I was listening to a fascinating article on the radio about the latest research on breast injury and how to prevent it whilst exercising. It is an area that is not often spoken about, nor reported or researched, despite half of the population having breasts. Sports bras are the go-to piece of kit to provide support and protection from exercise-induced breast injury. The first sports bra, known as a JockBra, wasn't invented until 1977 by Lisa Lindahl, and Polly Smith (a costume designer). Sports bra design research in relation to providing support to reduce breast movement, did not start in earnest until the 1990s (Bastone, 2017). Although most active women now report wearing a supportive sports bra, between 44-72% of active women and 44% of female athletes, report exercise-induced breast pain, as well as frictional injuries, caused by their sports bra.
The breasts, which have no significant anatomical protection, are held on to the chest wall by suspensory ligaments of Cooper which attach them to the pectoralis major muscle, leaving them fairly mobile throughout a woman's life and more so as we age and these ligaments stretch (McGhee and Steele, Jul 2020b). The skin covering the breast also plays an important role in maintaining breast shape and keeping it adhered to the chest through small fibrous connections to underlying muscle fascia and through it's own elasticity. This connection is particularly reinforced around the entire perimeter of the breast and especially in the midline and underneath the breasts (McGhee and Steele, 2020a).
There is a surprising lack of research on the biomechanics of the breast despite the potential applications of such knowledge in breast reconstruction, breast movement in exercise and the development of sports bras. It is important we understand how breasts move if we are to prevent injury and to enable women, at different stages of their lives to continue to exercise. The support required for breasts changes as we age, varies according to size and weight of breast tissue, and the specific changes we go through during pregnancy and breastfeeding. Breast injury is also largely undocumented and in one study of elite female athletes, less than 10% of the participants reported a breast injury to their coach or a medical professional, and only half used prevention strategies (Brisbine, et al., 2019). Contact breast injuries were, unsurprisingly, more reported in those who participate in contact and combat sports but also more frequently from women with larger breasts. Friction injuries were more reported by older athletes and also those with larger breasts. Breast pain is also associated with the exaggerated vertical motion of the breasts such as with running or jumping (McGhee and Steele, 2020a). The risk of breast injury in runners increases with the increased number of steps (shorter stride length, over longer distances). Loading of the upper torso and moving the centre of mass forward from the body is exaggerated in those with larger breasts. This can result in thoracic back pain, and secondary changes in posture (thoracic kyphosis, rounded shoulders and reduced shoulder movement) (McGhee and Steele, 2020b). Athletes participating in activities requiring repeated unilateral rotation such as playing tennis or golf, may be particularly at risk.
Treatment for breast injuries is another area that is under-researched and any recommended strategies often relate to compression injuries sustained by seatbelts in car collisions. Current guidelines recommend cold compresses, rest from aggravating activities and wearing comfortable support whilst the injured area heals. If a haematoma does not disappear or is severe, then get checked out by a medical professional and a follow up scan may be required. As always, prevention is better than cure.
A well fitted, well designed sports bra is still an essential piece of kit for all women wanting to exercise and would like some support. However, more research into the biomechanics of breast tissue during movement and exercise, is key in preventing breast injury and to make sure the sport bras we are wearing provide the level of support and protection we need. Better education, an increase in awareness and open discussions about breast injury will also help in the development of prevention and treatment strategies.
References
Bastone, K. (2017). A Brief History of the Sports Bra, Runners World [Online]. Available at: A Brief History of the Sports Bra | Runner's World (runnersworld.com) (Accessed 15.3.23).
Brisbine, B.R., Steele, J.R., Phillips, E.J., McGhee, D.E. (2019). The occurrence, causes and perceived performance effects of breast injuries in elite female athletes. Journal of Sports Science and Medicine 18(3), pp. 569-576 [Online]. Available at: The Occurrence, Causes and Perceived Performance Effects of Breast Injuries in Elite Female Athletes - PMC (nih.gov) (Accessed 14.03.23).
McGhee, DE. and Steele, JR. (2020a). Breast Biomechanics: What do we really know? Physiology 35. pp 144-156 [Online]. Available at: Breast Biomechanics: What Do We Really Know? (physiology.org) (Accessed 13.3.23).
McGhee, D. and Steele, J. (2020b). Biomechanics of breast support for active women. Exercise and Sports Sciences Reviews 48(30) pp. 99-109 [Online]. Available at: Biomechanics of Breast Support for Active Women : Exercise and Sport Sciences Reviews (lww.com) (Accessed 13.03.23).
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