Medical-attention injuries in community cricket : a systematic review
- Authors: McLeod, Geordie , O'Connor, Siobhan , Morgan, Damian , Kountouris, Alex , Finch, Caroline , Fortington, Lauren
- Date: 2020
- Type: Text , Journal article , Review
- Relation: BMJ Open Sport and Exercise Medicine Vol. 6, no. 1 (2020), p.
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- Description: Objectives The aim was to identify and describe outcomes from original published studies that present the number, nature, mechanism and severity of medically treated injuries sustained in community-level cricket. Design Systematic review. Methods Nine databases were systematically searched to December 2019 using terms "cricket
Time-to-event analysis for sports injury research part 1 : Time-varying exposures
- Authors: Nielsen, Rasmus , Bertelsen, Michael , Ramskov, Daniel , Møller, Merete , Hulme, Adam , Theisen, Daniel , Finch, Caroline , Fortington, Lauren , Mansournia, Mohammad , Parner, Erik
- Date: 2019
- Type: Text , Journal article , Review
- Relation: British Journal of Sports Medicine Vol. 53, no. 1 (2019), p. 61-68
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- Description: Background: 'How much change in training load is too much before injury is sustained, among different athletes?' is a key question in sports medicine and sports science. To address this question the investigator/practitioner must analyse exposure variables that change over time, such as change in training load. Very few studies have included time-varying exposures (eg, training load) and time-varying effect-measure modifiers (eg, previous injury, biomechanics, sleep/stress) when studying sports injury aetiology. Aim: To discuss advanced statistical methods suitable for the complex analysis of time-varying exposures such as changes in training load and injury-related outcomes. Content: Time-varying exposures and time-varying effect-measure modifiers can be used in time-to-event models to investigate sport injury aetiology. We address four key-questions (i) Does time-to-event modelling allow change in training load to be included as a time-varying exposure for sport injury development? (ii) Why is time-to-event analysis superior to other analytical concepts when analysing training-load related data that changes status over time? (iii) How can researchers include change in training load in a time-to-event analysis? and, (iv) Are researchers able to include other time-varying variables into time-to-event analyses? We emphasise that cleaning datasets, setting up the data, performing analyses with time-varying variables and interpreting the results is time-consuming, and requires dedication. It may need you to ask for assistance from methodological peers as the analytical approaches presented this paper require specialist knowledge and well-honed statistical skills. Conclusion: To increase knowledge about the association between changes in training load and injury, we encourage sports injury researchers to collaborate with statisticians and/or methodological epidemiologists to carefully consider applying time-to-event models to prospective sports injury data. This will ensure appropriate interpretation of time-to-event data. © 2019 Author(s).
Time-to-event analysis for sports injury research part 2 : Time-varying outcomes
- Authors: Nielsen, Rasmus , Bertelsen, Michael , Ramskov, Daniel , Møller, Merete , Hulme, Adam , Theisen, Daniel , Finch, Caroline , Fortington, Lauren , Mansournia, Mohammad , Parner, Erik
- Date: 2019
- Type: Text , Journal article , Review
- Relation: British Journal of Sports Medicine Vol. 53, no. 1 (2019), p. 70-78
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- Description: Background: Time-to-event modelling is underutilised in sports injury research. Still, sports injury researchers have been encouraged to consider time-to-event analyses as a powerful alternative to other statistical methods. Therefore, it is important to shed light on statistical approaches suitable for analysing training load related key-questions within the sports injury domain. Content: In the present article, we illuminate: (i) the possibilities of including time-varying outcomes in time-to-event analyses, (ii) how to deal with a situation where different types of sports injuries are included in the analyses (ie, competing risks), and (iii) how to deal with the situation where multiple subsequent injuries occur in the same athlete. Conclusion: Time-to-event analyses can handle time-varying outcomes, competing risk and multiple subsequent injuries. Although powerful, time-to-event has important requirements: researchers are encouraged to carefully consider prior to any data collection that five injuries per exposure state or transition is needed to avoid conducting statistical analyses on time-to-event data leading to biased results. This requirement becomes particularly difficult to accommodate when a stratified analysis is required as the number of variables increases exponentially for each additional strata included. In future sports injury research, we need stratified analyses if the target of our research is to respond to the question: 'how much change in training load is too much before injury is sustained, among athletes with different characteristics?' Responding to this question using multiple time-varying exposures (and outcomes) requires millions of injuries. This should not be a barrier for future research, but collaborations across borders to collecting the amount of data needed seems to be an important step forward.
