Your research can change the world
More on impact ›

SPECIALTY GRAND CHALLENGE article

Front. Sports Act. Living, 03 July 2020 | https://doi.org/10.3389/fspor.2020.00080

Great Challenges Toward Sports Injury Prevention and Rehabilitation

  • 1Inter-university Laboratory of Human Movement Science (LIBM EA 7424), University of Lyon, University Jean Monnet, Saint Etienne, France
  • 2Faculty of Medicine, Department of Clinical and Exercise Physiology, Sports Medicine Unit, University Hospital of Saint-Etienne, Saint-Etienne, France
  • 3Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, United States

Introduction

While the positive benefits of sport participation are numerous, unfortunately this is balanced by the negative effects of injury (Engebretsen and Bahr, 2005; Merkel, 2013; Malm et al., 2019). Sports injury prevalence and incidence vary according to sports and population. And unfortunately, short- and long-term negative consequences can impact a variety of different domains (e.g., physical, psychological, sport, professional, financial, or social). Whatever these impacts, there is a need to reduce the occurrence and consequences of sports injury in order to allow a healthy and sustainable sports participation (Engebretsen and Bahr, 2005). This is the important challenge of injury prevention and rehabilitation! This challenge includes primary prevention (i.e., to reduce the occurrence of the first injury event), secondary prevention (i.e., to reduce the occurrence of reinjury after a first injury event) and tertiary prevention (i.e., to reduce the occurrence of sequalae) (Commission on Chronic Illness, 1957).

The popular saying, “prevention is better than cure,” has been known for quite some time. While large efforts have launched to continue to engage in this challenging goal of injury prevention, it still remains a real problem in sports. This could be due to the complex and multifactorial nature of sports injury (Meeuwisse, 1994; Bittencourt et al., 2016; Pol et al., 2019), which makes its “prevention” / “reduction” difficult. It seems that sports injury is not the result of one unique cause but likely the combination and interactions of several factors (including among others intrinsic and extrinsic risk factors and injury mechanism) (Meeuwisse, 1994; Bahr and Krosshaug, 2005; Bittencourt et al., 2016).

In order to face this challenging problem of sports injury, there is thus even more of a need to understand sports injury: How to monitor sports injury? What are the risk factors? How these factors interact? What is the healing process injured tissue? How can we optimize the process of healing, functional recovery, and safe return to sports? Then, there is a need to continue to reflect and develop strategies that can help to reduce the occurrence and recurrence of sports injuries: How can we play on/modify these factors to reduce the occurrence and/or recurrence of sports injuries? Which strategy or combination of strategies can reduce the occurrence and/or recurrence of sports injuries? Are these strategies efficient to reduce the occurrence and/or recurrence of sports injuries, in the context of scientific studies and in real life? How can we implement these strategies? How can athletes be compliant with these strategies? To answer these questions and reach this great challenge of injury prevention and rehabilitation, we believe that there is not one way, we believe that approaches should be comprehensive, multidisciplinary and holistic, including contributors from different fields, with communication between them and by embracing new fields.

Prevent or Reduce?

Before going to concrete aspects, there is maybe a need to improve knowledge and accuracy on some conceptual and terminological aspects.

“Prevention” is a widely used term, however, this is likely not the most appropriate or feasible term within sports. This term is well-known and recognized as a banner of work which aims to protect the health of athletes, especially injuries and illnesses, perhaps thanks to the important efforts of the Oslo Sports Trauma Research Center and the IOC toward injury and illness prevention (Engebretsen and Bahr, 2005; Ljungqvist, 2008; Engebretsen et al., 2014). Although this term could be useful to describe the field (as we use for the name of our section Injury Prevention and Rehabilitation), it is maybe not the most appropriate when we want to accurately discuss about the concrete goals. Indeed, “prevention” means no occurrence of injuries, which is probably not possible. So, most appropriate terms would probably be “injury control” or “injury risk management” or “injury risk reduction” (Avery, 1995; Webster and Hewett, 2018). Other terms are also used on our field that deserve to have clear definitions for proper use, such as for instance “efficacy,” “effectiveness,” “compliance,” “prediction,” “prognostic.” Therefore, we believe that some discussions, researches and/or consensus should clarify these aspects.

