Other health considerations
Research and performance initiatives are increasingly focused on meeting the specific needs of female participants.
Sport science, research and coaching professionals are increasingly looking to identify and focus on how to tailor research and performance initiatives to meet the specific needs of female athletes and participants, recognising that much of the current research and evidence base was designed for male athletes and participants. 111, 112
While much of the female health and performance research focusses on the menstrual cycle and pregnancy other relevant research can include breast injuries and health, pelvic floor health and incontinence, specific injury risks and responses, and more. 112, 113, 114, 115
For example, research suggests that female athletes are more likely to suffer from sport-related concussions and experience worse outcomes when compared with male athletes. 116, 117
Initiatives like the Australian Institute of Sport’s Female Performance Health Initiative (FPHI) will continue to expand the evidence base for sport and ensure more female specific research and practice is available to help women and girls achieve their sporting goals at all levels.
"Women are not just small men" 110
Stacy Sims, PhD, Rodale Books, (2016)
Resources and reading
- Breast health researcher heading to FairBreak Invitational with message for female cricketers, opens in a new tab, Justin Huntsdale, ABC Illawarra, (4 April 2023). When breast health researcher Deirdre McGhee assessed 90 international female cricketers last year, she was shocked by what she found. Her research found female cricketers suffer a high number of breast injuries, most of which go unreported and untreated. Not only had 30 per cent of the players experienced a breast injury while playing the sport, fewer than 10 per cent had even reported it. She will run clinics to train female athletes in appropriate sports bra use and breast injury treatment.
- ‘Women aren’t just small men’: World Rugby funds landmark study into breast injuries, opens in a new tab, Carla Jaeger, Sydney Morning Herald, (22 March 2023). World Rugby is funding an Australian landmark study to investigate the cause and impact of breast injuries sustained during matches, taking the lead on how sporting codes tackle the widespread yet little-understood problem affecting women who play contact sport.
- The importance of the pelvic floor in returning to physical activity after childbirth, opens in a new tab, Iris Lesser, Megan Sawatsky, SIRC blog, 20 July 2022). The pelvic floor is a crucial group of muscles that helps maintain bladder and bowel control, support internal organs, and coordinates with the deep core, diaphragm and deep back muscles. These muscles can require rehabilitation after having done a lot of the heavy lifting during pregnancy and possibly having been injured during childbirth.
- Zena Sport: Helping a new generation of females to play with confidence, opens in a new tab, Australian Sports Technologies Network, (8 June 2022). Women’s participation in sport is booming but so is the rate of injury. Research reveals that women have a higher risk of injury compared to men and too often we wait for an injury to occur and then we do something about it.
- How Australian football is tackling the ACL injury problem for women athletes, opens in a new tab, Samantha Lewis, ABC News, (28 February 2022). ACL injuries have disproportionately affected women compared with their male counterparts since data began being recorded in the 1990s. Early theories around why women were more likely than men to sustain ACL injuries overwhelmingly pointed to "sex"-based biological factors: anatomy, physiology, biomechanics, hormones. But as research has evolved and more gender-specific data has been collected, this essentialised biological framing of women's bodies has started to be questioned.
- AFL Women's Joins VU in Landmark Study to Improve Mental Health and Wellbeing of Women Athletes, opens in a new tab, Victoria University, (4 November 2021). The AFL are proud to be a lead industry partner on Victoria University’s (VU) commonwealth-funded national study into factors that impact mental health and wellbeing of women athletes. Researchers from Victoria University’s Institute for Health and Sport are commencing a comprehensive study to assess and track the mental health and wellbeing of Australian women athletes in semi-professional and professional sports.
- Sports concussions affect men and women differently. Female athletes need more attention in brain research, opens in a new tab, Shreya Mcleod, James Donnelly, The Conversation, (5 May 2021). Female athletes are more likely to sustain a concussion than their male counterparts. Like males, women report a range of symptoms after a concussion, such as headaches, mental fatigue, concentration difficulties and mood swings. Although symptoms can last longer in some people, recovery from a concussion normally takes seven to ten days for adults. Research on length of recovery is mixed but overall supports that women take longer to recover than men. Women also perform worse on neurocognitive testing post-injury, which measures things like decision-making ability and processing. These gender-based differences may be due to a combination of factors.
