A focused emphasis on the orthopaedic health of female athletes of all ages is taking shape at Duke Sports Medicine as specialists build a research-based, preventative care program customized for women in sports.

Two Duke orthopaedic surgeons in the division of sports medicine who were collegiate athletes — Jocelyn Ross Wittstein, MD, and Kendall E. Bradley, MD — collaborate to share guidance for female athletes to help avoid common injuries while offering the latest therapies for treating injuries when they occur. They focus on surgeries that commonly affect young, active populations, which commonly include ACL tears, patellar dislocations, and shoulder stabilizations.

Wittstein and Bradley are developing a multi-year plan to expand the reach of the Duke Sports Science Institute (DSSI) in Wake County, home to one of the nation’s largest youth soccer programs, many large gymnastics and dance organizations, and 33 public high schools.  

Duke sports medicine provides care in Wake County for five high schools as well as St. Augustine’s University, Oak City United WPSL soccer, Apex Academy for the Performing Arts, SGA Gymnastics, and Team Attraction Gymnastics. The Duke Sports Medicine team serves a  population that is growing with the increase in female soccer players, gymnasts, and dancers.

Wittstein began practicing in Wake County in 2017; she has been joined by Bradley as well as two female primary care sports medicine doctors at Duke Sports Medicine Green Level in Cary. 

The Green Level team works to engage coaches, physical therapists, parents, and young athletes to promote injury prevention and to reduce risk of reinjury following surgery. The trend of early, single-sport specialization by young athletes has increased awareness about common injuries, risks, and prevention.

Our increasing awareness of the propensity for certain injuries and their outcomes has helped us to optimize musculoskeletal health for female athletes,” says Wittstein, who was a gymnast and cyclist at Cornell University. Bradley played soccer at Duke University.

“As a soccer player who was part of the Wake County programs, it’s particularly exciting to offer services to those athletes,” Bradley says. “Duke wants to be part of the growth and development of youth soccer, which has become a wildly popular sport.”

Their experience as former athletes helps the surgeons connect with young patients and develop strong relationships. “In some situations, it’s helpful to have a female physician who was an athlete and understands the challenges young girls or women face,” Bradley says.

Wittstein and Bradley treat male and female patients, but they emphasize the need for the female perspective in orthopaedic surgical clinics. “Much of the research for so many clinical topics is based on the 70 kilogram male,” Wittstein says. “But we are seeing an increased understanding and awareness of the propensities for certain injuries in female athletes, who have different risk profiles and responses to treatments.”

Soccer players also benefit from Duke Health’s role as one of only three FIFA Medical Centers of Excellence in the United States; only 49 centers have earned this distinction internationally. The global governing body of soccer, FIFA assigns the designation to centers that have demonstrated leadership in soccer medicine with facilities and programs customized to serve athletes involved in the sport.

The specialized training and research associated with the FIFA Center of Excellence designation offers many benefits for young soccer players who seek care at Duke. In conjunction with Duke’s orthopaedic research, young athletes benefit from surgical innovations, including novel fracture repairs and advanced surgical techniques.

Wittstein and Bradley highlight several areas that can have a unique impact on female athletes of varying ages:

• Musculoskeletal development in immature children, particularly when sports injuries require surgery.
• Adhesive capsulitis, or frozen shoulder. Wittstein has published studies on this condition in scientific papers published by the North American Menopause Society.
• ACL injury and the hormone-related risk of ACL injury.
• Deep vein thrombosis prevention in female athletes.
• Contraception and its effects on female athletes.
• Awareness and treatment of the female athlete triad, defined as the combination of disordered eating, amenorrhea, and osteoporosis.
• Relative energy deficiency in sport, a syndrome of poor health and declining athletic performance that occurs when athletes do not get enough fuel from food to support training demands.