In addition, sports injury prevention research is often modeled around the classic four-step sequence presented by van Mechelen et al. (1992) nearly 30 years ago. This model has provided a conceptual framework to monitor progress and effectiveness of decreasing the incidence of a variety of sport injuries (Edouard et al., 2015; Hewett et al., 2016). The “sequence of prevention” conceptual framework was extended in 2006 by Finch (2006) to phases related to the implementation of prevention measures and evaluation of real-world impact. Recently, Bolling et al. (2018) revised the four-steps sequence by improving the first step of the sequence extended to exploration of the context of the sports injury. Other frameworks have been developed to detail some steps of the sequence or some specific aspects, for instance, concept of sports injury (Timpka et al., 2014b), etiology of sports injury (Meeuwisse, 1994), understanding injury mechanisms (Bahr and Krosshaug, 2005), a biomechanics-focused model (Hewett and Bates, 2017), complex systems approach (Bittencourt et al., 2016; Pol et al., 2019), risk factor-based categorization of the prevention (Jacobsson and Timpka, 2015), prevention measure implementation (Tee et al., 2020), and individualized approach (Roe et al., 2017). These conceptual frameworks of sports injury prevention research can continue to benefit from improvements or details to help researchers and/or practitioners.

Primary and Secondary Prevention = Same Fight!

Methodology used in primary prevention could seamlessly assist secondary prevention and vice versa (Hewett and Bates, 2017; Cools et al., 2020). In addition, given the high prevalence of sports injury, a large percentage of athletes will participate in sport with history of previous injury. Therefore, the need for secondary prevention is ongoing and increasingly more important as athletes age. However, primary and secondary approaches are sometimes compartmentalized; sports scientists and coaches may be more involved with primary prevention, while health professionals involved with secondary prevention. Consequently, scientific literature may also be compartmentalized. Therefore, we strongly support that all knowledge regarding both primary and secondary prevention should be directly translated to all stakeholders (applied, clinical). In addition, we suggest increased communication and collaboration between professionals and community to reach success in this challenge.

Specificity of Sports Rehabilitation

Secondary prevention can be addressed through rehabilitation (Hewett and Bates, 2017; Cools et al., 2020). This particular phase of the sports injury management has some specificities. It aims to orient/guide the injured tissue healing process, restore the function, and help the patient/athlete return to sporting activities while at the same time minimizing the risk of reinjury. This multi-goal management is currently approached mainly through biological/physical aspects (e.g., physiological, biomechanical…). However, psychological, social and contextual factors play a critical role in the recovery of patients/athletes after sports injury, and should be taken into account in this phase of the sports injury management.

Sports rehabilitation should thus be done in a multifactorial biopsychosocial approach, bringing the patient/athlete from injury to return to his desired activity, by taking into account the consequences of the sports injury at these different levels (Ardern et al., 2016; Van Melick et al., 2016; Cools et al., 2020).

Unity is Strength: Need of Multidisciplinary Teamwork!

To face the problem of sports injury, everyone is needed! Each person has a different experience, expertise, and view of the problem. So, it is important to encourage and act on the input from all parties involved. This implies a multidisciplinary approach, with inputs from several fields (e.g., sports medicine, sports and exercise science, physical conditioning and training, biomechanics, nutrition, physiology, psychology, sociology, data science…). This implies for instance at a field level that health professionals and coaching staffs, who are facing the same problem of sports injury, share their points of view, arguments, proposals of management in order to find the optimal solution for athletes. Likewise, this should be extended to other fields working with athletes in order to create a cohesive multidisciplinary team. This approach should be favored at the field/clinical and research levels.

Such an approach implies communication to go beyond discussions simply within a field and extend to discussions between diverse fields of interest. This also means for athletes' monitoring or research purpose collecting data from different fields, and probably makes choice or compromise given the amount of data this can represent. These discussions or choices are probably not easy because of some conceptual or language barriers, potential for competition, or perceived skepticism. There will maybe a need to structure discussion / choice, and there is a need to clarify the responsibility of each other, especially when coming the decision. But we believe that this is a relevant orientation to overcome the great challenge of sports injury prevention and rehabilitation. We suggest this would be a win-win approach for all stakeholders. The resulting benefits of discussion, exchange, and collaboration would be greater than the sum of each individual input.

