Top Docs Q&A: Lyle Micheli

Last April, he founded the Micheli Center for Sports Injury Prevention.

This post is part of our Top Docs Q&A series where we ask a physician who was selected as one of our Top Docs questions about their field, life as a doctor, and practicing in the Greater Boston area. 

Name: Lyle Micheli

Hospital Affiliation: Boston Children’s Hospital

Title: Director of Division of Sports Medicine; clinical professor of orthopedic surgery at Harvard Medical School

Field: Sports medicine

Speciality: Pediatric sports medicine and injury prevention

Lyle Micheli founded the Division of Sports Medicine at Boston Children’s Hospital. He is also the attending physician of the Boston Ballet and the secretary general of the International Federation of Sports Medicine. Last April, he opened the Micheli Center for Sports Injury Prevention, which works on preventing sports injuries.

Why did you choose pediatric sports medicine?

Like many of the people who go into sports medicine, I had an athletic background. I played football, rugby, and I boxed. I was also interested in pediatric orthopedics, so I combined the two fields. Later I became interested in injury prevention because I thought that we were seeing too many unnecessary and reoccurring injuries.

What do you love most about pediatric sports medicine?

I love the patients. They do what you ask, they’re very cooperative, they don’t complain, and in turn they tend to really get better.

How has this field changed in the four decades you’ve been practicing? 

I founded the Division of Sports Medicine at Boston Children’s Hospital in 1974, and it was a bit ahead of its time. Back then, pediatric sports medicine wasn’t seen as a separate area of interest, so I think we had a certain number of resistances to the idea of forming this clinic. Now of course it’s all changed, and it’s become a pretty recognized field in it’s own right. Also the number of kids getting injured in sports is rapidly increasing, and it’s probably in large part due to the fact that more kids are doing organized sports. We think the rate of injury is increasing per child, too. It could be from kids specializing in one sport too early and/or high levels of training time.

Do you think this increase of injuries is because we are pushing our kids too hard in athletics?

Well in some cases yes. You’ll see kids who did too much in a short period of time and then they get an unnecessary stress fracture, tendonitis, or something like that. If they had just trained a little more gradually it could have been prevented.

What are the latest advancements happening in sports medicine?

The latest trend is the emphasis on the prevention of sports injuries. We’re learning a lot more about that, and there’s more and more research on prevention of injury rather then just diagnosis or treatment. I think that it’s part of a medical trend in this country; we’ve realized that we can’t keep just getting these injuries and treating them over and over again, because we’ll just run out of resources. We have to prevent illnesses like heart disease and diabetes, and so our interest is sort of coat tailing on that. I’ve been writing articles about sports injury prevention for about 20 years, but now, in the last five or so years, there’s been far more interest across the world. Right now, [we have] 21 research projects all focused on prevention.

What do you hope to see for the future of pediatric sports medicine?

The hope is that a child receives a really comprehensive evaluation before they start practicing a sport in a serious manner. You measure their strength, their flexibility, their body dimensions, etc., and then you make recommendations for how they can participate in that sport affectively and safely. That’s the bulk of what we are doing at the Micheli Center.

What are some ways that our children can prevent injuries?

I think that a slow progressive increase in training is important. It’s what we call the 10 percent rule; don’t increase the amount of training more than 10 percent a week. Proper strengthening is another good way. A lot of people think kids shouldn’t lift weights, but really they just have to be instructed on how to do it properly. Overall, I also think that having that early assessment can go a long way in preventing these unnecessary injuries. To really help someone prevent injuries unique to them you have to assess them individually.

The Micheli Center for Sports Injury Prevention is going to be a year old in April. What has the center accomplished so far?  

I think the response has been tremendous. I think that month in and month out we are probably seeing easily five to six times the kids that we saw when we first started. When we started, we had to change how people think, because typically people don’t want to seek medical help until something starts to hurt. I think the message is getting out though, and parents and physicians now understand the importance of prevention. We also now have a very active scholarship program because we are trying to get every kid seen, regardless of their means. In addition, we want to set up more teaching programs for coaches so they can teach sports safely.

What is your favorite part about practicing in Boston?

It’s a smaller city so I can ride my bike into work. I’m also the attending physician for the Boston Ballet, so I can finish up my clinic work, jump on the [T], and be down at the theater district in 12 minutes. Boston is also a very stimulating atmosphere academically.

As the attending physician of the Boston Ballet, what is the main difference between working with athletes in dance versus sports?

I think in order to really treat dancers affectively you have to know what demands are on them. Early on when I started with the ballet 25 to 30 years ago, I used to watch the company classes to get an idea of what the various positions are, what they do with their hips, what they do with their back, etc. The more you know about a given sport or discipline like dance, the more useful the advice you can give the patient is. We also now have physical therapists right at the ballet, so if we can catch injuries early, then the dancers are seen immediately.

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