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Complex systems approach for sports injuries: moving from risk factor identification to injury pattern recognition—narrative review and new concept
  1. N F N Bittencourt1,
  2. W H Meeuwisse2,
  3. L D Mendonça3,
  4. A Nettel-Aguirre4,
  5. J M Ocarino5,
  6. S T Fonseca5
  1. 1Physical Therapy Department, Minas Tenis Clube and Uni-BH University, Minas Gerais, Belo Horizonte, Brazil
  2. 2Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Alberta, Canada
  3. 3Physical Therapy Department, Universidade dos Vales do Jequitinhonha e Mucuri, Minas Gerais, Diamantina, Brazil
  4. 4Departments of Paediatrics and Community Health Sciences, University of Calgary, Alberta, Canada
  5. 5Graduate Program in Rehabilitation Science, Physical Therapy Department, Universidade Federal de Minas Gerais, Minas Gerais, Diamantina, Brazil
  1. Correspondence to Dr ST Fonseca, Graduate Program in Rehabilitation Science, Physical Therapy Department, Universidade Federal de Minas Gerais, Minas Gerais, Avenida Presidênte Antônio Carlos, 6627—Pampulha, Belo Horizonte—MG 31270-901, Brazil; sfonseca{at}


Injury prediction is one of the most challenging issues in sports and a key component for injury prevention. Sports injuries aetiology investigations have assumed a reductionist view in which a phenomenon has been simplified into units and analysed as the sum of its basic parts and causality has been seen in a linear and unidirectional way. This reductionist approach relies on correlation and regression analyses and, despite the vast effort to predict sports injuries, it has been limited in its ability to successfully identify predictive factors. The majority of human health conditions are complex. In this sense, the multifactorial complex nature of sports injuries arises not from the linear interaction between isolated and predictive factors, but from the complex interaction among a web of determinants. Thus, the aim of this conceptual paper was to propose a complex system model for sports injuries and to demonstrate how the implementation of complex system thinking may allow us to better address the complex nature of the sports injuries aetiology. According to this model, we should identify features that are hallmarks of complex systems, such as the pattern of relationships (interactions) among determinants, the regularities (profiles) that simultaneously characterise and constrain the phenomenon and the emerging pattern that arises from the complex web of determinants. In sports practice, this emerging pattern may be related to injury occurrence or adaptation. This novel view of preventive intervention relies on the identification of regularities or risk profile, moving from risk factors to risk pattern recognition.

  • Sporting injuries
  • Injury prevention
  • Risk factor
  • Sport

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