Need for a Holistic and Individual Approach

Recent evidence supports that several factors of varying types can play a role in the occurrence of injury or reinjury (Kerkhoffs et al., 2012; Hewett et al., 2016; Green et al., 2020). In addition, each athlete will respond differently to these factors and combination of factors; each will not have an injury for the same reasons. Hence, patients will respond differently to the injury and its consequences. This is supported in contemporary sports injury management which should utilize a bio-psycho-social approach at an individual level and grounded in evidenced-based practice. Thus, efforts should be made in sports injury research to provide knowledge and evidence in each of these different fields, and if possible, combining all these fields.

Given the complexity of sports injury, the research approach currently simplifies the problem, but there will need to go deeper in complex multifactorial individualized approach to better meet the “reality” of sports injury (Meeuwisse, 1994; Bittencourt et al., 2016; Pol et al., 2019).

There is thus a need for a more complex approach, a comprehensive holistic and individual approach, as for understanding the determinants of the sports injury as for the development of strategies that aim to reduce the occurrence of injury or reinjury. Examples are proposed through conceptual or perspective articles (Mendiguchia and Brughelli, 2011; Mendiguchia et al., 2017; Buckthorpe et al., 2019), and there is now a need to provide supporting evidence of the theses approaches.

Improve Methodological and Analytical Approaches

One of the challenges in injury prevention research is to capture the outcome, i.e., sports injury. Efforts have been done to develop and improve methodology for recording and reporting injuries (Hagglund et al., 2005; Fuller et al., 2006; Junge et al., 2008; Timpka et al., 2014a; Bahr et al., 2020) and should continue to most accurately capture injuries and their complexities.

Alternative analytical approaches of effectiveness of injury prevention measures can use as outcome the consequences of the sports injury at physical, psychological, social or financial levels. Injury prevention is of course useful to reduce the occurrence or reoccurrence of injuries, but also that of sequelae (Engebretsen and Bahr, 2005) or of the financial impact (Krist et al., 2013). Taking into account the economical burden of sports injuries (Hickey et al., 2014; Hespanhol Junior et al., 2017) could also be a way to improve stakeholders adherence to prevention and increase means for sports injury prevention and rehabilitation at the practical and research levels.

The multifactorial biopsychosocial approach leads to the need of adding in the measurements, data collection or monitoring, information related to the sports injury and the injured athletes, taking into account their multifactorial and complex nature, as well as about the context including individual, socio-cultural and environmental/policy levels (Bolling et al., 2018).

The multifactorial approach leads to multimodal methodological approaches. Traditionally quantitative analyses are used in sports injury prevention and rehabilitation research. There is thus a need to improve knowledge through qualitative approach (Bolling et al., 2018, 2019a,b). There is also a need for more behavioral approach when it comes to actual sports injury prevention (Verhagen et al., 2010) and when we aim increase compliance to prevention measures.

The multifactorial approach leads to analytical challenges. Indeed, this implies increasing the magnitude and type of data, which is of interest to fit the complex nature of sports injury, but can be difficult to managed by traditional analytical approaches, and for sure imply the collaboration with statistical and data science community (Casals and Finch, 2018; Nielsen et al., 2020b). To analyse complex interactions between factors and/or between sports injury and factors, there is a need for new analytical advances (Bittencourt et al., 2016; Nielsen et al., 2020b). As a consequence, other fields of data analyses, such as for instance machine learning, will continually be embraced in the future (Bittencourt et al., 2016; Ruddy et al., 2019). These analytical approaches may help analyse complex interactions as well as estimating the risk of sports injury occurrence, with application to understand the sports injury as well as to reduce their occurrence or recurrence (Bittencourt et al., 2016; Ruddy et al., 2019).