- How to train like a woman, opens in a new tab, Dr Emma Ross, Baz Moffat and Dr Bella Smith, Athletics Weekly, (27 April 2021). Currently, female athletes usually train and are coached in a way which doesn’t always consider the ‘female’ part of being a female athlete. The support that is applied to their performance – nutrition, physiology, psychology, etc – tends to be based on research which has been done on men, or what has been seen to be successful with male athletes. But women are very different from men. Women have periods and menstrual cycles, they may use hormonal contraception, they have breasts, they are far more likely to have pelvic floor dysfunction, they have a much higher risk of injury, they manage emotions and derive confidence differently from men.
- AFLW gets a kick out of new finding, opens in a new tab, Victoria University, (11 February 2021). Using a 3D motion-capture system, Dr Cust measured elite women’s foot and ball velocities, kick impact efficiency, kick movement patterns and kick strategies. The results reveal differences in movement patterns between women’s and men’s kicks: the women had a greater knee and hip range of motion, and faster knee action speeds while kicking for both their preferred and non-preferred kick legs. The women also showed less knee bend on the support leg during higher impact kicks. The study is important because of the high impact and repetitive nature of kicking in elite Australian Football, leading to athlete-specific strengthening programs to avoid injuries.
- Research to curb injury in women’s footy, opens in a new tab, La Trobe University, (7 October 2020). La Trobe sports injury researchers are working with the AFL, Medibank and other partners to reduce knee injury among female Australian football players, thanks to a grant from the National Health and Medical Research Council (NHMRC).
- Sport Science on Women, Women in Sport Science., opens in a new tab Mujika, Iñigo; Taipale, Ritva S., International Journal of Sports Physiology and Performance, Volume 14(8), pp.1013-1-14, (2019). This editorial article discusses issues on women in sport science and sex differences in responses and adaptations to training. Some interesting comments/links to research in the text include:
- Unique to women is the ability to legally and ethically alter their hormonal profile and menstrual cycle by using exogenous hormones (hormonal contraceptives).
- Approximately 42% of exercising women believe that their menstrual cycle has a negative impact on exercise training and performance.
- Approximately 50% of elite athletes are currently using hormonal contraceptives, and up to 70% have used them. Unfortunately, we still do not fully understand the effects of the menstrual cycle and hormonal contraceptives on training and performance.
- Monitoring and reporting of menstrual-cycle phase takes a little extra time and effort but could explain “interesting” results. More research should test women in different phases of the menstrual cycle to further elucidate the possible phase effects on training responses, adaptations, and performance (instead of just testing in the follicular, or “low-hormone,” phase of the menstrual cycle, when hormonal profile is “most similar” to that of men).
- When applicable, use of accurate measurements for determination of both ovulation and nonovulatory cycles may also be important (a menstrual bleed does not necessarily indicate ovulation).
- Users of hormonal contraceptives should be included in research in their own group to further elucidate the possible effects of exogenous hormones on training adaptations and performance, and the type and delivery methods of hormonal contraceptives should be reported.
- It would also be of benefit for researchers to consider the potential underlying issues that might have been a reason for using hormonal contraceptives (eg, relative energy deficiency in sport, polycystic ovary syndrome, endometriosis, etc), as these may have influenced endogenous hormone profiles prior to taking hormonal contraceptives.
- UOW undertakes world-first research into breast injuries in contact sport, opens in a new tab, [1:23 hrs], UOWTV, (31 March 2021). A/Prof. Deirdre McGhee is one of a few people in the world studying breast injuries in women’s sport. Her team of researchers found only 10% of the people they surveyed who played rugby league, AFL and rugby union reported a breast injury to a coach or team official. Breast injuries can result in serious short-term effects for the athlete, including bruising and swelling which affects the athlete’s ability to perform at an optimum level. A/Prof. McGhee said, with women’s sport at national and grass-root levels continuing to increase, preventative measures need to be put in place to help the athletes recover from breast injuries.