Epidemiology of injuries in women playing competitive team bat-or-stick sports : A systematic review and a meta-analysis
- Authors: Panagodage Perera, Nirmala , Joseph, Corey , Kemp, Joanne , Finch, Caroline
- Date: 2018
- Type: Text , Journal article , Review
- Relation: Sports Medicine Vol. 48, no. 3 (2018), p. 617-640
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- Description: Background: Team bat-or-stick sports, including cricket, softball and hockey, are popular among women. However, little is known about the injury profile in this population. Objective: The aim was to describe the incidence, nature and anatomical location of injuries in bat-or-stick sports played by women in a competitive league. Methods: This review was prospectively registered (PROSPERO CRD42015026715). CINAHL, MEDLINE, PsycINFO, PubMed, SPORTDiscus were systematically searched from January 2000 to September 2016, inclusive. Peer-reviewed original research articles reporting the incidence, nature and anatomical location of injuries sustained by women aged 18 + years in competitive bat-or-stick sports were included. Two meta-analyses based on injury incidence proportions (injury IP) and injury rates per 1000 person-days of athletic exposure (AE) were performed. Results: A total of 37 studies satisfied the inclusion criteria, and five had low risk of bias. The weighted injury IP was 0.42 [95% confidence interval (CI) 0.39–0.45]. The weighted injury rate was 6.12 (95% CI 6.05–6.18) overall, and greater in games [15.79 (95% CI 15.65–15.93)] than in practice [3.07 (95% CI 2.99–3.15)]. The ankle was the most commonly injured anatomical location, followed by the hand (including wrist and fingers), knee and head. Soft tissue and ligament injuries were most common types of injuries. Conclusion: Injury prevention in women’s sports is a novel and emerging field of research interest. This review highlights that injury incidence is high among female bat-or-stick players, but little information is known about direct causal mechanisms. This review clearly establishes the need for enhancements to injury data collection. Without this information, it will not be possible to develop evidence-based injury prevention interventions. © 2017, Springer International Publishing AG, part of Springer Nature.
Guidance for sports injury surveillance : The 20-year influence of the australian sports injury data dictionary
- Authors: Finch, Caroline , Staines, Carolyn
- Date: 2018
- Type: Text , Journal article , Review
- Relation: Injury Prevention Vol. 24, no. 5 (2018), p. 372-380
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- Description: Background Injury prevention requires information about how, why, where and when injuries occur. The Australian Sports Injury Data Dictionary (ASIDD) was developed to guide sports injury data collection and reporting. Sports Medicine Australia (SMA) disseminated associated data collection forms and an online tool to practitioners and the sports community. This paper assesses the long-term value, usefulness and relevance of the ASIDD and SMA tools. Methods A systematic search strategy identified both peer-reviewed and grey literature that used the ASIDD and/or the SMA tools, during 1997-2016. A text-based search was conducted within 10 electronic databases, as well as a Google Image search for the SMA tools. Documents were categorised according to ASIDD use as: (1) collected injury data; (2) informed data coding; (3) developed an injury data collection tool and/or (4) reference only. Results Of the 36 peer-reviewed articles, 83% directly referred to ASIDD and 17% mentioned SMA tools. ASIDD was mainly used for data coding (42%), reference (36%), data collection (17%) or resource development (14%). In contrast, 86% of 66 grey literature sources referenced, used or modified the SMA data collection forms. Conclusions The ASIDD boasts a long history of use and relevance. Its ongoing use by practitioners has been facilitated by the ready availability of specific data collection forms by SMA for them to apply to directly their settings. Injury prevention practitioners can be strongly engaged in injury surveillance activities when formal guidance is supported by user-friendly tools directly relevant to their settings and practice. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018.