In addition, there is a need to use appropriate methodologies to analyse the efficacy of each of these strategies. Randomized Controlled Trial is currently the gold standard to analyse the efficacy of an intervention (Philipps et al., 2009), it is the design that should allow the highest level of evidence by minimizing the risk of bias. However, such design may not be the most relevant to reflect the reality of sports given, among others, the risk of low compliance (Nielsen et al., 2020a). We could benefit from improvement in methodological design inspired from other research fields. In addition, usual analytical approaches, such as intention-to-treat, per protocol or as treated analyses, can lead to bias, especially in the context of low compliance (Edouard et al., in revision). Therefore, there is a need to explore other analytical approaches, as IV analysis, or other G-estimation, which can address some of the problems that arise from low compliance without losing the value of randomization and can also be helpful in observational studies (Edouard et al., in revision).

Conclusions

Although injury prevention and rehabilitation are not new disciplines, there is still an unmet need to improve knowledge toward theoretical understanding on epidemiology, risk factors, and injury mechanisms, as well as on practical strategies that can reduce the risk of sports injury or reinjury and of sequalae after injuries. Given the complex nature of injury, a holistic multifactorial biopsychosocial approach is needed through comprehensive, multidisciplinary and individualized approach to reach this great challenge. We therefore hope that this new section Injury Prevention and Rehabilitation of the Frontiers in Sports and Active Living can contribute to this improvement of knowledge, but also positively impact the sustainable and safe participation and short and long-term health of athletes.

Author Contributions

All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.

Funding

This work was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award number R21AR069873 (to KF).

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

Ardern, C. L., Glasgow, P., Schneiders, A., Witvrouw, E., Clarsen, B., Cools, A., et al. (2016). 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br. J. Sport. Med. 50, 853–864. doi: 10.1136/bjsports-2016-096278

PubMed Abstract | CrossRef Full Text | Google Scholar

Avery, J. G. (1995). Accident prevention-injury control-injury prevention-or whatever? Inj. Prev. 1, 10–11. doi: 10.1136/ip.1.1.10

PubMed Abstract | CrossRef Full Text | Google Scholar

Bahr, R., Clarsen, B., Derman, W., Dvorak, J., Emery, C. A., Finch, C. F., et al. (2020). International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020 (including STROBE Extension for Sport Injury and Illness Surveillance (STROBE-SIIS).) Br. J. Sports Med. 54, 372–389. doi: 10.1136/bjsports-2019-101969

CrossRef Full Text | Google Scholar

Bahr, R., and Krosshaug, T. (2005). Understanding injury mechanisms: a key component of preventing injuries in sport. Br. J. Sport. Med. 39, 324–329. doi: 10.1136/bjsm.2005.018341

PubMed Abstract | CrossRef Full Text | Google Scholar

Bittencourt, N. F. N., Meeuwisse, W. H., Mendonça, L. D., Nettel-Aguirre, A., Ocarino, J. M., and Fonseca, S. T. (2016). Complex systems approach for sports injuries: moving from risk factor identification to injury pattern recognition—narrative review and new concept. Br. J. Sports Med. 50, 1309–1314. doi: 10.1136/bjsports-2015-095850

PubMed Abstract | CrossRef Full Text | Google Scholar

Bolling, C., Barboza, S. D., Mechelen, W., and Van Pasman, H. R. (2019a). Letting the cat out of the bag : athletes, coaches and physiotherapists share their perspectives on injury prevention in elite sports. Br. J. Sports Med. 9:bjsports-2019-100773. doi: 10.1136/bjsports-2019-100773

PubMed Abstract | CrossRef Full Text | Google Scholar

Bolling, C., Delfino Barboza, S., van Mechelen, W., and Pasman, H. R. (2019b). How elite athletes, coaches, and physiotherapists perceive a sports injury. Transl. Sport. Med. 2, 17–23. doi: 10.1002/tsm2.53

PubMed Abstract | CrossRef Full Text | Google Scholar

Bolling, C., van Mechelen, W., Pasman, H. R., and Verhagen, E. (2018). Context matters: revisiting the first step of the ‘sequence of prevention' of sports injuries. Sport. Med. 48, 2227–2234. doi: 10.1007/s40279-018-0953-x

PubMed Abstract | CrossRef Full Text | Google Scholar

Buckthorpe, M., Wright, S., Bruce-Low, S., Nanni, G., Sturdy, T., Gross, A. S., et al. (2019). Recommendations for hamstring injury prevention in elite football: translating research into practice. Br. J. Sports Med. 53, 449–456. doi: 10.1136/bjsports-2018-099616

