WALTHAM — Pressing her ponytail against a large rubber ball, Allison Coukos goes through a series of neck exercises — then progresses to lunges, shuttle runs, and medicine ball tosses.
Coukos, 17, handles it all with ease, even exuberance, as she prepares for her hoped-for hockey comeback, something she says she “never really thought was possible” after being sidelined by severe postconcussion syndrome.
She is staking her faith in the new Micheli Center for Sports Injury Prevention, counting on its innovative approach to reducing risk to make her return to the ice feasible.
The nonprofit Micheli Center’s goal is to help athletes build strength, improve balance, and learn injury-avoiding techniques to match their chosen sport’s demands. The facility is largely a workout space and, once it begins collecting data for injury prevention studies, it also will function as a research facility, using its findings to create and test new training regimens.
That sort of dual approach to injury prevention is rare; founder Dr. Lyle Micheli and director Dr. William Meehan believe the center may be the first of its kind.
“We think the time has come in this country to focus on prevention of injuries,” said Micheli, who is also director of the Division of Sports Medicine at Boston Children’s Hospital. “It sort of ties in with the direction of our health-care master game plan. We’re going to try to prevent heart disease. We’re going to try to prevent obesity. We’re going to try to prevent sports injuries.”
American children and teenagers suffer approximately 3.5 million sports injuries each year, according to a study published in the Journal of Athletic Training.
Micheli and Meehan’s ambitious goal: that in 10 years the center’s work will cut the rate of injury in young athletes in half in major sports in the country, and that its research will produce ACL and concussion-prevention training programs that high schools will run throughout the year.
But is that goal realistic? Dr. Robert Cantu, one of the country’s top sports concussion specialists and an expert who has no stake in the center, said, “I don’t think it’s unrealistic to reach for that.”
Cantu noted that the center’s injury rate reduction goal should be placed in the larger sports injury context. In recent decades, with kids and teenagers often focused on a single sport year round, the number of overuse injuries has increased dramatically among young athletes. If Micheli Center research can help devise better training routines, then Cantu figures some types of injuries may be reduced by more than 50 percent and some less than 50 percent with an average around the center’s goal.
Through its research, the center aims to be as important to improving sports safety as the well-known Framingham Heart Study has been to preventing cardiovascular disease.
Micheli envisions a similar sports-injury prevention study in which the center’s staff would assess kids, follow them through high school, and determine how well various exercises and training worked — just as the Framingham study has followed its heart research population since 1948.
Located on the Waltham campus of Boston Children’s Hospital, the Micheli Center fills workout rooms with specialized equipment, including a curvilinear treadmill, a camera and pressure-plate set up that assesses balance, a three-dimensional motion capture system and a handheld dynamometer that measures strength in different muscle groups.
The center, which opened in April, welcomes athletes of all ages, abilities, and sports, charging $275 for initial injury-prevention evaluations. The center doesn’t see injured athletes, and is not a rehab facility.
“I worried a little bit that we would get just elite athletes,” said Meehan. “We’ve been getting tons of elite athletes, but we’re also getting non-elite athletes, young children, people who have not been athletic and want to be athletic and want to do it safely.”
Of the more than 600 people who have visited the facility to date, the greatest number of evaluations have been performed on soccer players (33 percent) and the most common age range is 14-18 (53 percent). Significantly more female athletes (63 percent) than male athletes (37 percent) have undergone evaluations. Many such as Coukos come because they’ve struggled with serious sports injuries in the past.
A couple of years ago, postconcussion syndrome left Coukos practically bedridden for four months. “I was basically in my room all day in the dark,” she said.
At the center, her focus has been on building neck and core strength, which can help athletes absorb hits, and on improving agility and balance, which can help avoid collisions.
The training made Coukos and her family feel confident that she could return to the ice. Still, like all Micheli Center clients, they know there are no guarantees. No matter how much strength or agility training an athlete does, the breaks of the game, bad luck, and sometimes a fast-approaching opponent cannot be avoided.
“It doesn’t give us peace of mind in terms of feeling like she’s got money in the bank [and can take some risks on the ice], ” said Allison’s father, Stephen Coukos. “But I think the Micheli Center gives both Allie and me peace of mind knowing that she’s putting herself in as strong a position as possible.”
