Why ‘best practice’ is not always best in sport

As sport and exercise medicine clinicians, we are constantly faced with challenging decisions. We contend with a diverse range of physical and psychological ailments, how to optimise rehabilitation, clear players to return to play and even the advancement of training to improve performance. Accordingly, clinicians often seek to provide evidence-based ‘best practice’.1 Monocausal thinking may drive the adoption of so-called ‘best practice’.2 However, while evidence-based solutions can provide a foundation for decision making, the quest for ‘best practice’ may often be misplaced given the complexity of both sports performance and injury manifestations.3 4 Problems arise in different contexts, requiring different responses. We may use the process of sense-making—defined as ‘how we make sense of the world so we can act in it’5—to understand and respond to such injury and performance dilemmas. A decision support framework from this field can benefit clinicians by guiding appropriate styles of thinking and responses to the array of problems faced.6 Cynefin (pronounced ku- nev -in) is a conceptual framework used in industry, government and academia that aids decision making. It offers four principal decision-making domains that …