- Return to play in RED-S. Female athlete health (Part 2), opens in a new tab, [8mins], BMJ Talk Medicine, SoundCloud, (November 2020). A dive into female athlete health with Dr Nicky Keay. Dr Keay is a Sports and Dance Endocrinologist and Honorary Fellow at the Department of Sport and Exercise Sciences at Durham University.
- Why women are not small men, opens in a new tab, [1:16hrs], VeloNews, (17 May 2019). There has been a long history of gender-neutralizing sports science. Money in sports science research is tight, and physiologists often assume they don’t have the resources to study male-female differences. We’ll address later in the show why that “added expense” assumption isn’t true, but the more important issue is that most research is conducted on men and then generalized to women. The problem is that women are not just small men. Now that sports science research is being conducted specifically on women, we are discovering, not surprisingly, that men and women don’t have the same physiology. And what works for men doesn’t always work for women.
- The Exercising Female. Science and Its Application, opens in a new tab, 1st edition, Forsyth J., and Roberts C. Routledge, (2018). The Exercising Female: Science and Its Application is the first book to provide students, researchers, and professionals with an evidence-based reference on the exceptional scientific issues associated with female participation in sport and exercise. Based on the latest research, and treating women as a unique population, the book seeks to critically evaluate current debates, present the science underpinning female sport and exercise performance, and inform applied practice for the exercising female. Featuring contributions from leading scientists from around the world, and adopting a multidisciplinary approach—from exercise physiology, endocrinology, and biochemistry to psychology, biomechanics, and sociology—the book includes chapters on topics such as: Exercise and the menstrual cycle, contraception, pregnancy, motherhood, and menopause.
- Sex Hormones, Exercise and Women. Scientific and Clinical Aspects, opens in a new tab, Hackney, AC. Springer, (2016). The thematic question explored in this work is: if exercise affects reproductive hormones, conversely then could the reproductive hormones have physiological effects unrelated to reproduction that influence the capacity of women to exercise? In exploring this question, the goal is to better understand the unique physiology of women and whether female sex hormones might account for some of the variance in physiological performance between amenorrheic and eumenorrheic women, and within women across the age span as they experience menarche to menopause. Sex Hormones, Exercise and Women: Scientific and Clinical Aspects synthesizes the research by exploring the physiology and psychology behind these occurrences. This novel title will not only be of interest to researchers, exercise scientists, graduate students, and clinicians; it will also serve as a source of valuable information for female athletes and their trainers in the context of preparing for competitions.
- Roar: how to match your food and fitness to your unique female physiology for optimum performance, great health, and a strong, lean body for life, opens in a new tab, Stacy Sims, Rodale Books, (2016). "Women are not small men. Stop eating and training like one. Because most nutrition products and training plans are designed for men, it's no wonder that so many female athletes struggle to reach their full potential. ROAR is a comprehensive, physiology-based nutrition and training guide specifically designed for active women. Because women's physiology changes over time, entire chapters are devoted to staying strong and active through pregnancy and menopause.
- Methodological Considerations for Studies in Sport and Exercise Science with Women as Participants: A Working Guide for Standards of Practice for Research on Women, opens in a new tab, Kirsty Elliott-Sale, Clare Minahan, Xanne Janse de Jonge, et al., Sports Medicine, Volume 51, pp.843861, (March 2021). The purpose of this paper was to highlight the specific considerations needed when employing women (i.e., from athletes to non-athletes) as participants in sport and exercise science-based research. These considerations relate to participant selection criteria and adaptations for experimental design and address the diversity and complexities associated with female reproductive endocrinology across the lifespan. This statement intends to promote an increase in the inclusion of women as participants in studies related to sport and exercise science and an enhanced execution of these studies resulting in more high-quality female-specific data.
- Female Performance and Health Initiative (FPHI), Australian Institute of Sport, (accessed 24 March 2023). The FPHI was established in October 2019, to improve female athlete specific knowledge and systems of support. The initiative will benefit Australian athletes, coaches, parents, sporting organisations and support staff in the sport sector and will raise awareness and understanding to key female athlete performance and health considerations, including but not limited to: the menstrual cycle and associated dysfunction including endometriosis and Polycystic ovary syndrome (PCOS); Medical conditions impacting female athletes; Pelvic floor health and incontinence; Breast health; Pregnancy and return to sport.
