What is it about?  

The health benefits of running are well established, but the high incidence of injuries remains an important challenge. How can we better address this issue? 

Running-related injuries (RRI) and current limitations 

RRI prevalence ranges from 10.9% to 74%, with direct and indirect impacts, such as the treatment costs (173€), affecting daily life and running dropout. Despite positive outcomes, runners have not benefited totally from existing preventive strategies. One possible explanation? Most of the RRI studies follow the traditional scientific paradigm, which investigates a phenomenon through the principles of reduction. This approach provides a ‘box of manageable variables’ to reduce injury risk, but lacks a deep comprehension of the phenomenon, since it does not consider the multifactorial nature of the injuries. 

Embracing complexity  

Advances indicate that Complex Systems Theory can enhance understanding of the topic. Unlike the traditional approach, the theory considers injuries as an outcome of a multidimensional, dynamic, and time-varying interaction. In this regard, two principles can help clarify methodological choices and enhance understanding for future applications: non-linearity and dynamics. 

Non-linearity: different paths for the same outcome 

Imagine two runners who both develop the same injury. Despite the same diagnosis, they probably developed the injury through completely different paths − the causes (inputs) are not the same, even if the outcome looks identical. Therefore, the “one-size-fits-all” strategy is unlikely to be effective. 

Dynamic: the time-varying nature 

Potential risk factors for injuries interact and change over time. For example, stress from increased training volume can be manageable for one runner, but lead to injury in another if combined with insufficient recovery. Instead of simply trying to identify and provide a direct relation between risk factors and injuries, this approach enforces the importance of creating a personalized “risk profile”. 

Both principles provide insights regarding the importance of adopt a person–specific approach for injury prevention. At the same time, they highlight that we need to advance in monitoring RRI risk factors, which also bring some challenges:  

• How to measure variables expressed in different time scales?  

• How to monitor variables in a training-real-life context?  

Possible answers to these questions include: 

• Defining and mapping the parameters with the potential to modify, over time, the probability of injury occurrence;  

• Defining the strategies for monitoring this variable and understanding the pattern of change over time.  

For both steps, wearable technology (external and internal load, sleep hours, heart rate variability) and well-being brief screening tools should be used by professionals and runners to monitor and identify trigger points that modify the risk profile. 

Why is it important?  

RRI represent a significant economic burden and a cause of running dropout. We aim to highlight the application of Complex Systems Theory to better understand the multifactorial and time-varying characteristics of injury by recognizing non-linear and dynamic interactions between variables. Instead of isolating risk factors, this approach focuses on identifying patterns of interaction to create personalized injury risk profiles. While there are methodological challenges, this shift in perspective is timely, as wearable technology and digital health tools now allow for the simultaneous monitoring of multiple variables in real-world settings. By integrating complex systems thinking with practical tools, this work aims to empower runners and professionals with insights to approach injury risk in a personalized and context-sensitive way, in order to support long-term engagement in running. 

带回家的信息  

• The Complex Systems Theory recognises multifactorial, non-linear, and time-varying interactions between RRI risk factors; 

• Wearable technology and digital health tools are useful to monitor, and identify trigger points that modify the injury risk profile. 

Authors: Dr. Mabliny Thuany¹ Dr. Gabriela Vasconcelos²

Affiliation: 1 Department of Sports, States University of Para, Para-Brazil; 2 Department of Functional Health, Federal University of Goias, Goiania – Brazil