Physiotherapists use a small number of behaviour change techniques when promoting physical activity : A systematic review comparing experimental and observational studies
- Authors: Kunstler, Breanne , Cook, Jill , Freene, Nicole , Finch, Caroline , Kemp, Joanne , O'Halloran, Paul , Gaida, James
- Date: 2018
- Type: Text , Journal article , Review
- Relation: Journal of Science and Medicine in Sport Vol. 21, no. 6 (2018), p. 609-615
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- Description: Objectives: Physiotherapists promote physical activity as part of their practice. This study reviewed the behaviour change techniques physiotherapists use when promoting physical activity in experimental and observational studies. Design: Systematic review of experimental and observational studies. Methods: Twelve databases were searched using terms related to physiotherapy and physical activity. We included experimental studies evaluating the efficacy of physiotherapist-led physical activity interventions delivered to adults in clinic-based private practice and outpatient settings to individuals with, or at risk of, non-communicable diseases. Observational studies reporting the techniques physiotherapists use when promoting physical activity were also included. The behaviour change techniques used in all studies were identified using the Behaviour Change Technique Taxonomy. The behaviour change techniques appearing in efficacious and inefficacious experimental interventions were compared using a narrative approach. Results: Twelve studies (nine experimental and three observational) were retained from the initial search yield of 4141. Risk of bias ranged from low to high. Physiotherapists used seven behaviour change techniques in the observational studies, compared to 30 behaviour change techniques in the experimental studies. Social support (unspecified) was the most frequently identified behaviour change technique across both settings. Efficacious experimental interventions used more behaviour change techniques (n = 29) and functioned in more ways (n = 6) than did inefficacious experimental interventions (behaviour change techniques = 10 and functions = 1). Conclusions: Physiotherapists use a small number of behaviour change techniques. Less behaviour change techniques were identified in observational studies compared to experimental studies, suggesting physiotherapists use less BCTs clinically than experimentally.
A framework for the etiology of running-related injuries
- Authors: Bertelsen, Michael , Hulme, Adam , Petersen, Jesper , Brund, Rene , Sørensen, Henrik , Finch, Caroline , Parner, Erik , Nielsen, Rasmus
- Date: 2017
- Type: Text , Journal article , Review
- Relation: Scandinavian Journal of Medicine and Science in Sports Vol. 27, no. 11 (2017), p. 1170-1180
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- Description: The etiology of running-related injury is important to consider as the effectiveness of a given running-related injury prevention intervention is dependent on whether etiologic factors are readily modifiable and consistent with a biologically plausible causal mechanism. Therefore, the purpose of the present article was to present an evidence-informed conceptual framework outlining the multifactorial nature of running-related injury etiology. In the framework, four mutually exclusive parts are presented: (a) Structure-specific capacity when entering a running session; (b) structure-specific cumulative load per running session; (c) reduction in the structure-specific capacity during a running session; and (d) exceeding the structure-specific capacity. The framework can then be used to inform the design of future running-related injury prevention studies, including the formation of research questions and hypotheses, as well as the monitoring of participation-related and non-participation-related exposures. In addition, future research applications should focus on addressing how changes in one or more exposures influence the risk of running-related injury. This necessitates the investigation of how different factors affect the structure-specific load and/or the load capacity, and the dose-response relationship between running participation and injury risk. Ultimately, this direction allows researchers to move beyond traditional risk factor identification to produce research findings that are not only reliably reported in terms of the observed cause-effect association, but also translatable in practice. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Injury surveillance in the professional football codes : An overview of current data collection, injury definition and reporting practices
- Authors: Shaw, Louise , Orchard, John , Saw, Richard , Finch, Caroline
- Date: 2017
- Type: Text , Journal article , Review
- Relation: Minerva Ortopedica e Traumatologica Vol. 68, no. 2 (2017), p. 110-123
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- Description: INTRODUCTION: Whilst football has been found to have many positive effects from a health perspective, injuries are common, particularly at the elite or professional level of play. Injury surveillance is therefore required to inform the development and implementation of strategies to increase safety in professional football codes. EVIDENCE ACQUISITION: A systematic search of peer reviewed and available grey literature was conducted to identify publications presenting methodological details of ongoing injury surveillance systems in professional football codes. Data extracted included population under surveillance, player/team coverage, injury definition and other relevant information. EVIDENCE SYNTHESIS: Following literature search and review, seven injury surveillance systems were identified that record ongoing data within professional football codes. A range of methodologies was used across the surveillance systems with variations in the definitions of injury, who records the data, the data-recording tool and dissemination of the data. CONCLUSIONS: There are many benefits for football associations, clubs and players themselves in conducting comprehensive injury surveillance. A range of surveillance methods is employed across the different football codes including injury definitions. Some professional football codes have developed consensus statements, which provide guidance on key issues relating to injury surveillance. Dissemination of findings differed with some systems publishing via peer review journals, with others through annual disclosure to the media. Financial considerations and funding are a crucial factor for creating and maintaining an injury surveillance system. Findings from professional football injury surveillance have been used to implement rule changes and develop preventive programmes, all aimed at increasing player safety.