PubMed Abstract | CrossRef Full Text | Google Scholar

Casals, M., and Finch, C. F. (2018). Sports biostatistician: a critical member of all sports science and medicine teams for injury prevention. Br. J. Sports Med. 52, 1457–1461. doi: 10.1136/bjsports-2016-042211rep

PubMed Abstract | CrossRef Full Text | Google Scholar

Commission on Chronic Illness (1957). Chronic Illness in the United States, Vol. 1: Prevention of Chronic Illness. Cambridge: Harvard University Press. doi: 10.4159/harvard.9780674497474

CrossRef Full Text | Google Scholar

Cools, A. M., Maenhout, A. G., Vanderstukken, F., Declève, P., Johansson, F. R., and Borms, D. (2020). The challenge of the sporting shoulder: from injury prevention through sport-specific rehabilitation toward return to play. Ann. Phys. Rehabil. Med. doi: 10.1016/j.rehab.2020.03.009. [Epub ahead of print].

PubMed Abstract | CrossRef Full Text | Google Scholar

Edouard, P., Alonso, J. M., Jacobsson, J., Depiesse, F., Branco, P., and Timpka, T. (2015). Injury prevention in athletics: the race has started and we are on track! New Stud. Athl. 30, 69–78.

Engebretsen, L., and Bahr, R. (2005). An ounce of prevention? Br. J. Sports Med. 39, 312–313. doi: 10.1136/bjsm.2005.018333

PubMed Abstract | CrossRef Full Text | Google Scholar

Engebretsen, L., Bahr, R., Cook, J. L., Derman, W., Emery, C. A., Finch, C. F., et al. (2014). The IOC Centres of Excellence bring prevention to Sports Medicine. Br. J. Sports Med. 48, 1270–1275. doi: 10.1136/bjsports-2014-093992

PubMed Abstract | CrossRef Full Text | Google Scholar

Finch, C. (2006). A new framework for research leading to sports injury prevention. J. Sci. Med. Sport 9, 3–9. doi: 10.1016/j.jsams.2006.02.009

PubMed Abstract | CrossRef Full Text | Google Scholar

Fuller, C., Ekstrand, J., Junge, A., Andersen, T. E., Bahr, R., Dvorak, J., et al. (2006). Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Scand. J. Med. Sci. Sport. 16, 83–92. doi: 10.1111/j.1600-0838.2006.00528.x

CrossRef Full Text | Google Scholar

Green, B., Bourne, M. N., and van Dyk, N, Pizzari, T. (2020). Recalibrating the risk of hamstring strain injury (HSI) - A 2020 systematic review and meta- - analysis of risk factors for index and recurrent HSI in sport. Br. J. Sports Med. doi: 10.1136/bjsports-2019-100983. [Epub ahead of print].

PubMed Abstract | CrossRef Full Text | Google Scholar

Hagglund, M., Walden, M., Bahr, R., and Ekstrand, J. (2005). Methods for epidemiological study of injuries to professional football players: developing the UEFA model. Br. J. Sports Med. 39, 340–346. doi: 10.1136/bjsm.2005.018267

PubMed Abstract | CrossRef Full Text | Google Scholar

Hespanhol Junior, L. C., van Mechelen, W., and Verhagen, E. (2017). Health and economic burden of running-related injuries in dutch trailrunners: a prospective cohort study. Sport. Med. 47, 367–377. doi: 10.1007/s40279-016-0551-8

PubMed Abstract | CrossRef Full Text | Google Scholar

Hewett, T. E., and Bates, N. A. (2017). Preventive biomechanics: a paradigm shift with a translational approach to injury prevention. Am. J. Sports Med. 45, 2654–2664. doi: 10.1177/0363546516686080

PubMed Abstract | CrossRef Full Text | Google Scholar

Hewett, T. E., Myer, G. D., Ford, K. R., Paterno, M. V., and Quatman, C. E. (2016). Mechanisms, prediction, and prevention of ACL injuries: cut risk with three sharpened and validated tools. J. Orthop. Res. 34, 1843–1855. doi: 10.1002/jor.23414

