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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      Building on the established \u2018TRAjectory of knee heaLth in runners\u2019 (\n                      <jats:italic>TRAIL<\/jats:italic>\n                      ) prospective cohort study and designed with patient and content-expert partners, the nested\n                      <jats:italic>TRAIL-W<\/jats:italic>\n                      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\n                      <jats:italic>TRAIL<\/jats:italic>\n                      6-monthly data collection, all active\n                      <jats:italic>TRAIL<\/jats:italic>\n                      female and male participants will be invited to complete a once-off \u2018\n                      <jats:italic>TRAIL-W<\/jats:italic>\n                      survey\u2019 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\u2019 experiences of female-specific health factors and their association with running behaviour.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>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\u2019 knee health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjsem-2025-003132","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T16:15:11Z","timestamp":1773245711000},"page":"e003132","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Knee health and associations with female-specific health, physical, psychological and social-gendered factors in women runners: the TRAIL-W cohort study protocol"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6366-0896","authenticated-orcid":false,"given":"Melissa J","family":"Haberfield","sequence":"first","affiliation":[{"name":"La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia"},{"name":"Australian IOC Research Centre, La Trobe University, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4360-8310","authenticated-orcid":false,"given":"Benjamin F","family":"Mentiplay","sequence":"additional","affiliation":[{"name":"Australian IOC Research Centre, La Trobe University, Melbourne, Victoria, Australia"},{"name":"Sport and Exercise Science, La Trobe University, Melbourne, Victoria, 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