Injuries are an inevitable element of sport, and for most athletes, will present at some point or another. Injuries arise in many forms, and as I covered in a previous article overall injury rates do not appear to be improving in sport by any means. Examining the data there is a clear consensus that we are missing something, as injury rates across virtually all major sports and spanning all levels of competition appear to be trending in a concerning direction.
Rather than examining this issue as being a simple, or binary problem to solve, we must first appreciate the complexity at hand. There are an abundance of factors to consider for why injuries occur. Factors ranging from the athlete morphology and trauma history, to present psychological state and environmental conditions- among many, many more- all influence the potential for injury. The question shouldn’t be whether we can completely absolve injury risk, but rather, identify the areas we can make meaningful impact and reduce the overall probability of injury. The graphic below (be sure to zoom in) is adopted from (Tsarbou, C et al. 2024) and provides one of the better illustrations I’ve found demonstrating the complexity of injury variables.
While we should obviously understand the impossibility of completely preventing injuries, it is a mistake to feel that we are also an indifferent component to the outcome. Injuries are a microcosm of a complex system, and within any complex system we have component parts. As shown in the image above, there are many component parts within this system that can certainly be influenced within training and performance settings. I believe a central problem in the field today is that coaches and practitioners are quick to become siloed to one or two variables they believe are most significant. This promotes a reductionist view to the problem at hand, as thinking we can adequately restore injuries with a single component is purely shortsighted.
Complex systems at their root are just that- complex. And trying to bring a single (or simple) solution to a complex problem is a surefire way of failing. I believe the social media era has compounded this problem by allowing us to create echo chambers reinforcing our ideology; but again, we cannot simplify what is complex, more is required. The fundamental job of the human performance team is to properly identify where influence can be had and understand how this influence is executed across multiple members of the team. Which leads me to the priority of this article, and what I believe is the most essential strategy for managing or preventing injuries in sport- establishing an interdisciplinary (systems) approach.
Understanding Complex Systems
A system is defined simply as a set of component parts working together as parts of a mechanism or interconnecting network. According to one of the pioneers in systems thinking, Ludwig von Bertalanffy, a complex system must include:
1. Component (individual parts)
2. Interconnectedness & interdependence
3. Common purpose or function
In this sense, the performance team functions and operates like an ecosystem. A high-performance setting requires a team of individuals (component parts) that work together and are aligned to a common purpose or outcome (the athlete and their goals). These component parts are developed with the athlete at the epicenter of the ecosystem, and our job is to determine what the best approach could be with the team, time, and resources available.
To that end, most athletes, at most levels, need mostly the same things, and in most cases, this isn’t the complicated part. What changes from case to case, and can become complicated, is understanding the dose (amount), intensity, and frequency of what is applied in training or restoration. A simpler way of seeing this is considering our work as being “the same things done routinely but differently” based on the context or demands.
This is a discussion Stu McMillan has spoken about at length, and as he’s emphasized a system is not simply the net result of its component parts. In other words, the interdependence and interrelationship between and across the component parts within a system will determine their magnitude in a cohesive outcome. As this applies to the performance setting and injuries, we can define a systems approach a little more succinctly as “multiple inputs aligned to a singular outcome.”
These component parts have an independent function (skillset or modality) that must coalesce and work together in an integrated manner designed to serve a common outcome. A simple example of this in our world is thinking about the effectiveness of strength and conditioning in isolation compared to having S&C, nutrition, and recovery modalities. It takes no expert to recognize that S&C is most likely more effective when paired with proper nutritional guidance and recovery efforts. Equally, nutrition and regeneration are likely more effective when S&C is being performed. We become more capable of training at higher levels for longer, can recover more efficiently between training bouts, and so forth.
The essential intangibles of a successful system are formed in the communication, trust, and transparency that are held throughout. To speak to the first and perhaps most important, is communication. All (human-based) systems will live and die by their ability to communicate. Both sport and injury are dynamical, in that they are constantly changing, moving, and evolving. This accentuates the importance of communication as what we knew last week may not be what needs to be known this week.
Trust and transparency, although recognized as key elements by virtually anyone, are rarely practiced as they’re preached. But to establish an effective ecosystem, there needs to be a certain comfort and vulnerability amongst the team so honest and perhaps difficult conversations can be had without disrupting the stability of the system or desired outcomes. See the video below for a few strategies on building and establishing these fundamentals in the professional setting.