- Ignite Athlete Program, opens in a new tab, Swim Australia, (accessed 23 March 2023). This program has been designed to address the unique challenges that female athletes face when it comes to managing their health and wellbeing. We hope to empower you with the information you need to reach your full potential. Dive into the modules for: Evidence-based information and resources centred around female physiology; Guidance from Australian Dolphin swimmers; Direct access to a national network of women’s health experts from City Fertility.
- SmartHER: EIS prioritising female athlete health, opens in a new tab, English Institute of Sport, (accessed 24 March 2023). The English Institute of Sport (EIS) has prioritised opening up conversations amongst athletes, coaches and staff in high performance sport around female athletes’ menstrual cycle and its possible effects, as well as offering expertise to help elite British female athletes be healthy, happy and deliver world class performances.
- E-Alliance: research hub for gender and equity in sport, opens in a new tab, (accessed 24 March 2023). Created in late 2020, E-Alliance is a knowledge sharing hub made up of scholars and partner organizations from across Canada who are dedicated to gender+ equity in sport. E-Alliance is led by three co-directors, Dr. Gretchen Kerr (University of Toronto), Dr. Guylaine Demers (Université Laval) and Dr. Ann Pegoraro (University of Guelph).
- The Sports Bra Project, opens in a new tab [Australia], Women Sport Australia, (accessed 3 April 2023). The Sports Bra Project (TSBP) works to remove barriers to sports participation for women and girls around the world by providing new sports bras to organisations and programs operating in countries and communities where opportunities and access to sport is limited.
- Towards Improving the Safety and Wellbeing of Women in Sport, opens in a new tab, Victorian University, Institute of Health and Sport, (2023). Determining the factors that positively contribute to athletes’ wellbeing is crucial for the development of evidence-informed strategies that support and better target the needs of athletes. In order to address and improve the wellbeing of women athletes, it is necessary to examine gender specific stressors. The primary aims of the research investigation were to: Ascertain the current status of mental health and wellbeing in women elite and semi elite athletes (athletes who are financially supported by a sporting organisation or are paid to train and compete in their sport). Identify and understand the psychosocial stressors experienced by athletes. Report on safety and exposure to violence.
- Inspiring Women to be Active During Midlife and Menopause, opens in a new tab, Women in Sport, (May 2021). Within this new research, we examined every aspect of women’s lives over a five-month period to fully understand their experiences of menopause and physical activity and uncover the barriers that women experience to being active throughout midlife and menopause. We focused specifically on women in lower socioeconomic groups because we know they face additional barriers and are less likely to be active, and spoke exclusively to inactive women who had either lapsed from being active previously or had never enjoyed being active. Five principles to inspire women to be active in midlife:
- Endless Possibilities – Expand perceptions and opportunities for being active.
- Judgement-Free Zone – Welcoming and supportive environment.
- Support Network – Offer built-in social support.
- Expand the Image of What Sporty Means – Inspiring, relatable role models.
- Make It Relevant – Reference specific, relevant benefits.
- Body confident coaching: a pilot randomized controlled trial evaluating the acceptability of a web-based body image intervention for coaches of adolescent girls, opens in a new tab, Jekaterina Schneider, Emily Matheson, Aline Tinoco, et al., Journal of Applied Sport Psychology, (22 May 2023). Body dissatisfaction is common among girls in sport, but coaches are unprepared and unskilled to address these concerns, and few resources for coaches exist. A new education program was found to be appropriate, useful, and enjoyable for coaches and improved their ability to recognize and address athletes’ body image concerns.
