The women’s sports medicine program at TRIA addresses the unique challenges female athletes face, such as higher rates of ACL injuries and the effects of hormonal changes on training and recovery. Dr. Heather Bergeson emphasizes the importance of comprehensive care and the need for more research to better support female athletes throughout their lives.
The women’s sports medicine program at TRIA addresses the unique challenges female athletes face, such as higher rates of ACL injuries and the effects of hormonal changes on training and recovery. Dr. Heather Bergeson emphasizes the importance of comprehensive care and the need for more research to better support female athletes throughout their lives.
Hosts: Kari Haley, MD, and Steven Jackson, MD
Guest: Dr. Heather Bergeson
HealthPartners website: Off the Charts podcast
Got an idea? Have thoughts to share? We want to hear from you. Email us at offthecharts@healthpartners.com.
Kari Haley:
He's a rehab doctor from Chicago.
Steven Jackson:
She's an emergency medicine doctor from the Twin Cities.
Kari Haley:
Together, we're examining the health equity emergency.
Steven Jackson:
Inviting voices for change without the cue cards.
Kari Haley:
I'm Dr. Kari Haley.
Steven Jackson:
I'm Dr. Steven Jackson.
Unison:
And this is "Off the Charts."
Steven Jackson:
Hello and welcome to "Off the Charts," where we have conversations about health equity. Today we're joined by Dr. Heather Bergeson to talk about the women's sports medicine program at TRIA, and orthopedic and sports medicine side of HealthPartners.
Dr. Bergeson is medical co-director for women's sports medicine and assistant professor at the University of Minnesota, and team physician for Gopher Athletics. Go, Gophers. Dr. Bergeson, welcome to the show and thank you for being here.
Heather Bergeson:
Thank you for having me.
Kari Haley:
Yeah, thanks so much for being here. I think I want to just start things off with how is this really the first unique women's program for sports medicine?
Because women have been in sports for a while now, but tell me more about the history leading up to this and what the program is about.
Heather Bergeson:
Yeah. So it was founded by my colleague, Dr. Heather Cichanowski, in 2018 and I came on a few years ago as co-director at our Bloomington site, so Dr. Cichanowski is at our Woodbury site. And we really are the first in the region for a women's sports medicine program, and the only one still in the Twin Cities. So we try and provide a comprehensive care for female athletes of all ages and abilities.
And we do that in a comprehensive way, 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. So that might be menstrual cycle issues, hormonal fluctuations, bone health. And as we go through the lifespan, as women, we have all of these touch points that we go through.
So whether it's puberty or pregnancy or as we get to peri-, 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.
Steven Jackson:
I'm curious to know, let's say, and number one, this program is awesome and I'm looking forward to hearing more about it.
Let's say this program wasn't in existence. What would we be missing in terms of how we render care?
Heather Bergeson:
Yeah. So I think that female athletes are different in many ways. We have different anatomy and hormonal fluctuations, different ways that we get injured. So we want to have a team of people there to help support that.
So we have sports medicine physicians, orthopedic surgeons, physical therapists, a sports dietician, research scientists that can all come together in a multidisciplinary way, and really help support that athlete.
Kari Haley:
What are some of the biggest things or most common injuries that women get that maybe males don't have as commonly?
And/or women get more severely compared to their male counterparts?
Heather Bergeson:
Yeah, so studies show that women have more ACL tears, which is really a devastating injury.
Concussion, bone stress injuries, osteoporosis, patellar dislocations, shoulder dislocations. There's a lot of injuries that women get more of.
Steven Jackson:
I need a pen and pad.
Heather Bergeson:
Yeah. And then the other thing that in sports research, women have been underrepresented for so long.
So do you know what year it was when National Institutes of Health required sex and gender to be a variable in their funded studies?
Steven Jackson:
I'm going to guess recent, 1980.
Heather Bergeson:
2015.
Kari Haley:
Yeah, I was going to get into the 2009-2015.
Heather Bergeson:
I know, right? So there's studies that show that, like there's a study from 2012 to 2020 that looked at all of the sports and exercise studies and the ratio of men and women, and 34% were women. And of those, 9% were peri-, post-menopausal women. And as we know with all the benefits of Title IX and now all of those women are now peri-, post-menopausal, a lot of them.
So we're starting to see a lot of them wanting to continue to be active, but their bodies are changing, they're having all this joint pain, and they're trying to figure out, "How can I continue to do this and should I continue to do this?" And there's a lot of misinformation in the media right now about diets, which don't work for female athletes.
