From monocausality to systems thinking: a complementary and alternative conceptual approach for better understanding the development and prevention of sports injury

Abstract

The science of sports injury control, including both its cause and prevention, has largely been informed by a biomedical and mechanistic model of health. Traditional scientific practice in sports injury research has routinely involved collapsing the broader socioecological landscape down in order to analyse individual-level determinants of injury - whether biomechanical and/or behavioural. This approach has made key gains for sports injury prevention research and should be further encouraged and allowed to evolve naturally. However, the public health, Applied Human Factors and Ergonomics, and injury epidemiological literature more broadly, has accepted the value of a socioecological paradigm for better understanding disease and injury processes, and sports injury research will fall further behind unless it does the same. A complementary and alternative conceptual approach towards injury control known as systems thinking that builds on socioecological science, both methodologically and analytically, is readily available and fast developing in other research areas. This review outlines the historical progression of causal concepts in the field of epidemiology over the course of the modern scientific era. From here, causal concepts in injury epidemiology, and models of aetiology as found in the context of sports injury research are presented. The paper finishes by proposing a new research agenda that considers the potential for a systems thinking approach to further enhance sports injury aetiological understanding. A complementary systems paradigm, however, will require that sports injury epidemiologists bring their knowledge and skillsets forwards in an attempt to use, adapt, and even refine existing systems-based approaches. Alongside the natural development of conventional scientific methodologies and analyses in sports injury research, progressing forwards to a systems paradigm is now required.

Complex systems approach for sports injuries: moving from risk factor identification to injury pattern recognition—narrative review and new concept

“…In sports, the focus should be on identifying the stable (sometimes complex) relationships among injury determinants that support the emergence of injuries and not on the contribution of isolated factors 11. We need to be aware that when we reduce a complex problem into its units, the relationships are neglected and prediction may not be possible 11 23.…”

“…In sports, the focus should be on identifying the stable (sometimes complex) relationships among injury determinants that support the emergence of injuries and not on the contribution of isolated factors 11. We need to be aware that when we reduce a complex problem into its units, the relationships are neglected and prediction may not be possible 11 23. Sports injury will be better understood if we recognise the frequent patterns of interaction among multilevel risk factors instead of focusing on identifying risk factor at the units level 11.…”

“…We need to be aware that when we reduce a complex problem into its units, the relationships are neglected and prediction may not be possible 11 23. Sports injury will be better understood if we recognise the frequent patterns of interaction among multilevel risk factors instead of focusing on identifying risk factor at the units level 11. Accordingly, Mendiguchia et al ,4 Quatman et al 2 and Hulme and Finch11 have proposed a paradigm shift in sports injury research.…”

“…Sports injury will be better understood if we recognise the frequent patterns of interaction among multilevel risk factors instead of focusing on identifying risk factor at the units level 11. Accordingly, Mendiguchia et al ,4 Quatman et al 2 and Hulme and Finch11 have proposed a paradigm shift in sports injury research. These authors emphasised that the literature is limited to consistently identifying predictive factors, because current research methods based on unidirectional and analytical approaches neglect the multifactorial and complex conditions for sports injuries emergence 11.…”

“…We propose that, to fully uncover this complex nature of sports injury aetiology, a complex systems approach is necessary. This approach rests on identifying interactions and clarifying how these interactions contribute to the emergence of sports injuries 10 11. In addition, it allows seeking regularities (see explanation in the characteristics of a complex system section), by means of pattern recognition techniques,12 that enable the identification of the risk profile for an athlete or group.…”