- Most modifiable risk factors for hamstring muscle injury in women’s elite football are extrinsic and associated with the club, the team, and the coaching staff and not the players themselves: the UEFA Women’s Elite Club Injury Study, opens in a new tab, Jan Ekstrand, Anna Hallén, Vittoria Marin, et al., Knee Surgery, Sports Traumatology, Arthroscopy, (1 May 2023). Article describes the perceived importance of suggested hamstring injury risk factors according to chief medical officers (CMOs) of European women’s professional football clubs. A secondary objective was to compare if these perceptions differed between teams with a lower-than-average and higher-than-average hamstring injury burden.Twenty-one risk factors were suggested, most of which were extrinsic in nature, hence associated with the coaching staff, the team or the club organization rather than with the players themselves. The risk factors with the highest average importance were: “lack of communication between medical staff and coaching staff” and “load on players” (each with a weighted average of 3.9), followed by “lack of regular exposure to high-speed football actions during training” and “playing matches 2–3 times a week” (weighted average of 3.8 and 3.7). Differently from the LOW group, the HIGH group perceived the coaching factors (style of coach leadership, training/exercise surveillance by coaching staff) as more important.
- Experience of Playing Sport or Exercising for Women with Pelvic Floor Symptoms: A Qualitative Study, opens in a new tab, Jodie Dakic, Jean Hay-Smith, Kuan-Yin Lin, et al., Sports Medicine - Open, Volume 9, Article number: 25, (April 2023). Experiencing PF symptoms during sport/exercise caused considerable limitation to participation. Generation of negative emotions and pain-staking coping strategies to avoid symptoms, limited the social and mental health benefits typically associated with sport/exercise in symptomatic women. The culture of the sporting environment influenced whether women continued or ceased exercising. In order to promote women’s participation in sport, co-designed strategies for (1) screening and management of PF symptoms and (2) promotion of a supportive and inclusive culture within sports/exercise settings are needed.
- Creating Prep to Play PRO for women playing elite Australian football: A how-to guide for developing injury-prevention programs, opens in a new tab, Andrea Bruder, Alex Donaldson, Andrea Mosler, et al., Journal of Sport and Health Science, Volume 12(1), pp.130-138, (January 2023). A 7-step intervention-development process, incorporating a partnership with the sport's governing organisation and a focus on engaging program implementers, was applied to create Prep to Play PRO, the first injury-prevention program for women playing elite Australian football. Critical stakeholders across multiple socioecological levels provided varied perspectives to guide Prep to Play's development and implementation strategy in the elite Australian Football League for Women. Prep to Play PRO is a flexible, dynamic injury-prevention strategy that is integrated into each training session. Prep to Play PRO is evidence-informed and context-specific and includes 5 stand-alone components (movement skills, football-specific preparation, education, strength and conditioning, and individual preparation).
- A multi-phase intervention study of sports bra prescription for elite UK female athletes preparing for the Tokyo Olympics and Paralympics, opens in a new tab, Joanna Wakefield-Scurr, Amy Sanchez, Melissa Jones, et al., Research in Sports Medicine, (16 June 2022). 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.
- Women Have Tendons… and Tendinopathy: Gender Bias is a “Gender Void” in Sports Medicine with a Lack of Women Data on Patellar Tendinopathy—A Systematic Review, opens in a new tab, Camilla Mondini Trissino da Lodi, Maria Paola Landini, Emanuela Asunis, et al., Sports Medicine - Open, Volume 8, article 74, (June 2022). Women represent only a minority of patients studied for this topic. The few documented cases are further fragmented by being related to different treatments, thus basically offering no solid evidence for results and limitations of any therapeutic approach in women. This literature analysis showed a greater gender gap than what is recognized in science and general medicine; it showed a gender blindness in sports medicine when investigating a common problem like patellar tendinopathy.
- The effect of washing and wearing on sports bra function, opens in a new tab, Joanna Wakefield-Scurr, Caitlin Hamilton, Katie Reeves, et al., Sports Biomechanics, (1 March 2022). ports bras provide support by restricting breast motion during exercise, which may prevent damage to breast structures. Laundering affects the mechanical properties of some sports bra materials. Bra function on the wearer after washing is unreported, meaning sports bra durability is unknown. This intervention study compared subjective and objective performance of sports bras that were washed, and worn/washed, to a control. Sports bra support reduced after 25 washes; this was compounded by wear. Participants detected reduced support, but comfort was sustained, suggesting replacement may not be considered. Guidelines on sports bra durability are recommended for breast health.