Intervention strategies used in sport injury prevention studies : A systematic review identifying studies applying the Haddon matrix
- Authors: Vriend, Ingrid , Gouttebarge, Vincent , Finch, Caroline , van Mechelen, Willem , Verhagen, Evert
- Date: 2017
- Type: Text , Journal article , Review
- Relation: Sports Medicine Vol. 47, no. 10 (2017), p. 2027-2043
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- Description: Background: Prevention of sport injuries is crucial to maximise the health and societal benefits of a physically active lifestyle. To strengthen the translation and implementation of the available evidence base on effective preventive measures, a range of potentially relevant strategies should be considered. Objective: Our aim was to identify and categorise intervention strategies for the prevention of acute sport injuries evaluated in the scientific literature, applying the Haddon matrix, and identify potential knowledge gaps. Methods: Five electronic databases were searched (PubMed, EMBASE, SPORTDiscus, CINAHL, Cochrane) for studies that evaluated the effect of interventions on the occurrence of acute sport injuries. Studies were required to include a control group/condition, prospective data collection, and a quantitative injury outcome measure. Results: A total of 155 studies were included, mostly randomised controlled trials (43%). The majority of studies (55%) focussed on strategies requiring a behavioural change on the part of athletes. Studies predominantly evaluated the preventive effect of various training programmes targeted at the ‘pre-event’ phase (n = 73) and the use of equipment to avoid injury in the ‘event phase’ (n = 29). A limited number of studies evaluated the preventive effect of strategies geared at rules and regulations (n = 14), and contextual modifications (n = 18). Studies specifically aimed at preventing re-injuries were a minority (n = 8), and were mostly related to ankle sprains (n = 5). Conclusions: Valuable insight into the extent of the evidence base of sport injury prevention studies was obtained for 20 potential intervention strategies. This approach can be used to monitor potential gaps in the knowledge base on sport injury prevention. © 2017, The Author(s).
Is subsequent lower limb injury associated with previous injury? A systematic review and meta-analysis
- Authors: Toohey, Liam , Drew, Michael , Cook, Jill , Finch, Caroline , Gaida, Jamie
- Date: 2017
- Type: Text , Journal article , Review
- Relation: British Journal of Sports Medicine Vol. 51, no. 23 (2017), p. 1670-1678
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- Description: Background Previous injury is a strong risk factor for recurrent lower limb injury in athletic populations, yet the association between previous injury and a subsequent injury different in nature or location is rarely considered. Objective To systematically review data on the risk of sustaining a subsequent lower limb injury different in nature or location following a previous injury. Methods Eight medical databases were searched. Studies were eligible if they reported lower limb injury occurrence following any injury of a different anatomical site and/or of a different nature, assessed injury risk, contained athletic human participants and were written in English. Two reviewers independently applied the eligibility criteria and performed the risk of bias assessment. Meta-analysis was conducted using a random effects model. Results Twelve studies satisfied the eligibility criteria. Previous history of an ACL injury was associated with an increased risk of subsequent hamstring injury (three studies, RR=2.25, 95% CI 1.34 to 3.76), but a history of chronic groin injury was not associated with subsequent hamstring injury (three studies, RR=1.14, 95% CI 0.29 to 4.51). Previous lower limb muscular injury was associated with an increased risk of sustaining a lower limb muscular injury at a different site. A history of concussion and a variety of joint injuries were associated with an increased subsequent lower limb injury risk. Conclusions The fact that previous injury of any type may increase the risk for a range of lower limb subsequent injuries must be considered in the development of future tertiary prevention programmes. Systematic review registration number CRD42016039904 (PROSPERO). © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
The new concussion in sport guidelines are here. But how do we get them out there?