Intermittent fasting is a horrible thing to do as an athlete. We need to be fueled, so we say that fuel is faster, so we really want to make sure we're nourishing bodies. And there's a lot we can talk about some other things too, about what in that population, what is the research that has been done? What it shows about how they should be training.
Kari Haley:
If we don't have the data, we don't have the information, we can't really come up with best practices in terms of how we're treating injuries in female athletes, and/or just treating female athletes as they age.
What are some of the things that we do know that work? Or what are some of the things that maybe work really well for our males when they're going through an injury or healing from injuries that really don't work for women?
Heather Bergeson:
Yeah. So first thing is probably on the nutrition front, and that is a lot of that intermittent fasting diet. And what we do know as females, especially through our menstrual cycle, we need to be fueling. And then as we get peri-, post=menopausal, we're starting to lose a lot of muscle mass, bone density.
So we need to make sure we're getting enough protein, and sometimes we need more than we think. There were a lot of unintended consequences of Title IX. So it was great for women in many ways, but I think we started training all of our women like the men because we thought that was OK. The resources are different.
In the news, there was that NCAA women's basketball where they had not their training room, but their locker room, well, and training room, was so much different than what was provided for the men. And coaching, we still don't have representation of women as coaches, especially in NCAA.
Steven Jackson:
Yep.
Heather Bergeson:
So there's still been these unintended consequences that we need to be thoughtful about.
And probably the same way that we train and treat men is not the same for women, and different as we go through those touch points throughout our lifespan.
Steven Jackson:
I like the underlying definition of equity that I'm hearing, because equity is giving people or populations what they need to thrive. Whereas equality is treating everybody the same, and obviously, we can't treat everybody the same.
We can't treat our female athletes the way we treat our male athletes and vice versa. I'm interested to know of some of the challenges, if any, because I'm sure everything went perfectly.
But any of the challenges in launching a program such as this, speak to those people that say, "Well, why are we doing this? Why do we even need to do this kind of program?"
Heather Bergeson:
Yeah. I think one of our biggest challenges has just been marketing it and getting the public to know about it, so women want this. They want to be able to come in and maybe, for example, I'll give you a typical clinic appointment. So we've got maybe a woman coming in with shin pain, so maybe it's going to be some bone stress injury.
And the way that it would start, there's a questionnaire that we have them fill out, which is more paperwork and homework, but it serves as a nice guideline to be able to launch off from there. So it has questions about menstrual history, where they are in menopause or not. Are they having regular periods?
Was there ever a time where they weren't having regular periods? Because then we worry more about that relative energy deficiency in sport or female athlete triad issue. History of bone stress injuries, what does their nutrition look like? What's their history of eating disorder? What's their body image? What are they training for?
Do they have some event coming up that we need to try and get them ready for? So things like that will then help launch how we dive into how we care for them. And then from the medical side, it's going to be, "OK, establishing do they have a bone stress injury and how are we going to treat it?" And then what other support do we need and referrals?
So we're going to have them always see our physical therapist, who's going to then help program their strengthening and keep them as healthy as they can as they're recovering from it, and then also program their return to sport. And then our sports dietician, who's going to make sure that they are fueling appropriately through all of this.
And then as we look into other things, we might need to get lab work to look at bone health or a bone density DEXA (dual-energy X-ray absorptiometry) scan to look at all of that. So in that way, we really utilize all of our resources to help and support that female athlete, and try and prevent it from happening again.
Kari Haley:
Yeah. No, that's amazing. That's a very holistic approach, and I think that's what probably is definitely needed for women to be successful in their athletics. It's just made me think a little bit about, you mentioned Title IX and the lessons learned and stuff.
And I was just thinking, so I have a 14-year-old and just how crazy youth sports have become with clubs, and the intensity and frequency for which they're doing impactful sports and stuff. But thinking kind of turning that, how do we help young females?
Now we're even talking like 10-year-olds, who are getting into club sports, and doing sports five days a week, year-round intensive. How do we start integrating some of that into the current culture of youth sports? Because it's definitely different than even when it was when Title IX started.
Heather Bergeson:
Yeah, absolutely. And that's my other soapbox is youth sports, so I gave a TED Talk a few years about that. So early sports specialization, year-round play and all that is youth sports culture. And then also what I'm really worried about, is now how that all the NIL and revenue sharing at the collegiate level, is going to now trickle down and affect that youth sports pressure.
So our youth athletes have a lot of pressure on them, both from internally motivated, intrinsically motivated, but also from their coaches and their parents, and social media and all of those things that they're having to navigate. And also then meshing into that is toxic fitness culture, diet culture. So for our young women, we really want to try and make sure that we're creating a safe space for them, a body-confident place for them.