- Optimizing Health and Athletic Performance for Women, opens in a new tab, Celina de Borja, Cindy Chang, Rhonda Watkins, et al., Current Reviews in Musculoskeletal Medicine, Voluem 15, pp.10-20, (January 2022). Female athletes are considered high risk for certain conditions such as ACL tears, patellofemoral pain syndrome, bone stress injuries, sport-related concussions, and sexual violence in sport. Addressing factors specific to female athletes has been found to be valuable in preventing injuries. Strength and conditioning can optimize athletic performance but remains underutilized among female athletes. Although diversity in healthcare workforce has been found to be beneficial for multiple reasons, women remain underrepresented in sports medicine. Increasing female team physician representation may positively impact care for female athletes. Team physicians must understand the physiologic, biomechanical, and anatomic factors that are unique to female athletes in order to tailor injury prevention programs and optimize their athletic performance. Advocating for gender equity in sports medicine to advance representation of women in the field will increase workforce diversity and promote excellence in sports medicine care.
- Recommendations and Nutritional Considerations for Female Athletes: Health and Performance, opens in a new tab, Bryan Holtzman Kathryn Ackerman, Sports Medicine, Volume 51, pp.43–57, (September 2021). While general concepts about micro- and macronutrients and timing of food and fluids are addressed in sports science, rarely are the specific effects of women’s physiology on energy and fluid needs highly considered in research or clinical practice. Women differ from men not only in size, but in body composition and hormonal milieu, and also differ from one another. Their monthly hormonal cycles, with fluctuations in estrogen and progesterone, have varying effects on metabolism and fluid retention. Such cycles can change from month to month, can be suppressed with exogenous hormones, and may even be manipulated to capitalize on ideal timing for performance. But before such physiology can be manipulated, its relationship with nutrition and performance must be understood. This review will address general concepts regarding substrate metabolism in women versus men, common menstrual patterns of female athletes, nutrient and hydration needs during different phases of the menstrual cycle, and health and performance issues related to menstrual cycle disruption. We will discuss up-to-date recommendations for fueling female athletes, describe areas that require further exploration, and address methodological considerations to inform future work in this important area.
- Anterior cruciate ligament injury: towards a gendered environmental approach, opens in a new tab, Parsons JL, Coen SE, Bekker S, British Journal of Sports Medicine, Volume 55(17), pp.984-990, (August 2021). The anterior cruciate ligament (ACL) injury rate for girls/women has not changed in over 20 years, and they remain 3–6 times more likely to experience injury compared with boys/men. To date, ACL injury prevention and management has been approached from a sex-based biological point of view which has furthered our understanding of injury risk factors, mechanisms, and prevention and rehabilitation programmes. However, the traditional sex-based approach does not take into account the growing recognition of how sex and gender (a social construct) are ‘entangled’ and influence each other. We propose adding gender as a pervasive developmental environment as a new theoretical overlay to an established injury model to illustrate how gender can operate as an extrinsic determinant from the presport, training and competition environments through to ACL injury and the treatment environment.
- Effect of Pelvic Floor Symptoms on Women's Participation in Exercise: A Mixed-Methods Systematic Review With Meta-analysis, opens in a new tab, Jodie Dakic, Jean Hay-Smith, Jill Cook, et al., Journal of Orthopaedic and Sports Physical Therapy, Volume 51(7), pp.345-361, (July 2021). For 1 in 2 women, UI symptoms negatively affect exercise participation. Half of women with UI reported either stopping or modifying exercise due to their symptoms. Limited data on pelvic organ prolapse also demonstrated adverse exercise effect.
- Return to Sport and Reinjury Rates in Elite Female Athletes After Anterior Cruciate Ligament Rupture, opens in a new tab, Kate E. Webster, Sports Medicine, (7 January 2021). While there has been significant interest in the documentation of return to sport outcomes following anterior cruciate ligament (ACL) injury, the elite level female athlete has not been a focus of this research. This is despite women being at increased risk for ACL injury and considerable global growth in women participating in sport. Therefore, the focus of this review was to examine the available literature regarding return to sport outcomes in elite level women with an ACL injury. The topics of discussion focus on return to sport rates, timing and determinants of return to sport, longevity of play, return to sport performance, and further ACL injury. Knee health in the longer term is also briefly discussed along with the limitations of the existent literature.