The human body is complex. Injuries are complex. Sports and athletes are complex, and our work happens to be explicitly built around all of these… making it, you guessed it, complex. This is where these intangibles of communication, trust, and transparency- both between team members and with the athlete, have a crucial impact on our work. Complex systems possess an undercurrent that feeds the direction and speed of the cycles. This can broadly be analyzed by seeing systems as either being more vicious or virtuous, and for athletes, we see far more of the former than the latter.
Vicious & Virtuous Cycles
We’re all familiar with the concept of vicious cycles, but what about virtuous? Where a vicious cycle is experiencing a collapse of multiple component parts, a virtuous one is where the component parts all operate at (or near) their peak within the system. Routine, habit formation, and consistency are all critical elements to influencing the direction of the cycle. All systems operate around a centerpoint, which in our case is the athletes we work with. As demonstrated in the illustration below (Wulf, G. 2016), there must be a concerted focus on developing athlete autonomy. Autonomy equips the athlete by allowing them to genuinely feel a part of and have discretion within their situation. Autonomy generates confidence, confidence amplifies belief.
At its core, a coaching endeavor is an educational responsibility. Not only are we providing the technical inputs, but we are also instituting how and why athletes should make the decisions they do- forming autonomy. Another underlying but key element of influencing autonomous behavior is directing the athletes focus. We can tell athletes what’s important until we run out of air, our job is to show them through training (corrective reinforcement) and shaping perspective (expectation management) that they are progressing towards their goals. As described above, “goal-action coupling” indicates we are effectively aligning the athletes desired outcomes with their daily actions and behaviors.
Establishing an Interdisciplinary Approach
The components and infrastructure of your system may look dramatically different depending on your setting. A primary distinction for how this may look is whether you are in the private or public sector of human performance. Other determining factors may include population (youth or professional athletes), budget and resources, and available time and training setting. For the sake of clarity and authenticity, the remaining will emphasize a systems approach from the viewpoint of private sector operations.
My introduction to a systems approach to performance was derived from my time at Virginia High Performance (VHP) where we worked predominantly with Naval Special Warfare personnel (SEALs). This presented us with some truly complex cases and ones that equally required performance and restorative applications. Our work was largely driven by injury (present and history), however most of our athletes still had imminent performance demands creating a sensitivity and urgency to our work.
What we found was that the key ingredient to success wasn't a single application or modality, but having the right balance of the ingredients involved. This included both strength training, in many of its forms, and a handful of tailored supporting modalities. The strength training promoted the central adaptations, the modalities potentiated and facilitated these adaptations.
While these support pillars (i.e., nutrition, soft tissue therapy, chiropractic) were aiming to influence the athlete’s ability to recover, we also noticed an additional and critical benefit. Several of these modalities were also providing a potentiating effect which we looked at as “creating the best transient opportunities to apply stress” during training. For injuries to be fully restored they must be loaded, loaded heavily and frequently, and under velocity conditions. But for high performing athletes, especially those with significant injury histories, creating the appropriate windows to train was equally essential. Both components were necessary to our outcomes, neither was considered a priority but both were perceived as requirements for success.
While I have been adjusting this model as I have transitioned to working with athletes, I’ve noticed some similarities between the military and pro athlete world. At their roots, we have high level individuals who are fiercely committed to their process, subjected to unscrupulous amounts of pressure, and decimated by injuries. These are also groups of individuals who often live very complicated lives, entangled by an undercurrent of transactional relationships and instability.
This is just further justification that a systems approach to performance or injury should be seen as the preferential approach. The inherent complexity, depth, and demand for individualization to injuries underscores the significance and demand for a systems approach- a treatment in isolation will never provide a complete solution. And along with this, among many necessary attributes, performance coaches must be effective communicators, problem solvers, and independently skilled. Systems are dynamic, our ability to maintain good observation and adaptability are essential for positive outcomes.
To wrap this one up, check out the video below for the five essential strategies for developing a systems approach. And then stay tuned for the next installment of our essential strategies & controlling chaos series to follow soon.
Great work here sir!