It is now well accepted that to prevent sports injuries we need more intervention studies.1 Therefore, it is somewhat alarming that most sports injury studies still only focus on the first two steps of the four-step prevention sequence of van Mechelen et al2: only counting injuries and describing causal factors. This has clearly been shown by Klügl et al,3 who reviewed approximately 5274 original sports injury publications, of which only 492 studies intended to establish the preventive value of a measure or programme. This review showed that although the number of efficacy/effectiveness studies has slowly increased over the years, this is still lagging behind the approximately 4000 descriptive and aetiological studies.

A similar issue is apparent in relation to implementation research.4 Consider the hierarchy in research questions: efficacy questions being on the fundamental scientific knowledge side, effectiveness questions in the middle and implementation questions on the practical end of the spectrum. Klügl et al3 unmistakably show that, just as with the sequence of prevention, we are stuck somewhere halfway. The field is starting to set a solid foundation of efficacy evidence but has not progressed to addressing the effectiveness questions, let alone beyond.

This is where we are facing an important knowledge gap because positive prevention …