PubMed Abstract | CrossRef Full Text | Google Scholar

Hickey, J., Shield, A. J., Williams, M. D., and Opar, D. A. (2014). The financial cost of hamstring strain injuries in the Australian Football League. Br. J. Sports Med. 48, 729–730. doi: 10.1136/bjsports-2013-092884

PubMed Abstract | CrossRef Full Text | Google Scholar

Jacobsson, J., and Timpka, T. (2015). Classification of prevention in sports medicine and epidemiology. Sport. Med. 45, 1483–1487. doi: 10.1007/s40279-015-0368-x

PubMed Abstract | CrossRef Full Text | Google Scholar

Junge, A., Engebretsen, L., Alonso, J. M., Renström, P., Mountjoy, M., Aubry, M., et al. (2008). Injury surveillance in multi-sport events: the International Olympic Committee approach. Br. J. Sports Med. 42, 413–421. doi: 10.1136/bjsm.2008.046631

PubMed Abstract | CrossRef Full Text | Google Scholar

Kerkhoffs, G. M., van den Bekerom, M., Elders, L. A., van Beek, P. A., Hullegie, W. A., Bloemers, G. M., et al. (2012). Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline. Br. J. Sport. Med. 46, 854–860. doi: 10.1136/bjsports-2011-090490

PubMed Abstract | CrossRef Full Text | Google Scholar

Krist, M. R., Van Beijsterveldt, A. M. C., Backx, F. J. G., and Ardine de Wit, G. (2013). Preventive exercises reduced injury-related costs among adult male amateur soccer players: a cluster-randomised trial. J. Physiother. 59, 15–23. doi: 10.1016/S1836-9553(13)70142-5

PubMed Abstract | CrossRef Full Text | Google Scholar

Ljungqvist, A. (2008). Sports injury prevention : a key mandate for the IOC. Br. J. Sports Med. 42:391.

PubMed Abstract | Google Scholar

Malm, C., Jakobsson, J., and Isaksson, A. (2019). Physical activity and sports—real health benefits: a review with insight into the Public Health of Sweden. Sports 7:127. doi: 10.3390/sports7050127

PubMed Abstract | CrossRef Full Text | Google Scholar

Meeuwisse, W. (1994). Assessing causation in sport injury: a multifactorial model. Clin. J. Sport Med. 4, 166–170. doi: 10.1097/00042752-199407000-00004

CrossRef Full Text | Google Scholar

Mendiguchia, J., and Brughelli, M. (2011). A return-to-sport algorithm for acute hamstring injuries. Phys. Ther. Sport 12, 2–14. doi: 10.1016/j.ptsp.2010.07.003

PubMed Abstract | CrossRef Full Text | Google Scholar

Mendiguchia, J., Martinez-Ruiz, E., Edouard, P., Morin, J.-B., Martinez-Martinez, F., Idoate, F., et al. (2017). A multifactorial, criteria-based progressive algorithm for hamstring injury treatment. Med. Sci. Sports Exerc. 49, 1482–1492. doi: 10.1249/MSS.0000000000001241

PubMed Abstract | CrossRef Full Text | Google Scholar

Merkel, D. L. (2013). OAJSM-33556-youth-sports—risky-business-or-a-necessary-evil-. Open Access J. Sport. Med. 4, 151–160. doi: 10.2147/OAJSM.S33556

CrossRef Full Text | Google Scholar

Nielsen, R. O., Bertelsen, M. L., Ramskov, D., Damsted, C., Verhagen, E., Bredeweg, S. W., et al. (2020a). Randomised controlled trials (RCTs) in sports injury research: Authors - Please report the compliance with the intervention. Br. J. Sports Med. 54, 51–57. doi: 10.1136/bjsports-2019-100858

PubMed Abstract | CrossRef Full Text | Google Scholar

Nielsen, R. O., Shrier, I., Casals, M., Aguirre, A. N., Møller, M., Bolling, C., et al. (2020b). Statement on methods in sport injury research from the 1st METHODS MATTER Meeting, Copenhagen, 2019. Br. J. Sports Med. doi: 10.1136/bjsports-2019-101323

