-sectional survey. Level of Evidence: Level 3. Methods: Participants were Victorian community AF players from 165 participating teams (<16 years, <18 years, senior women’s). Demographics, injury prevalence, and health outcomes are reported descriptively. To explore relationships between sociodemographic factors and anterior cruciate ligament (ACL) injury history, the authors fitted univariate logistic regression models. Independent variables were age, body mass index, number of career AF games, sport experience, location (metropolitan/regional), and socio-economic index. Results: A total of 2435 players (95% of players enrolled in the trial), aged 24 ± 7 years completed the survey. One-quarter (n = 619, 25%) reported a current injury, and half (n = 1238, 51%) reported a previous significant injury. The most common injury sites were knee (n = 160 26% current, n = 403 33% previous), ankle (n = 130 21% current, n = 427 35% previous), and hand/fingers (n = 100 16% current, n = 317 26% previous). Self-reported previous ACL injury (n = 139, 6%) and concussion (n = 1335, 55%) were also prevalent. Increasing age (odds ratio [OR], 1.07; 95% CI, 1.05-1.09) and more career games (OR, 2.22; 95% CI, 1.24-3.97) were associated with ACL injury history. Conclusion: Women and girls playing community AF reported high rates of significant injury. Injury prevention programs should target the most prevalent injury sites: head (concussion), ankle, knee, and hand/fingers. Clinical Relevance: These findings highlight high injury rates for women playing AF and will be invaluable in shaping injury prevention strategies.

Breast injuries and breast pain have not been specifically investigated in women's community-based rugby union despite their high prevalence in football codes. This study investigated the prevalence and severity of breast injuries and pain and the use and perception of breast protective equipment and sports bras in community-based women's rugby union. Cross-sectional, retrospective data of 51 community-based players (age: 18-31 years; experience: 1-10 seasons) were collected using an anonymous online survey. Mann-Whitney U tests and binomial regressions were used to compare respondent characteristics with and without previous breast injuries and pain (p < 0.05). The prevalence of breast injury was 40%, moderate mode pain intensity and pain duration of 1-7 days for 45% of respondents, and 65% had bruising and swelling that lasted 1-7 days. Life-long prevalence of breast injuries was associated with increased age and greater exposure (higher number of seasons played). Breast protective equipment was worn by 11%. The prevalence of breast pain was ∼85%; pain intensity was moderate for 49% and severe for 21% of respondents. Approximately, 50% of respondents reported to not know how to identify the design features of high-support sports bras or determine if their sports bras were correctly fitted. Breast injuries and pain were perceived to negatively affect athletic performance by 90% and 56% of respondents, respectively. Community-based rugby union players have a high prevalence of breast injuries and breast pain and insufficient knowledge of breast protection and breast support. Improved management is required to maximise breast health and performance.

This study presents the design and preliminary validation of a novel portable, wireless, and wearable sensing system—The Breast Impact Monitoring System (BIMS)—for female athletes, developed to monitor and quantify localised mechanical impacts to the breast during high-intensity sporting activity. The platform addresses a critical gap in sports biomechanics by enabling, for the first time, objective measurement of breast forces in both controlled mechanical impact testing and preliminary on-body tackling trials for female athletes. Its application extends to advancing understanding of sports-related breast injuries, informing prevention strategies, and assessing the effectiveness of protective equipment. The BIMS leverages an array of 16 thin-film Force Sensitive Resistors (FSRs) and employs a dual-core microcontroller architecture to manage the trade-off between wireless constraints and high-speed data fidelity, successfully achieving uninterrupted acquisition at 856 Hz for each channel. The system was rigorously validated against a reference instrument using a commercial Force Plate and a custom mechanical drop rig, demonstrating high accuracy with a calibration model (R2=0.9988). Preliminary wearable testing confirmed the system’s capability to detect and spatially map high localised impact forces, including peak forces up to 550 N (across an area diameter of 20 mm), during preliminary rugby tackling activities. By offering a practical and scalable solution for capturing previously inaccessible data, this system establishes a foundation for future research into athlete welfare and long-term breast health.

OBJECTIVES:Breast injuries are female-specific injuries that occur across a range of women's sports. Literature investigating this important women's breast health issue is scarce. This review aimed to collate and summarise published research on breast injuries in women's sports, highlighting the limitations and gaps in the literature. DESIGN:Scoping review. METHODS:Studies were included if they investigated breast injuries sustained by female athletes or the use of breast protective equipment in sports. RESULTS:Eight of the 152 studies identified met the inclusion criteria. Six were retrospective cross-sectional survey studies, and two were case studies. Breast injury prevalence ranged from 26 % to 58 % and was higher in contact/combat sports than in non-contact sports. Most injuries were deemed mild-moderate in severity because most athletes continued to play, albeit with a perceived negative effect on performance. In rare cases, injuries were severe with long-term consequences and required surgical intervention. Breast injury mechanism was sport-specific, and management and prevention strategies were extremely limited, with a very low percentage of injuries reported (~10 %) and a lack of breast injury surveillance. CONCLUSIONS:The paucity of research and lack of awareness and understanding of breast injuries highlights the urgent need for education within women's sports and further research to develop evidence-based management and prevention strategies. Recommendations for future research include assessment of sport-specific mechanisms and incidence, the use of standardized clinical assessment of breast injury severity, long-term consequences, and inclusion of sub-groups of female athletes, such as females with breast implants, developing breasts, and lactating breasts.