- A Saddle sores among female competitive cyclists: A systematic scoping review, opens in a new tab, Keira Bury, Justine E. Leavy, Charlene Lan, et.al., Journal of Science and Medicine in Sport, Volume 24(4), pp.357-367, (2021). Saddle sores are a prominent but an under investigated health issue among female competitive cyclists. The authors found limited research investigating the prevalence, prevention and treatment of saddle sores among female competitive cyclists, although it has been described as a common occurrence by those in the cycling community. Research is required to understand its prevalence, along with trials to investigate prevention and management methods, so that evidence informed guidelines and/or protocols can be developed.
- Breast pain affects the performance of elite female athletes., opens in a new tab Brisbine, Brooke R.; Steele, Julie R.; Phillips, Elissa J.; et.al., Journal of Sports Sciences, Volume 38(5), pp.528-533, (2020). Although breast pain is problematic for many active women, no published research has investigated breast pain experienced by elite female athletes. This study aimed to examine the extent that mastalgia and exercise-induced breast pain affected the sporting performance of elite female athletes during training and competition. Five hundred and forty female athletes competing nationally or internationally across 49 different sports participated in the survey. Sixty-three percent of respondents reported experiencing breast pain associated with their menstrual cycle and 33% reported that this pain worsened during activity. Forty-four percent of athletes reported experiencing exercise-induced breast pain during training or competition. Both types of breast pain were also reported to negatively affect sporting performance (20% and 32%, respectively). Mastalgia associated with the menstrual cycle and exercise-induced breast pain should be acknowledged as potential problems affecting the sporting performance of elite female athletes. Awareness around the impact of breast pain and the development and implementation of breast pain management strategies are essential for this population.
- Effects of Breast Motion on Lower-Body Kinematics during Running, opens in a new tab, Gibson Taylor M., Langenderfer Joseph E., Ustinova Ksenia I., International Journal of Human Movement and Sports Sciences, Volume 8(2), pp.51-56, (2020). We measured the effects of breast motion on lower-body kinematics during overground running. Thirty female participants aged 18–60 years completed two blocks of three trials each of overground running for 25 m at self-selected pace under two conditions: with and without breast support provided by a sports bra. Participants' body movements were analyzed with 18 parameters characterizing breast and lower-body kinematics. Sports bra use reduced breast motion and increased about 83% of the lower-body kinematic parameters, including running velocity; stride length; foot clearance; vertical and lateral center of mass displacement; and thorax, hip, knee, and ankle range of motion (all p < 0.05). Among the changed characteristics, the stride length, center of mass displacements, thorax and knee range of motions correlated negatively (r = –0.25 to –0.46) with the velocity of breast motion. Therefore, the reduction of breast motion may improve lower-body kinematics during running, which may influence sport and leisure performance.
- Sport-Related Concussion in Female Athletes: A Systematic Review, opens in a new tab, Neil K. McGroarty, Symone M. Brown, and Mary K. Mulcahey, Orthopaedic Journal of Sports Medicine, Volume 8(7), (2020). A total of 25 studies met the inclusion criteria. Female athletes appear to sustain more severe concussions than male athletes, due in part to a lower biomechanical threshold tolerance for head impacts. Additionally, concussions may alter the hypothalamic-pituitary-ovarian axis, resulting in worse symptoms and amenorrhea. Although females are more likely to report concussions than males, underreporting still exists and may result in concussions going untreated.