- Authors: Finch, Caroline , White, Peta
- Date: 2017
- Type: Text , Journal article , Review
- Relation: British Journal of Sports Medicine Vol. 51, no. 24 (2017), p. 1734-1736
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Towards the reduction of injury and illness in athletes : Defining our research priorities
- Authors: Finch, Caroline , Bahr, Roald , Drezner, Jonathan , Dvorak, Jiri , Engebretsen, Lars , Hewett, Timothy , Junge, Astrid , Khan, Karim , Macauley, Domhnall , Matheson, Gordon , McCrory, Paul , Verhagen, Evert
- Date: 2017
- Type: Text , Journal article , Review
- Relation: British Journal of Sports Medicine Vol. 51, no. 16 (2017), p. 1178-1182
- Relation: http://purl.org/au-research/grants/nhmrc/1058737
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Compliance with sport injury prevention interventions in randomised controlled trials : A systematic review
- Authors: van Reijen, Miriam , Vriend, Ingrid , van Mechelen, Willem , Finch, Caroline , Verhagen, Evert
- Date: 2016
- Type: Text , Journal article , Review
- Relation: Sports Medicine Vol. 46, no. 8 (2016), p. 1125-1139
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- Description: Introduction Sport injury prevention studies vary in the way compliance with an intervention is defined, measured and adjusted for. Objective The objective of this systematic review was to assess the extent to which sport injury prevention randomised controlled trials (RCTs) have defined, measured and adjusted results for compliance with an injury prevention intervention. Methods An electronic search was performed in MEDLINE, PubMed, the Cochrane Center of Controlled Trials, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PEDro (Physiotherapy Evidence Database) and SPORTDiscus. English RCTs, quasi-RCTs and cluster-RCTs were considered eligible. Trials that involved physically active individuals or examined the effects of an intervention aimed at the prevention of sport-or physical activity-related injuries were included. Results Of the total of 100 studies included, 71.6 % mentioned compliance or a related term, 68.8 % provided details on compliance measurement and 51.4 % provided compliance data. Only 19.3 % analysed the effect of compliance rates on study outcomes. While studies used heterogeneous methods, pooled effects could not be presented. Conclusions Studies that account for compliance demonstrated that compliance significant affects study outcomes. The way compliance is dealt with in preventions studies is subject to a large degree of heterogeneity. Valid and reliable tools to measure and report compliance are needed and should be matched to a uniform definition of compliance.
Sports-related workload and injury risk : Simply knowing the risks will not prevent injuries : Narrative review
- Authors: Drew, Michael , Cook, Jill , Finch, Caroline
- Date: 2016
- Type: Text , Journal article , Review
- Relation: British Journal of Sports Medicine Vol. 50, no. 21 (2016), p. 1306-1309
- Relation: http://purl.org/au-research/grants/nhmrc/1058737
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- Description: Training loads contribute to sports injury risk but their mitigation has rarely been considered in a sports injury prevention framework. A key concept behind monitoring training loads for injury prevention is to screen for those at increased risk of injury so that workloads can be adjusted to minimise these risks. This review describes how advances in management of workload can be applied as a preventive measure. Primary prevention involves screening for preparticipation load risk factors, such as low training loads, prior to a training period or competition. Secondary prevention involves screening for workloads that are known to precede an injury developing so that modification can be undertaken to mitigate this risk. Tertiary prevention involves rehabilitation practices that include a graded return to training programme to reduce the risk of sustaining a subsequent injury. The association of training loads with injury incidence is now established. Prevention measures such as rule changes that affect the workload of an athlete are universal whereas those that address risk factors of an asymptomatic subgroup are more selective. Prevention measures, when implemented for asymptomatic individuals exhibiting possible injury risk factors, are indicated for an athlete at risk of developing a sports injury. Seven key indicated risks and associated prevention measures are proposed.