Background Osteoarthritis (OA) is a prevalent, debilitating and costly chronic condition. National and international guidelines recommend the conservative treatment strategies of body mass reduction and exercise for the management of hip and knee OA because of the strong evidence to support the efficacy of these interventions. Despite this, these conservative management strategies are currently underutilised in Australia. Appropriately designed, novel models of care may play a role in improving the utilisation of appropriate conservative treatment strategies for hip and knee OA. Therefore, a qualitative study was conducted to investigate patient and clinician perspectives of a novel multidisciplinary case conference model to conservatively manage hip and knee OA within a primary care setting. Methods Qualitative data were collected via telephone-based semi-structured one-on-one interviews with patients with OA (n = 11), general practitioners (n = 2), accredited exercise physiologists (n = 2), accredited practising dietitians (n = 2) and practice nurses (n = 2). Results Thematic content analysis led to the generation of four major themes from the data: (i) potential benefits; (ii) foreseeable challenges; (iii) the benefit-engagement cycle and (iv) maintenance of lifestyle changes. Conclusion The proposed multidisciplinary model of care to conservatively manage hip and knee OA was perceived by both patients and clinicians to have many benefits and a limited number of manageable challenges. The identified challenges provide guidance on how the model should be refined before it is implemented in clinical practice.

Background: Predicting breast tissue motion using biomechanical models can provide navigational guidance during breast cancer treatment procedures. These models typically do not account for changes in posture between procedures. Difference in shoulder position can alter the shape of the pectoral muscles and breast. A greater understanding of the differences in the shoulder orientation between prone and supine could improve the accuracy of breast biomechanical models. Methods: 19 landmarks were placed on the sternum, clavicle, scapula, and humerus of the shoulder girdle in prone and supine breast MRIs (N = 10). These landmarks were used in an optimization framework to fit subjectspecific skeletal models and compare joint angles of the shoulder girdle between these positions. Findings: The mean Euclidean distance between joint locations from the fitted skeletal model and the manually identified joint locations was 15.7 mm 2.7 mm. Significant differences were observed between prone and supine. Compared to supine position, the shoulder girdle in the prone position had the lateral end of the clavicle in more anterior translation (i.e., scapula more protracted) (P < 0.05), the scapula in more protraction (P < 0.01), the scapula in more upward rotation (associated with humerus elevation) (P < 0.05); and the humerus more elevated (P < 0.05) for both the left and right sides. Interpretation: Shoulder girdle orientation was found to be different between prone and supine. These differences would affect the shape of multiple pectoral muscles, which would affect breast shape and the accuracy of biomechanical models.

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.

Purpose. To investigate patient perceptions of physical rehabilitation received for various adverse physical effects following breast cancer surgery and the content and delivery methods of the physical rehabilitation received. Methods. Cross‐sectional study of 509 Australian women living with breast cancer (n = 178 (35%) (Breast Conserving Surgery (BCS)), n = 168 (33%) (Mastectomy (MAST)), and n = 163 (32%) (Breast Reconstruction Surgery (BRS)). Retrospective, online survey investigated the physical rehabilitation received after surgery/treatment. The survey explored the respondents′ perceptions (open response) and satisfaction levels with the physical rehabilitation received and its content and delivery method (closed responses). Perceptions were analyzed using a thematic analysis; satisfaction levels and delivery methods for each adverse physical effect were tabulated. Results. Major perceptions: (i) unaware of and unprepared for adverse physical effects, (ii) unsuitable information delivery, and (iii) insufficient follow‐up from health professionals. Physical rehabilitation content focused on shoulder issues and lymphedema; less than half of respondents received any information about scars, torso, and donor site issues or physical discomfort disturbing sleep. The proportion that received each delivery method varied for each adverse physical effect. Pamphlets and verbal instruction were the most common delivery methods and sessions with health professionals where issues were physically assessed, checked, or progressed the least common. Satisfaction levels varied for each adverse physical effect; all were less than 50%. Conclusion. Women perceived their physical rehabilitation did not prepare them for the adverse physical effects they experienced, the method and timing of delivery did not meet their needs at various stages of recovery, and the follow‐up was insufficient. Quantitative data on the content and delivery method support these perceptions. Explanations of why these perceptions occurred and recommendations to improve physical rehabilitation through greater use of patient‐related outcome measures and spreading limited physical rehabilitation resources using a three‐level model of care are recommended. Although many women recover from breast cancer, improved physical rehabilitation could enable women to manage any immediate or long‐term side effects of their breast cancer surgery and treatment.

