Breast health, pain and injury within rugby
Kilian Bibby is currently undertaking a PhD with Irish Rugby Injury Surveillance. Kilian explains some of his work exploring breast health within rugby and what the player experience is.
In a survey we asked close to 500 female rugby players from 29 different countries about their experience with and awareness of contact breast injuries (CBI) and exercise-induced breast pain (EIBP).
EIBP and CBI have a high occurrence worldwide with over 50% of active female rugby players having experienced either or both during their career.
Over 55% of the players participating in the survey were either very unaware or unaware of either CBI or EIBP.
Similar was found in recent interviews, with 50% of interviewees not being aware of breast health issues.
Both the survey and interviews showed limited awareness of potential future health complications associated with CBI and EIBP with respectively 64% and 85% not being aware of such.
What are contact breast injuries (CBI) and exercise-induced breast pain (EIBP)?
Contact breast injuries (CBI) can arise through direct contact with the breast, e.g. contact with the ground or with a ball or involvement in the tackle.
Exercise-induced breast pain (EIBP) often originates from excessive movement of the breast during activities such as sprinting, jumping and landing.
Both issues can lead to future health complications such as tissue scaring, ligament strains and fat necrosis.
The current research indicates that general and rugby specific movements to be causes of both CBI and EIBP. Blunt trauma to the breast tissue during a tackle for example is a prominent cause.
We need a more comprehensive picture. There is a demand for prospective injury surveillance on breast health issues to make clearer statements on things like injury mechanism, severity and incidence rate.
How does breast heath affect playing and training?
Both contact breast injuries (CBI) and exercise-induced breast pain (EIBP) have shown to negatively influence performance. There are two predominant implications for performance: increased hesitancy from players to be involved in the tackle and the inability to run comfortably.
Overall, there is currently very limited indication that breast health issues cause time loss.
There is a multitude of reasons why this is the case: players and support staff are not aware that CBI and EIBP are actual issues and there is a subsequent lack of reporting and recording of these injuries. There are also subcultural androcentric rugby values of being tough and “just getting on with it”.
There is a recent call for research on evidence based protective equipment in contact and combat sports. With regards to CBI there is currently limited research out there on what has a proven effect on reducing the risk of breast injury but with people investigating the issue it will hopefully change.
What protection is there?
World Rugby at present recommends sports bra padding as an additional layer of protection. For breast pain, there is clear evidence that a well fitted sports bra reduces exercise-induced breast pain (EIBP)
World Rugby and other unions such as the RFU and IRFU provide guidance on what makes a sports bra fit well.
Even though a well-fitted sports bra has some protective component, my research has shown that female Rugby players often utilise other prevention strategies such as the wearing of multiple sports bras or even worse no prevention strategy at all.
For contact breast injuries (CBI), as mentioned there needs to be more prevention strategies.
For EIBP it is more about educating female players and stakeholders on the benefits of a well-fitting sports bra and where and how to find such.
While we do not yet know the injury burden comprehensively for rugby breast injury, i.e. how long players need to spend away from training and matches if at all, we are starting to log and track this at the amateur game level.
Perhaps, more importantly, we need to do this for several years to get a picture of any longer-term health effects of CBI in particular.
Unfortunately, players were very unaware of any prevention stategies. My most recent interviews with players and other rugby stakeholders such as coaches, physiotherapists and strength and conditioning coaches again showed the limited knowledge and awareness of protective equipment.
Players mentioned that a lot of protective equipment such as shoulder pads would have been developed for males and wouldn’t fit as they were too long or only provided protection for the shoulders and sternum but not the breast.
Overall, there is very limited knowledge and awareness around the topic in the first place and logically this also counts for protective equipment.
Approaching the topic
In general, I noticed a good reception from players, coaches, physiotherapist and S&C involved in the game when approaching them with the topic.
Players and support staff actually realised that they have either been exposed to contact breast injuries (CBI) or exercise-induced breast pain (EIBP), or have witnessed scenarios in which they occurred but just weren’t aware of them.
Breast health issues still have a certain level of topic delicacy, which has been identified as one of the main reasons for non-reporting in the first place.
I think you can see similarities to when the menstrual cycle is broached as a female specific health component amongst athletes. By now the menstrual cycle is a well-established female specific health component and is being spoken about more openly.
This development is based on (preliminary) education and the creation of awareness around the topic so therefore the aim is to achieve similar for breast health issues.
The end goal is that breast health issues are being treated like any other injury or pain.
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