When evidence fails in real life: Rethinking sports injury rehabilitation and prevention
Sérgio T. Fonseca, Evert Verhagen, Caroline Bolling · Brazilian Journal of Physical Therapy · 2026
Background: Traditional models of sports injury prevention and rehabilitation have largely relied on linear, reductionist frameworks that emphasize isolated risk factors and standardized interventions. Although these approaches have advanced the field of sports, they have shown limited capacity to explain real-world injury patterns or to guide effective, context-sensitive clinical practice. Emerging perspectives grounded in complexity science, contemporary interpretations of evidence-based practice, and dynamic biopsychosocial thinking offer more comprehensive ways to understand and manage sports injuries.
Objective: To critically examine the historical and conceptual foundations of sports injury prevention and rehabilitation, clarify misconceptions surrounding evidence-based practice, and discuss the limitations of reductionist applications of the biopsychosocial model. The
Goal: is to propose a more integrated, complexity-informed framework to support patient-centered and contextually relevant physical therapy practice.
Discussion: The current sports injury literature shows that these injuries arise from nonlinear, dynamic interactions among biological, psychological, and social determinants, challenging the adequacy of linear causality and one-size-fits-all interventions. Evidence-based practice is often misinterpreted as a hierarchy of study designs rather than as an integrative process that combines research evidence, clinical expertise, and patient values within real-world constraints. Similarly, the biopsychosocial model is frequently applied in a fragmented manner, treating its components as separate rather than interdependent. Integrating complexity thinking with a fully realized EBP framework and a dynamic biopsychosocial perspective enables clinicians to navigate uncertainty, tailor interventions, and deliver care that aligns with athletes' lived realities. This approach strengthens clinical reasoning and supports more effective, patient-centered rehabilitation.