Article Text

Download PDFPDF

From microscopic to macroscopic sports injuries. Applying the complex dynamic systems approach to sports medicine: a narrative review
  1. Rafel Pol1,
  2. Robert Hristovski2,
  3. Daniel Medina3,
  4. Natalia Balague4
  1. 1 Futbol Club Barcelona. Complex Systems in Sport Research Group, INEFC, Universitat de Lleida (UdL), Barcelona, Spain
  2. 2 Complex Systems in Sport Research Group, Faculty of Physical Education, Sport and Health, Saints Cyril and Methodius University, Skopje, Macedonia (the former Yugoslav Republic of Macedonia)
  3. 3 Futbol Club Barcelona. Complex Systems in Sport Research Group, Barcelona, Spain
  4. 4 Complex Systems in Sport Research Group, INEFC, Universitat de Barcelona (UB), Barcelona, Spain
  1. Correspondence to Dr Natalia Balague, Complex Systems in Sport Research Group, INEFC, Universitat de Barcelona (UB), Barcelona, Spain; nataliabalague{at}


A better understanding of how sports injuries occur in order to improve their prevention is needed for medical, economic, scientific and sports success reasons. This narrative review aims to explain the mechanisms that underlie the occurrence of sports injuries, and an innovative approach for their prevention on the basis of complex dynamic systems approach. First, we explain the multilevel organisation of living systems and how function of the musculoskeletal system may be impaired. Second, we use both, a constraints approach and a connectivity hypothesis to explain why and how the susceptibility to sports injuries may suddenly increase. Constraints acting at multiple levels and timescales replace the static and linear concept of risk factors, and the connectivity hypothesis brings an understanding of how the accumulation of microinjuries creates a macroscopic non-linear effect, that is, how a common motor action may trigger a severe injury. Finally, a recap of practical examples and challenges for the future illustrates how the complex dynamic systems standpoint, changing the way of thinking about sports injuries, offers innovative ideas for improving sports injury prevention.

  • sporting injuries
  • risk factor
  • skeletal muscle
  • tear
  • tendon
View Full Text

Statistics from


  • Contributors RP, RH and NB contributed to the manuscript’s conception and design. DM contributed to the accurate and critical revision of the manuscript as well as approval of the final version. All authors were involved in the preparation and editing of the manuscript.

  • Funding This study has been supported by the Institut Nacional d’Educació Física de Catalunya (INEFC), Generalitat de Catalunya.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.