BACKGROUND:Female breasts change throughout a woman's life in response to fluctuating hormonal influences. Individuals managing active women and those modeling female breasts must understand these structural and functional changes across a female's lifespan because these changes affect breast injuries sustained by women.METHODS:We initially review female breast structure and function and then describe how breast structure changes across a woman's lifespan. Key studies about direct contact and frictional breast injuries are then summarized. Limitations of current breast injury research, gaps in knowledge about breast injuries incurred by specific populations, and the lack of breast injury models are also highlighted.FINDINGS:With minimal anatomical protection, it is unsurprising that breast injuries occur. Although research about breast injuries is scant, direct contact during blunt force trauma to the anterior chest wall and frictional breast injuries have been reported. There is a lack, however, of research documenting the incidence and severity of breast injuries incurred in occupational settings and in women's sports. Therefore, to design effective breast protective equipment, we recommend research to model and investigate the mechanisms and forces involved in breast injuries, particularly injuries sustained during sport.INTERPRETATION:This unique review summarizes how female breasts change over a woman's life span, with implications for breast injuries sustained by females. Knowledge gaps about female breast injuries are highlighted. We conclude by recommending research required to develop evidence-based strategies to improve how we classify, prevent, and clinically manage breast injuries sustained by females.SUMMARY:We review changes to the breast across a woman's lifespan, highlighting implications for managing and modeling female breast injuries.

Introduction: Cricket is the second-highest participated sport for females globally. Female cricket players need sports bras that provide a high level of breast support because batting, bowling, and fielding cause substantial breast movements, which can be associated with breast pain. Research of elite female football players found that over 50% were wearing ill-fitted sports bras that provided inadequate breast support. However, no previous research has investigated the breast-related issues of female cricket players or their breast support/bra fit knowledge and behaviour. Aim: To investigate the breast-related issues, breast support/bra fit of elite female cricket players, and the effect of a sports bra intervention on perceived breast pain, breast movement, and bra comfort and support. Methods: The sports bras worn by 46 elite female cricket players attending the Fairbreak Invitational 2022 International Cricket Competition (mean age 28.4 ± 6.4 years; bra sizes 8A–14H) was assessed using previously published sports bra design and bra fit criteria. Baseline rankings of perceived breast pain and movement (VAS 0-10 where 0=no pain or movement and 10=extreme pain and excessive movement) and bra comfort and support (VAS 0-10 where 0=low comfort and support and 10=high comfort and support) during running were collected, along with a short survey investigating breast-related issues. A sports bra intervention followed, where participants were professionally fitted into high-support sports bra(s) according to breast size. Post-intervention, the same measures taken at Baseline were repeated. Wilcoxon signed-rank tests were used to compare the Baseline and Post-intervention measures. Results: Over 50% of participants reported breast-related issues (breast pain and skin abrasions underlying their sports bra), with VAS scores ranging from 0-8/10 (mean ~2/10). The sports bras owned by 89% (n=41) of participants failed the breast support/bra fit assessment. Rankings of perceived breast pain and movement, and bra comfort and support significantly improved post-intervention (p<0.001; VAS scores Baseline to Post-intervention for breast pain: 2.4 ± 2.7 to 0.8 ± 0.8; breast movement 4.8 ± 2.1 to 1.8 ± 1.4; bra comfort 6.9 ± 2.0 to 8.9 ± 1.4 and bra support 5.8 ± 1.8 to 9.1 ± 1.0). Discussion: A high percentage of participants reported breast-related issues associated with insufficient breast support and ill-fitting sports bras. They were ranked as mild for most participants and severe for some. The rankings of breast pain/movement and bra comfort/support of each participant’s own sports bra suggest low levels of bra satisfaction and poor knowledge and skills to choose a correctly fitted, high-support sports bra independently. The breast support intervention provides evidence that correctly fitted and high-support sports bras can significantly improve breast pain/movement and bra comfort/support rankings. Impact/Application to the field: This research provides evidence that a high percentage of elite female cricket players experience breast-related issues, have a poor ability to choose a correctly fitted, high-support sports bra independently, and rank poorly in the comfort and support of their sports bras. It highlights the need for breast support and bra fit education within women’s cricket. Declaration: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.

Abstract Background A lying prone position is recommended when scanning women’s breasts to ensure the entire breast can be visualised. However, several large databases contain three-dimensional scans of women’s breasts and torsos that were obtained while the women were standing. This study aimed to establish the error associated with calculating breast volume from three-dimensional breast scans taken when women were standing relative to lying prone. Methods Breast volume was derived for 378 women with Small, Medium, Large and Hypertrophic breast sizes from scans taken while the women were standing and then lying prone. Results The magnitude of error associated with breast volume derived from scans obtained while women stood compared to lying prone, ranged from ∼8–22% and increased with increasing breast size. Conclusion Errors associated with breast volume data derived from breast scans collected while women stand must be accounted for, particularly for women with Medium, Large and Hypertrophic breast sizes. Practitioner summary: This original research provides evidence for bra designers and manufacturers on the degree of error associated when using breast scans obtained while women were standing, such as those scans readily available in large scanning databases. These errors increase with increasing breast size and must be accounted for when sizing and designing bra cups.