And I think we can do a better job, and there's a lot of ways that we are trying to do that, but it's I think we have to model that as adults. And it needs to be both a grassroots effort and then a top-down approach from professional leagues, collegiate level. But my concern is is that now with how things are going with NCAA, which those athletes should be compensated, I'm concerned about how that trickle down is going to happen now.
Kari Haley:
Yeah.
Steven Jackson:
This program is comprehensive, and even in the short time that we've been together, you've highlighted a lot of the female-specific, I wouldn't even say, issues, but definitely focal points that wouldn't necessarily apply to males.
So I'm thinking like your male colleagues, if a female goes to a male colleague, are they trained? Meaning is a male colleague trained or are they educated? Or do they say, "No, I'm going to refer you to Dr. Bergeson"?
So how does that play out? Because I feel like I all of a sudden feel very unprepared to treat anybody female.
Heather Bergeson:
Well, it depends on the training, and there's certainly male sports medicine physicians who do this around the country and are trained to do it. But it's a passion of mine because it affects me too, and so then it's easier.
And through our program, we do have some male orthopedic surgeons. We have a bone health expert who is male. So majority of the patients that he sees are women because we are more affected by osteoporosis.
Steven Jackson:
Well, obviously, they're able to take into account all the factors that you mentioned, the age, and anyway.
It's humbling because I'm sitting here thinking, "Wow, I don't know anything."
Heather Bergeson:
Well, this is what I'm supposed to know. This is our experts in our program, and we have additional training to do that.
Just like you are so skilled at what you do too, I would never want to take on that.
Steven Jackson:
Thank you. I feel a little better now. So in terms of just specific sports, so my youngest is a ballet dancer and I know a lot of female bodybuilders. Kind of walk me through maybe your thought process.
And maybe even a potential, different approach to not just these two examples, but just the different sporting areas in general. Is there a different approach or is it one size fits all in terms of the approach?
Heather Bergeson:
Oh, yeah. No, that's a big question, and I think it is different depending on the sport. So you've got your agility sports and ACL, and we should talk about that more at some point.
Steven Jackson:
OK.
Heather Bergeson:
And then you've got your sports like ballet or dance that really highlights the body aesthetic, which then that can get tricky, or bodybuilding where the focus really is on the body. And there are a lot of people that do that well and can navigate that.
But then there's some people, if they are more prone to disordered eating or eating disorders where you start doing a lot of body checking and comparing, and so that can get tricky. And then for any athlete, there's this idea of where it is a slippery slope of fueling for performance where we want to make sure that we have that dialed in.
But then we don't want to get on the other side of that slope and get into more eating disorder, even if it's an orthorexia-type picture. Orthorexia is not yet a DSM (Diagnostic and Statistical Manual of Mental Disorders) diagnosis, but it is something that we see a lot where athletes are really rigid in how they're eating, and not allowing for any to go outside of that box.
So they get really rigid and are restrictive to certain food groups and calories, and so it just gets this more rigid way of interacting with food. And I think that the messages that our women have had all of these years have been this thin ideal. And then coupled with that, is weight stigma and all that goes along with that in our medical community, and so that gets tricky.
But for each of those different athletes in different sports, they're going to need to train in a different way depending on what that is. And then there's sometimes where somebody's in a sport where their body is not representative of what you'd expect, but they can still be successful. They should still be able to do that. We talk about-
Steven Jackson:
I know exactly what you mean.
Heather Bergeson:
... a playground for all, so that everybody's able to participate. Yeah.
Kari Haley:
Those are big problems definitely, and I think it's awesome that you have a program. And that our organization has this program to at least start trying to put good messages out there for young women and women of all ages, honestly. Because of the media that we're fed and the messages that we're fed through, all of these other sources are very one-sided a lot of the time.
And I don't know if there's enough good messaging out there that is actually helpful for producing healthy bodies and healthy attitudes toward athletics. I do want to touch on the ACL thing because that is a huge. So I played soccer in high school and stuff, and so many of my teammates had ACL injuries. People who continued to play soccer as they got older, more of them got ACL injuries.
So why are ACL injuries so prevalent in females, especially with the agility-type sports that they do?
Heather Bergeson:
Yeah, we think that it's probably a variety of things that could play into it. Maybe there's some hormonal fluctuations that are changing. Our ligamentous laxity, we have typically smaller-caliber ACLs. We have wider hips, which changes the angle at our knees, and then also the training.