At 6 feet tall, college basketball player Emily Barrett displays impressive agility as she goes through running, jumping, and hamstring-strengthening drills.
She is 10 months removed from the second ACL surgery on her knee — an injury far more common among female basketball players because of differences in how they land after jumping and how they balance. Desperate to avoid a third injury during her senior year at Worcester State, she connected with the Micheli Center.
Barrett, 21, went through a roughly three-hour evaluation. The resulting data created what the center calls a “sports injury risk profile.”
After the evaluation, athletes follow “prescriptions” or training programs that address their specific risk factors.
The center’s “prescriptions” don’t involve new protocols. At the moment, many of the drills and exercises done at the Micheli Center are commonly included in standard rehab and workout programs — although that may change once the center’s specialized research program picks up speed.
Not everyone in the field is convinced that the center offers something above and beyond other workout programs and rehab plans. Said Dr. Peter Warinner, a sports neurology specialist at Brigham and Women’s hospital: “Much of what they do is founded on medical science, but I don’t think it’s that much different than going to a gym with personal trainers. I don’t think they have unique techniques.”
Dr. Heather Gillespie, a sports medicine team physician for UCLA who also runs a pediatric sports medicine clinic in Los Angeles, added: “It’s bringing a lot of what we’re now doing at the collegiate level, places that have funding and resources, to the community. There’s a big opportunity for research and learning more.”
The Micheli Center hopes that its soon-to-be-launched research will produce new discoveries, position the facility on the cutting edge of injury prevention, and prompt new training protocols. If all goes according to plan, the most innovative aspects of the center will be realized through research.
So far, athletes affected by concussions (33 percent) and ACL tears (7 percent) are among the center’s most frequent participants. The Running Program and gait training, however, have been its most popular offerings.
Hobbled by leg pain — first runner’s knee, then a pair of ACL sprains — John Navin, a Xaverian Brothers High School student, visited the center for an evaluation. Running on a treadmill that senses foot-pressure variations, he underwent a stride analysis. Treadmill data and video footage showed that Navin’s problems largely stemmed from overstriding, coming down heavily on his heels.
The Micheli Center staff went to work.
“They completely changed my stride around,” said Navin. “I can definitely run faster without using as much energy. I think I’ll be a much faster runner than before I got injured. And I feel generally stronger as an athlete, as well as a runner.”
Moving through an agility ladder, Teddy Caron, 7, struggles to keep his head up and his eyes focused straight ahead.
Micheli Center injury-prevention specialist Dennis Borg stands several feet in front of Caron and flashes two fingers, then five, then three. Borg wants Caron to call out the correct number — to show that he’s keeping his eyes straight ahead. It’s hit and miss. But Ted Caron sees weekly improvement in his hockey-playing son’s posture, coordination, reflexes, and overall athleticism.
“Being more athletic, I think, allows you to avoid dangerous situations,” said Ted Caron. “Instead of hitting the boards with your head, you might have your head up. You might have your hand out when you fall on the ice.”
In January, Teddy Caron didn’t have his hand out; he hit the back of his head on the ice during a mite tournament game. He briefly lost consciousness, lost feeling in his hands and feet, and for 12 hours didn’t know who his father was. The severe concussion eventually brought him to the Micheli Center.
“You want to catch them early,” said Micheli. “One of our doctors is convinced that prevention has to begin at age 4 or 5.”
That said, Micheli and Meehan want the center to have the broadest reach possible — young and older athletes, amateurs and elites. In 10 years, Micheli hopes similar injury-prevention centers have spread across the country, maybe a dozen in major cities.
The center has teamed with ice rink operator FMC Ice Sports to share its injury-prevention and training knowledge for hockey and figure skating at 30-plus rinks around Massachusetts. It also has partnered with more than 50 YMCAs throughout New England.
Additionally, the center hopes to motivate a cultural change.
“We want to see every school, every coach, every athletic trainer thinking that a big part of their job is prevention,” said Micheli.
He added: “We have to get past the point where we just accept that injuries happen.”