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Operating in Complexity: Applying Military Strategy to Sports Medicine
Sports injury risk reduction is complex and creates a challenge for sports medicine practitioners. Jason Tee discusses how they can apply military strategies to create systems that can withstand the complexity and adapt effectively to create meaningful change.
Australia’s Harry Wilson is substituted after sustaining an injury REUTERS/Siphiwe Sibeko
In the realm of sports medicine, there is a growing recognition that injuries do not arise from simple, isolated causes. Instead, they emerge from a dynamic interplay of multiple factors that interact in unpredictable ways. This perspective aligns with the concept of complex systems, a framework increasingly adopted in fields such as ecology, economics, and national security. In 2016, a collaboration of Brazilian and Canadian sport scientists published a seminal article in the British Journal of Sports Medicine, asserting that sports injuries should be understood as emergent phenomena of complex systems rather than the result of linear cause-and-effect chains(1).
A complex system has several key characteristics: numerous interacting elements, emergent behavior, non-linearity, feedback loops, and adaptability. In the context of sports injury, these elements are visible across multiple dimensions. Numerous factors contribute to injury risk—biomechanical, physiological, psychological, and social. These factors do not act in isolation; they interact dynamically. For instance, a footballer’s recent increase in training load might not pose a risk in isolation, but when coupled with poor sleep, emotional stress, and nutritional deficits, the system’s threshold may be exceeded.
Emergent behavior refers to the way a system’s overall output cannot be predicted merely by analyzing its components. An athlete who appears physically robust may still sustain an injury due to unseen psychosocial stressors. Non-linearity means that small changes in one area (like a minor change in running mechanics) can have disproportionately large effects. Feedback loops occur when system outputs feedback into the system as inputs—consider how fear of re-injury affects movement patterns, which in turn may predispose the athlete to another injury. Finally, adaptability speaks to the dynamic nature of athletes and their environments: both are in constant flux, adjusting to internal and external stimuli.
Given this complexity, it is no surprise that traditional injury prevention strategies often fall short. Most existing programs are predicated on linear models: identify a risk factor, apply an intervention, expect a predictable result. However, if injuries are emergent properties of complex systems, then controlling for one factor may have minimal or unpredictable effects. The Brazilian and Canadian research team note that "We should not seek to find a single risk factor, but rather understand how multiple factors interact to create conditions for injury."
This challenge is borne out in the data. Recent research in elite football demonstrates that injury numbers continue to continues to rise despite increased investment in injury prevention science(2). Specifically, the number of matches missed due to injury has not decreased over the last decade. This suggests that despite a more extensive understanding of risk factors and the proliferation of screening tools and load monitoring technologies, the injury burden remains substantial.
If injury prediction and prevention remain elusive despite decades of research, perhaps it is time to consider how other high-stakes professions deal with complexity and unpredictability. Fields such as aviation, emergency medicine, and the military have long operated in uncertain environments where clear cause-and-effect relationships are rare. These fields have developed tools and strategies for decision-making under conditions of uncertainty, and there may be valuable lessons here for sports injury professionals.
One such concept is VUCA, an acronym first introduced by the U.S. Army War College in 1987 to describe the post-Cold War world(3). VUCA stands for Volatility, Uncertainty, Complexity, and Ambiguity (see table 1). Leadership and strategy authors have adopted it to describe environments that are unpredictable, dynamic, and difficult to control. This description applies equally well to the injury landscape in elite sport.
Table 1: VUCA definitions
| V | Volatility is the degree to which events and situations change quickly. In sport, this may be reflected in sudden fixture congestion, last-minute travel, or a key player returning from injury. |
| U | Uncertainty is the lack of predictability. Despite knowing historical injury patterns, it remains difficult to forecast who will get injured next. |
| C | Complexity is the degree to which events and situations arise because of the unpredictable interactions between many connected parts. Athletes operate within a network of coaches, teammates, personal relationships, and external pressures. |
| A | Ambiguity is the difficulty in interpreting meaning. Is a slight drop in wellness score cause for concern, or just noise in the system? |
To navigate such environments, military strategists have turned to the OODA loop. Developed by U.S. Air Force Colonel John Boyd, the OODA loop is a decision-making cycle composed of four stages: Observe, Orient, Decide, and Act (see figure 1)(4). This framework is designed to help individuals and teams function effectively in chaotic, high-pressure settings. What makes the OODA loop particularly suited for VUCA environments is its iterative nature. It is not a one-time process but a continuous cycle that allows for rapid adjustment and learning (see figure 2).
