The passage of Title IX in 1972 sparked a seismic change in women’s sports, giving equal opportunity for countless athletes to pursue their athletic passions. And as Dr. Heather Bergeson says, it was great for women in many ways. However, as the medical co-director for women’s sports medicine at TRIA, an assistant professor of orthopedics at the University of Minnesota and a team physician for Gopher Athletics, she also notes that there were some unintended consequences.
In particular, that athletic programs started to approach women’s athletic training the same as for men. “Female athletes are different in many ways,” says Dr. Bergeson. “We have different anatomy and hormonal fluctuations, different ways that we get injured.” And as the same training and conditioning programs that worked for men were applied to women, the unique challenges that female athletes faced went unacknowledged in the sports research community for decades.
But the tide has been turning as the different needs of female athletes has become more recognized. Founded in 2018 by Dr. Heather Cichanowski, TRIA’s women’s sports medicine program was the first in the region and is currently the only one of its kind in the Twin Cities. In this episode of Off the Charts, Dr. Bergeson discusses the importance of a sports medicine program specialized for women, as well as the health issues that make that degree of care so crucial. Listen to the episode or read the transcript.
The importance of a specific program
With a team of sports medicine physicians, orthopedic surgeons, physical therapists, a sports dietitian and research scientists, TRIA’s women’s sports medicine program supports athletes through comprehensive care. As Dr. Bergeson describes the program, “[we] care for female athletes of all ages and abilities … where we’re taking into consideration all of the things that may lead to the root cause of why they’re there to see us.” These include health concerns like menstrual cycle issues, hormonal fluctuations and bone health.
The program also recognizes how health intersects with the touch points that women experience throughout their life. “So whether it’s puberty or pregnancy, or as we get to peri- [and] post-menopause, our bodies are changing in some amazing ways, doing some amazing things along the way. But with those times, there’s different things that can affect our health and the way that we train as athletes and treat injuries.”
It’s this knowledge that drives the specialized, woman-centered approach that patients want. For example, if someone comes in with shin pain, among the first questions they’re asked are about their menstrual history. Having irregular periods can highlight related issues like low energy and low bone density. If the shin is showing signs of bone stress injury, questions involving nutrition, body image and training status can be discussed. The answers can lead to specialized scans and treatments that bring in multiple team members to provide comprehensive care, including a physical therapist and sports dietitian. Together, the program gathers a team that is specifically attuned to the needs of female athletes and looks for conditions associated with female bodies, using all necessary resources to help and support female athletes. As a result, injuries are treated and rehabilitated to help prevent them from happening again.
ACL injuries are the most common injury for women
As far as the injuries Dr. Bergeson, her team and their colleagues see that happen more to women than men, the list is pretty specific: concussions, bone stress injuries, osteoporosis, patellar (kneecap) dislocations and shoulder dislocations. But at the very top of the list is an injury that Dr. Bergeson describes as particularly devastating – anterior cruciate ligament (ACL) tears.
Dr. Bergeson says there are a variety of possible causes why. “… hormonal fluctuations … ligamentous laxity (joint hypermobility) … smaller-caliber ACLs. [Women] have wider hips, which changes the angle at our knees.” But there’s also the known issue of training that overlooks the stretching and conditioning that can prevent ACL tears. In fact, there are well-established neuromuscular training programs available that have been shown to decrease the rate of ACL tears in female athletes by up to 80%.
Unfortunately, the ACL-saving conditioning included in these programs isn’t widely used – an issue that TRIA’s program has been working on to find the cause, along with the Aspen Institute’s Project Play and the National ACL Injury Coalition. Many coaches in women’s sports are parent volunteers that need to weave several trainings into their routines, including those to prevent concussions. But as Dr. Bergeson says, ACL-focused training is simple, takes only 10 minutes and can be integrated into a warm-up. As of right now, however, it’s still not universally adopted.
Unfortunately, ACL tears are substantial. While they can heal, they can be reinjured, and the ability to come back to the same pre-injury level of play isn’t great. In fact, when parents of an athlete with an ACL injury ask when their child can get back to play, Dr. Bergeson believes the better question is, “should they be going back?” While professional athletes have the intensive resources to come back from ACL tears, the best treatment for youth athletes is prevention. That’s why TRIA’s program and its partners are working to find a solution to keep players injury-free and in play.
Working with body image
Many women who come to TRIA are involved in sports that focus on the body aesthetic like ballet, dance and bodybuilding. While the injuries in these sports can be similar to those that happen in agility sports like soccer and track, disordered eating and eating disorders can also play a role. That’s why discussing body image is a part of the program’s approach to treatment.
Addressing body image is a conversation that Dr. Bergeson has multiple times a day. “We really try to focus on body trust. Your body knows what it needs to do. Just like we can’t control our height or our foot size, we can’t completely control what our weight is going to be. It wants to be at a set point, and we have to honor that. We have to honor our hunger cues.”
To help, TRIA’s program focuses on intuitive eating and mindful movement – all in sync with the team’s dietitian and physical therapist. Weight-inclusive care is available, but following programmed nutrition isn’t a rigid expectation of patients. Instead, the focus is more on how women can feel more confident about the bodies they do have.
“And sometimes it’s a discussion where we have to mourn the loss of the ideal body. These are our genes, these are our genetics, this is how our body is meant to be. Let’s celebrate that and all of the things it can do.” It’s an important discussion that affects women in all parts of life, especially as they transition from adolescence to adulthood to menopause. They’re also crucial discussions to have outside of the clinic, consistently at home and on the field.
To hear more from Dr. Bergeson, including how women’s sports medicine research is making up for lost time, what approaches work for women versus what works better for men, and details about the upcoming Female Athlete Summit in March 2026, listen to this episode of Off the Charts.
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