PubMed Abstract | CrossRef Full Text | Google Scholar

Philipps, B., Ball, C., Sackett, D., Badenoch, D., Strauss, S., Haynes, B., et al. (2009). Oxford Centre for Evidence-based Medicine Levels of Evidence. Available online at: https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/

Pol, R., Hristovski, R., Medina, D., and Balague, N. (2019). From microscopic to macroscopic sports injuries. Applying the complex dynamic systems approach to sports medicine: a narrative review. Br. J. Sports Med. 53, 1214–1220. doi: 10.1136/bjsports-2016-097395

PubMed Abstract | CrossRef Full Text | Google Scholar

Roe, M., Malone, S., Blake, C., Collins, K., Gissane, C., Büttner, F., et al. (2017). A six stage operational framework for individualising injury risk management in sport. Inj. Epidemiol. 4:26. doi: 10.1186/s40621-017-0123-x

PubMed Abstract | CrossRef Full Text | Google Scholar

Ruddy, J. D., Cormack, S. J., Whiteley, R., Williams, M. D., Timmins, R. G., and Opar, D. A. (2019). Modeling the risk of team sport injuries: a narrative review of different statistical approaches. Front. Physiol. 10:829. doi: 10.3389/fphys.2019.00829

PubMed Abstract | CrossRef Full Text | Google Scholar

Tee, J. C., Mclaren, S. J., and Jones, B. (2020). Sports injury prevention is complex : we need to invest in better processes, not singular solutions. Sport. Med. 50, 689–702. doi: 10.1007/s40279-019-01232-4

PubMed Abstract | CrossRef Full Text | Google Scholar

Timpka, T., Alonso, J.-M., Jacobsson, J., Junge, A., Branco, P., Clarsen, B., et al. (2014a). Injury and illness definitions and data collection procedures for use in epidemiological studies in Athletics (track and field): consensus statement. Br. J. Sports Med. 48, 483–490. doi: 10.1136/bjsports-2013-093241

PubMed Abstract | CrossRef Full Text | Google Scholar

Timpka, T., Jacobsson, J., Bickenbach, J., Finch, C. F., Ekberg, J., and Nordenfelt, L. (2014b). What is a sports injury? Sports Med. 44, 423–428. doi: 10.1007/s40279-014-0143-4

CrossRef Full Text | Google Scholar

van Mechelen, W., Hlobil, H., and Kemper, H. C. G. (1992). Incidence, severity, aetiology and prevention of sports injuries. A review of concepts. Sports Med. 14, 82–99. doi: 10.2165/00007256-199214020-00002

PubMed Abstract | CrossRef Full Text | Google Scholar

Van Melick, N., Van Cingel, R. E. H., Brooijmans, F., Neeter, C., Van Tienen, T., Hullegie, W., et al. (2016). Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br. J. Sports Med. 50, 1506–1515. doi: 10.1136/bjsports-2015-095898

PubMed Abstract | CrossRef Full Text | Google Scholar

Verhagen, E. A. L. M., Stralen, M. M., Van Mechelen, W., and Van (2010). Behaviour, the key factor for sports injury prevention. Sports Med. 40, 899–906. doi: 10.2165/11536890-000000000-00000

PubMed Abstract | CrossRef Full Text | Google Scholar

Webster, K. E., and Hewett, T. E. (2018). Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs. J. Orthop. Res. 36, 2696–2708. doi: 10.1002/jor.24043

PubMed Abstract | CrossRef Full Text | Google Scholar

Keywords: health protection, sports injury prevention, injury risk, sports rehabilitation, multidisciplinary approach, multifactorial approach

Citation: Edouard P and Ford KR (2020) Great Challenges Toward Sports Injury Prevention and Rehabilitation. Front. Sports Act. Living 2:80. doi: 10.3389/fspor.2020.00080

Received: 26 May 2020; Accepted: 28 May 2020;
Published: 03 July 2020.

Edited and reviewed by: Gregoire P. Millet, University of Lausanne, Switzerland

Copyright © 2020 Edouard and Ford. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Pascal Edouard, Pascal.Edouard42@gmail.com; Kevin R. Ford, kford@highpoint.edu