Applying iterative OODA cycles is to the practitioner’s advantage because it promotes rapid learning and improved decision making. Decision-making improves because the medical professional becomes increasingly aware and more experienced with dealing with the injury problems that occur within a particular environment.
- Reduces Uncertainty: By continuously observing and analyzing real-time data, practitioners can detect subtle changes in athlete status that may precede injury.
- Enables Agility: The cycle promotes responsiveness. If an athlete reports fatigue in the morning, practitioners can adjust the plan for the day rather than adhere to it rigidly.
- Improves Decision-Making: OODA encourages structured reflection. Rather than acting on instinct or habit, decisions are made with a deliberate understanding of context.
- Promotes Learning: The feedback inherent in the cycle means that each decision contributes to a growing repository of experience. Patterns may emerge over time that inform future strategies.
Consider the following example: A rugby player returns to training after a low-grade hamstring strain. The medical team observes data from strength tests, sprint metrics, and subjective feedback. They orient this data within the context of the player’s previous injury history and current training phase. A decision is made to limit sprinting volume that week. After acting on this plan, the player completes training without adverse effects, and the team learns that this strategy may be effective for similar cases in the future. This is OODA in action.
By embedding OODA into daily routines, sports injury professionals can foster adaptive expertise. Rather than relying solely on rigid protocols or prediction models, they become skilled at recognizing patterns, responding to change, and updating their understanding in real time. This does not mean abandoning evidence-based practice. On the contrary, it means integrating scientific knowledge into a flexible, responsive system that acknowledges the complexity of human health and performance.
Commander’s Intent: Strategy Without Micromanagement
Another useful concept borrowed from military operations is the commander’s intent. In complex and rapidly changing environments, military leaders have long recognized that it is impossible to control every action or predict every contingency on the ground. Instead of issuing rigid instructions, commanders convey their overall objective—why the mission matters and what outcome must be achieved.
For example, a commander might state: "We must occupy that hill because it overlooks the main supply route and gives us a tactical advantage." How the troops achieve this objective is left to those on the ground, who are empowered to adapt their tactics based on the unfolding situation. The key is that everyone understands the strategic importance of the goal.
This principle is highly applicable to sports injury prevention. There are many different approaches to managing risk, from load monitoring, to psychological support, to strength and conditioning. What matters is not prescribing a single "correct" method but enabling practitioners to choose the most effective strategy within their specific context.
Commander’s intent reminds practitioners that the goal is not to follow a checklist, but to achieve a meaningful outcome: reducing injury burden and supporting athlete well-being. It allows for flexibility, responsiveness, and creativity while keeping everyone aligned to a shared purpose. Combined with the OODA loop, it creates a powerful framework for action in complex systems.
Conclusion
The landscape of sports injury risk reduction is fraught with volatility, uncertainty, complexity, and ambiguity. Traditional linear approaches have struggled to make significant headway, and injury rates in elite sport remain stubbornly high. Recognizing injuries as emergent phenomena within complex systems requires a shift in mindset and method.
By borrowing from military strategy and adopting frameworks like VUCA, commander’s intent, and the OODA loop, sports injury professionals can improve their responsiveness and decision-making in unpredictable environments. These tools promote agility, continuous learning, and a more holistic understanding of athlete health.
Injury risk reduction is not about eliminating all risk or predicting every outcome. It is about navigating complexity with skill, humility, and adaptability. Sports injury professionals must ask: Are they simply reacting to injuries, or are they systematically observing, orienting, deciding, and acting in ways that foster resilience and readiness in the athletes they serve?
References
1. Br J Sports Med. 2016;50(21):1309–1314.
2. Br J Sports Med. 2022 Dec 6;57(5):292-298.
3. U.S. Army War College. Strategic Leadership Primer. Carlisle, PA: U.S. Army War College Press; 1987.
4. Boyd, John R. "The essence of winning and losing." Unpublished lecture notes 12.23 (1996): 123-125.
Jason Tee
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