The Relationship between training load and injury, illness and soreness : A Systematic and literature review
- Authors: Drew, Michael , Finch, Caroline
- Date: 2016
- Type: Text , Journal article , Review
- Relation: Sports Medicine Vol. 46, no. 6 (Jun 2016), p. 861-883
- Relation: http://purl.org/au-research/grants/nhmrc/1058737
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- Description: Background Clinically it is understood that rapid increases in training loads expose an athlete to an increased risk of injury; however, there are no systematic reviews to qualify this statement. Objective The aim of this systematic review was to determine training and competition loads, and the relationship between injury, illness and soreness. Methods The MEDLINE, SPORTDiscus, CINAHL and EMBASE databases were searched using a predefined search strategy. Studies were included if they analysed the relationship between training or competition loads and injury or illness, and were published prior to October 2015. Participants were athletes of any age or level of competition. The quality of the studies included in the review was evaluated using the Newcastle-Ottawa Scale (NOS). The level of evidence was defined as strong, 'consistent findings among multiple high-quality randomised controlled trials (RCTs)'; moderate, 'consistent findings among multiple low-quality RCTs and/or non-randomised controlled trials (CCTs) and/or one high-quality RCT'; limited, 'one low-quality RCT and/or CCTs, conflicting evidence'; conflicting, 'inconsistent findings among multiple trials (RCTs and/or CCTs)'; or no evidence, 'no RCTs or CCTs'. Results A total of 799 studies were identified; 23 studies met the inclusion criteria, and a further 12 studies that were not identified in the search but met the inclusion criteria were subsequently added to the review. The largest number of studies evaluated the relationship between injuries and training load in rugby league players (n = 9) followed by cricket (n = 5), football (n = 3), Australian Football (n = 3), rugby union (n = 2), volleyball (n = 2), baseball (n = 2), water polo (n = 1), rowing (n = 1), basketball (n = 1), swimming (n = 1), middle-distance runners (n = 1) and various sports combined (n = 1). Moderate evidence for a significant relationship was observed between training loads and injury incidence in the majority of studies (n = 27, 93 %). In addition, moderate evidence exists for a significant relationship between training loads and illness incidence (n = 6, 75 %). Training loads were reported to have a protective effect against injury (n = 9, 31 %) and illness (n = 1, 13 %). The median (range) NOS score for injury and illness was 8 (5-9) and 6 (5-9), respectively. Limitations A limitation of this systematic review was the a priori search strategy. Twelve further studies were included that were not identified in the search strategy, thus potentially introducing bias. The quality assessment was completed by only one author. Conclusions The results of this systematic review highlight that there is emerging moderate evidence for the relationship between the training load applied to an athlete and the occurrence of injury and illness. Implications The training load applied to an athlete appears to be related to their risk of injury and/or illness. Sports science and medicine professionals working with athletes should monitor this load and avoid acute spikes in loads. It is recommended that internal load as the product of the rate of perceived exertion (10-point modified Borg) and duration be used when determining injury risk in team-based sports. External loads measured as throw counts should also be monitored and collected across a season to determine injury risk in throwing populations. Global positioning system-derived distances should be utilised in team sports, and injury monitoring should occur for at least 4 weeks after spikes in loads.
From monocausality to systems thinking: a complementary and alternative conceptual approach for better understanding the development and prevention of sports injury
- Authors: Hulme, Adam , Finch, Caroline
- Date: 2015
- Type: Text , Journal article , Review
- Relation: Injury Epidemiology Vol. 2, no. 1 (2015), p. 1-12
- Relation: http://purl.org/au-research/grants/nhmrc/1058737
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- Description: 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. © 2015, Hulme and Finch.