We're training all these young female athletes like men, but we know that there's a way that we can prevent this from happening. So neuromuscular training programs like FIFA-11 or PEP program, which are well-established, and have been actually shown to decrease the rate of ACL tears in female athletes by up to 80%.
Kari Haley:
Wow.
Heather Bergeson:
The problem is they're not being implemented. So we're collaborating right now with Aspen Institute's Project Play and their National ACL Injury Coalition on trying to figure out, "OK, what are the barriers? Why isn't this getting implemented?"
And the reality is that coaches have a lot of other training that they have to do. They have to do concussion training, and hopefully they're doing some positive coaching training, and they're volunteer parent coaches a lot of the time.
Kari Haley:
Yeah.
Heather Bergeson:
But this is a really simple 10-minute thing that you can do as a warm-up. Like you're already going to do the warm-up, just do this one and it doesn't take too long to teach them. So we're trying to figure out what are the barriers?
Why isn't this getting implemented? And then how can we best implement it so that this is being done? Because if you want to have your players and keep them on the pitch, then let's keep them injury-free, right?
Kari Haley:
Yeah, and I know so many people, they'll have one injury. I've known multiple people that they had their one first injury, and then it's just never really, maybe it got better for a little while.
They got to play another season, but then they're just dealing with just recurrent injury, easier injury fatigue. How do we help mitigate some of that?
Heather Bergeson:
Well, and sometimes the right answer is if an athlete tears the ACL, their ACL, their parents are usually the ones that are asking, "When are they going to get back? When can they be back?" And the right answer is or the right question is, "Should they be going back?"
So an ACL tear is really a devastating injury, and our ability to get them back to the same level of play is not great. There's an ACL reconstruction is important for especially agility sports, pivoting, cutting sports, but there's a variety of reasons why they may not get back to their same level of play.
And whether that's a strength thing or even just a psychological, I don't feel... I'm apprehensive that this is going to happen again. Or and if it does happen again, well, then long-term, that knee's not going to be super healthy.
Steven Jackson:
It's amazing, because I think about some of the professional athletes at the highest level, who have multiple ACL tears, and they have to rehab and they come back.
And I feel like (former Minnesota Vikings running back) Adrian Peterson, as an example, he's an anomaly, because he came back and almost set the (NFL) single-season rushing record. It's amazing.
Heather Bergeson:
Yeah. That was hard to then have discussions with people later like, "Well, why can't I do that?"
Steven Jackson:
Exactly, I'm sure.
Heather Bergeson:
Because you don't have a physical therapist with you every single day.
Steven Jackson:
He hurt business a little, no.
Kari Haley:
Yeah. Is there differences between female and male for healing for ACL tears and how you heal afterwards, or how you approach the rehab afterwards?
Heather Bergeson:
There probably should be. I don't know of literature that shows that females don't heal as well necessarily. But there might be some literature that shows that the strength differences afterwards is not up to where we want it to be and it may take longer.
But I don't know that specific literature to speak of that too clearly. But then Lindsey Vonn, for example, who ACL tear and then she had a partial knee replacement, and now she's back going 80-some miles an hour down the hill.
Steven Jackson:
Yep.
Kari Haley:
That's crazy.
Heather Bergeson:
And yeah.
Steven Jackson:
It's like, "Enough said." No. Yeah, amazing.
Kari Haley:
I think that speaks a little bit to just how you mentioned earlier, just the lack of research for women and orthopedic injuries.
What would you like to see the next study? What study out there would you love to see or that you know of that's coming up that will be really great?
Heather Bergeson:
So we're working on them. So through our research institute, we're working on some bone stress injury studies, and I really would love to see better ACL injury prevention programs instituted. So we're going to start working on that as well, but there's so many. There's so many unanswered questions of what's the best?
And also with menstrual cycle, there's a lot of that that came out a few years ago about, "Well, we should be training to our menstrual cycle." And for some women, they found that to be really effective. So depending on what phase of your menstrual cycle you're in, you may be better off doing your strength workouts then and your cardio workouts another time.
And then more literature that came out and said, "Maybe that's not so correct." And I think every woman is going to feel differently throughout her cycle, so it might not match up for that, but we need more information about that.
Steven Jackson:
I'd love to go back just a little bit regarding the concept of body image, because obviously body image is a big thing for everybody. It's big with females, definitely depending on the circle you're in. And what I mean by that, I think about ballet and my own personal experience with my daughter, and just some of the stories she'd come home and tell me about.
And even I won't mention any particular ballet companies, but how some of... Put it this way, certain environments are conducive for body image issues. It's almost like it's fed into the teaching, "You need to look like this, you need to be like this, you need to lose weight."