- The Occurrence, Causes and Perceived Performance Effects of Breast Injuries in Elite Female Athletes, opens in a new tab, Brisbine, Brooke R.; Steele, Julie R.; Phillips, Elissa J.; et.al., Journal of Sports Science and Medicine, Volume 18(3), pp.569-576, (August 2019). This study aimed to investigate the occurrence, causes and perceived performance effects of breast injuries in elite female athletes across a wide range of sports. A custom-designed survey was distributed to female athletes aged over 18 years who were competing nationally or internationally in their chosen sport. 504 elite female athletes from 46 different sports completed the survey. 36% of participants (n = 182) reported experiencing breast injuries and 21% (n = 37) perceived that their breast injury negatively affected their performance. Contact breast injuries were reported by significantly more athletes involved in contact or combat sports and by athletes with larger breasts or a higher body mass index. Frictional breast injuries were reported by significantly more older athletes or those with larger breasts. Less than 10% of participants who experienced breast injuries reported their injury to a coach or medical professional and only half used any prevention strategies. Athletes, coaches and medical professionals associated with women’s sport need to be made aware of the occurrence and potential negative effects of breast injuries. It is critical to normalise conversations around breast health so that athletes can be encouraged to report and, when necessary, receive treatment for breast injuries. Further research is also required to better understand factors that affect breast injuries in sport in order to develop evidence-based breast injury prevention strategies.
- Breast Injuries in Female Collegiate Basketball, Soccer, Softball and Volleyball Athletes: Prevalence, Type and Impact on Sports Participation, opens in a new tab, Laura Smith, Tamara Eichelberger, Edward Kane, European Journal of Breast Health, Volume 14(1), pp.46-50, (2018). The long-term effects and sequelae of breast injuries reported by female collegiate athletes during sport play are unknown. Nearly 50% of participants had a breast injury during sports activities. Although 18.2% indicated that breast injury affected sports participation, only 9.6% of the injuries were reported to medical personnel with 2.1% receiving treatment.
- AIS Female Performance and Health Initiative resources (accessed 24 March 2023)
- Education modules. The AIS has partnered with specialist medical practitioners, high performance athletes and high performance coaches to design a suite of online learning modules for athletes, parents, coaches and medical practitioners. These modules aim to increase your knowledge about the menstrual cycle; menstrual abnormalities; puberty; hormonal contraception; bone, pelvic and breast health, body image; low energy availability and nutrition; and, considerations for coaches and medical practitioners working with female athletes.
- Breast health and bra fit.
- Endometriosis.
- Polycystic Ovary Syndrome (PCOS).
- Pelvic floor health.
- Breast Support Resources, opens in a new tab, University of Wollongong, (accessed 24 March 2023). Guidelines and resources to help support breast health for female athletes and active women.
- “Sports Bra” web-based app, opens in a new tab. A free app, supported by the Australian Institute of Sport, empowers women of all ages, breast sizes, and activity levels to choose a sports bra that provides proper support and a comfortable fit for exercise.
- NETBALLHer, opens in a new tab, England Netball, (accessed 16 June 2023). Working with female health experts, The Well HQ, England Netball is aiming to re-write the rules and reimagine best practice around the female body’s life stages. NETBALL Her provides information on key topics such as Pelvic Health; Menopause; the Menstrual Cycle; Bras & Kit; Nutrition; Pre & Post Natal; Injury; and Puberty. More resources, myth busting articles, relatable videos, and Her Latest Stories, all rooted in netball, at every level of the game are added regularly.
- Balanced Female Health, opens in a new tab, Sport New Zealand, (May 2023). A resource for adults supporting young people in community sport. Developed by health professionals working in the sport sector, this resource covers changes throughout female puberty, the menstrual cycle, and factors that impact the physical health and mental wellbeing of all young people.
- Towards improving the safety and wellbeing of women in sport: Call to action and mental health and wellbeing resources, opens in a new tab, Victoria University, (2023). This resource accompanies the listed recommendations in the report ‘Towards improving the safety and wellbeing of women in sport’. Below are a number of actions you can take and resources you can access. These resources have been categorised according to the thematic areas of psychosocial stress identified by the findings of Victoria University’s (VU) survey and interviews with women athletes, as well as VU’s synthesis of published research1 . These thematic areas include concerns over pregnancy and parenting, financial security, mental health, body shape and weight, and responding to violence.
Access to resources Where possible, direct links to full-text and online resources are provided. However, where links are not available, you may be able to access documents directly by searching our licenced full-text databases (note: user access restrictions apply). Alternatively, you can ask your institutional, university, or local library for assistance—or purchase documents directly from the publisher. You may also find the information you’re seeking by searching Google Scholar, opens in a new tab.
