By Robert McCunn @RobertMcCunn , Neil V Gibson @360CUK, Liam D Harper @lharper89

Qualitative research methods are underused in our field. The prevailing epistemological approach in sports medicine favours the use of objective, numerical data. Indeed, such data and methodology is important; however, it does not always tell the full story. Context and nuance are not easily codified and cannot always be reduced to numbers. In this blog, we explain how greater use of qualitative data may improve sports injury research.

1. Adding granularity

The old adage that ‘something is only worth what someone is willing to pay for it’ comes from the field of economics; however, a parallel can be drawn with sports injury prevention research. The worth (or value) of injury prevention research is reflected by its impact on real world injury incidence and burden. Indeed, a theoretically sound and effective injury prevention programme has little to no value if relevant parties in the field do not implement it. To rework the above phrase: sports injury research only has worth if someone is willing to use it.

Qualitative research methods allow us to address questions related to barriers of implementation and how they might be overcome, as well as the perceived value and use of injury prevention techniques. Surveys, interviews, focus groups and ethnography represent some of the ways in which answers to these questions can be sought qualitatively.[1] For example, use of the Nordic Hamstring Exercise has been shown to significantly reduce the incidence of hamstring strain injuries within association football, yet a majority of UEFA Champions League teams do not use it for reasons, as yet, unknown.[2] This is a perfect example of where further qualitative investigation can enrich our understanding and provide increased granularity on a relevant issue.

Embracing qualitative research also raises ontological (nature of being) questions relevant to sports medicine. For example, artificial pitches are a controversial issue within association football. Quantitative research investigating the issue of whether artificial pitches increase injury risk compared with natural grass generally supports the conclusion that there is little difference between the two types; however, the majority of elite players (>90%) believe surface type is a significant risk factor.[3, 4] Should we really ignore the insights and perceptions of individuals potentially under our care because we cannot confirm their perceived experiences using quantitative methods? The glaring disparity between the quantitative and qualitative data on this issue brings another old adage to mind: absence of evidence is not necessarily evidence of absence.

Stranger things

While any given sport has commonly observed injuries (eg, hamstring strains in association football), rare or unusual cases can crop up from time to time. There may be instances where researchers do not have enough data to carry out meaningful quantitative analyses based on the low number of observed cases. However, case studies that integrate qualitative data about the potential risk factors associated with the injury, as well as treatment options and rehabilitation programming could prove helpful for applied practitioners. Indeed, the use of case studies presented as narratives has recently been advocated in sport sciences.[5]

The power of storytelling

In a recent qualitative study investigating the injury surveillance practices of association football club academies, only half of respondents indicated that coaches formally review or engage with the injury statistics often collected.[6] This is a worrying finding given the negative relationship between inter-departmental communication and injury burden observed at the elite level.[7] Perhaps part of the problem here is that simple reporting of quantitative injury data (or any type of numerical data for that matter) may not be stimulating or meaningful to individuals not well versed in the interpretation of such statistics (ie, athletes, coaches and club administrators). Qualitative research techniques could prove invaluable in terms of translating and presenting the same information in alternative ways to certain audiences (including the general public). Methods such as creative nonfiction ethnography (whereby researchers create stories underpinned by empirical data), virtually unheard of within the field of sports medicine, could potentially elicit greater understanding and buy-in from various different stakeholders.[8]

Using both quantitative and qualitative methods in a pragmatic manner provides the opportunity for holistic investigation and interpretation of prevalent and contemporary issues in sports medicine. It is important to note that one is not more valuable than the other; they are complimentary and provide the opportunity to understand the totality of an issue. In many ways, quantitative research often establishes the what and when of injury prevention strategies, while qualitative data addresses questions related to the how and why.

Conflicts of interest to declare

None

Robert McCunn @RobertMcCunn is Performance Sport Manager at Oriam: Scotland’s Sports Performance Centre in Edinburgh, UK. Robert’s research interests broadly span the areas of injury prevention and physical preparation strategies for enhanced performance within association football. Email: r.mccunn@hw.ac.uk

Neil Gibson @360CUK is Director of Sport, Performance and Health at Oriam: Scotland’s Sports Performance Centre in Edinburgh, UK. Neil has worked in a range of sports including professional and international association football in addition to supporting Commonwealth and Olympic athletes. His research interests include the self-regulation of recovery during high intensity interval training. Email: n.gibson@hw.ac.uk

Dr Liam D. Harper @lharper89 is a Senior Lecturer in Sport, Exercise and Nutrition Sciences at the University of Huddersfield. Liam’s research interests include the application of science in team sports, particularly association football, the investigation of ergogenic aids to improve exercise performance, and the effectiveness of recovery modalities following exercise. Email: L.Harper@hud.ac.uk

References

1. Harper LD, McCunn R. “Hand in Glove”: Using qualitative methods to connect research and practice. Int J Sports Physiol Perform2017;12:990-93.
2. Bahr R, Thorborg K, Ekstrand J. Evidence-based hamstring injury prevention is not adopted by the majority of Champions League or Norwegian Premier League football teams: the Nordic Hamstring survey. Br J Sports Med2015;49:1466-71.
3. Williams S, Hume PA, Kara S. A review of football injuries on third and fourth generation artificial turfs compared with natural turf. Sports Med2011;41:903-23.
4. Mears AC, Osei-Owusu P, Harland AR et al.. Perceived links between playing surfaces and injury: a worldwide study of elite association football players. Sports Med Open2018;4:40.
5. Halperin I. Case studies in exercise and sport sciences: A powerful tool to bridge the science-practice gap. Int J Sports Physiol Perfom2018;13:824-25.
6. McCunn R, Gibson NV, Fullagar HHK et al. Professional youth football academy injury data: collection procedures, perceived value, and use. Science & Medicine in Football2018;2:141-48
7. Ekstrand J, Lundqvist D, Davison M et al. Communication quality between the medical team and the head coach/manager is associated with injury burden and player availability in elite football clubs. Br J Sports Med2018 [Epub ahead of print]
8. Smith B, McGannon KR, Williams TL. Ethnographic creative nonfiction. Exploring the what’s, why’s, and how’s. In: Purdy L, Molner G, eds. Ethnographies in Sport and Exercise. London: Routledge 2015:59-73.