And I'm just wondering with what you guys do, whether it's related to the program or even outside of the program, how do you address that in what you do? Because sports medicine, orthopedics, you have somebody who comes in with an ACL tear, but adjacent to that they're dealing with a body image challenge for whatever reason. How do you incorporate that into what you do in practice?
Heather Bergeson:
Yeah, great question. So it's a conversation that I have multiple times a day, so we really try and 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's going to be. It wants to be at a set point, and we have to honor that. We have to honor our hunger cues.
We have to really trust our bodies, and that's simple, but not easy, especially in our day and age. But we focus on intuitive eating, mindful movement, and through the other people that we refer to, our dietician, our physical therapist, all of us are on that same page of providing weight-inclusive care. So we're not going to be too prescriptive or programmatic about how we're going to program their nutrition.
If that's what they need and they want, then yes, we can say, "OK. Here's some ways that we can make sure that you're getting enough nourishment." But we're trying not to be too restrictive or prescriptive about that and really focus in on, "How can we get you more confident about the body that you do have?" And sometimes it's a discussion of we have to mourn the loss of the ideal body.
So this is our genes, this is our genetics, this is how our body is meant to be, and let's celebrate that and all of the things that it can do. And as we go through those transitions in our life, and we have these intersecting youth sports culture and diet culture, and then anti-aging culture and how all of that is intersecting.
As women, we tend to have little flash points of when we're entering these touch points in our lives where a lot of that body image stuff can start to come back in. So I think providing anticipatory guidance about that to say like, "Hey, when you guys are going to be entering menopause here in the next 10 years or whatever. You might expect that some feelings are going to come back up and you're going to have some body changes."
We lose our muscle mass and bone density, we're going to gain a little bit of belly fat. But sometimes that can be a lifesaver because that's keeping a bit of estrogen in there, and we need that for bones so it's by design. So some of those conversations is how we talk about it.
Steven Jackson:
That's awesome.
Kari Haley:
That is really good. And it's almost like things that just need to be not even in the clinic setting. These are the messages I wish that we were getting on a daily basis.
Steven Jackson:
At home.
Kari Haley:
Because it's about being healthy and truly healthy. What does your body need in order to function and not break your hip, and not do these things when you get old as you age?
So just hearing that, I'm hopeful that our listeners hear that because I don't think we get that message enough, especially as women.
Heather Bergeson:
Yeah, yeah. For sure, for sure. Last year we hosted our first and hopefully every biannual Female Athlete Summit, which was, we did it across the lifespan so we had four sections. We did a youth section and then an adolescent, college age, and then adult, and then peri-, post-menopause. We had experts from all over the nation come in and both virtually and in person.
It was a really inspiring, successful day, and so we're planning on doing that again next 2026, March. And it's a partnership with University of Minnesota Gopher Athletics, and then in collaboration with the Tucker Center. Do you guys know about the Tucker Center? It's Tucker Center for Research on Women & Girls in Sport through the Department of Kinesiology at the U.
And they just do really incredible psychosocial research about gender and sport. They created the Body Confident Sport that you might've seen in the Super Bowl last year. It was a collaboration between Nike, Dove, Tucker Center, and so that's there. And it's a free online course that you can take. It's so cool.
And then they also do their Coaching HER, which is also how do you coach girls and in a body confident, body-positive way? So it's a great collaboration, so look for that next March.
Kari Haley:
Next March.
Steven Jackson:
Next March, hear that plug? No. Listen, thank you, Dr. Bergeson, for just your time for this program. On behalf of all the female athletes that are benefiting and will benefit from this, this is a need. This is not a novelty. Let me say it again, this is a need.
And I'm hoping that our listeners and beyond will take full advantage of the services that are available. And equally as important as the services, are the messages that just need to be heard, like you said, Dr. Haley, at home, at the dinner table or on the sporting field.
We got to take care of each other, and this is just one of many great ways to do that. So thank you so much.
Heather Bergeson:
Well, thank you. Thank you for the opportunity to be here, and thanks for all the great conversations that you guys are having. They're really important conversations. Thank you.
Steven Jackson:
Thank you.
Kari Haley:
Thanks for being here.
Steven Jackson:
"Off the Charts" is a production of HealthPartners and Park Nicollet.
Kari Haley:
It is recorded by Jimmy Bellamy, with creative by Peggy Arnson, Tina Long, Tim Myers and Jeff Jondahl.
Steven Jackson:
Production services provided by Matriarch Digital Media.
Kari Haley:
Our theme music is by Ryan Ike.