Realist synthesis in sport and exercise medicine: 'time to get real'

In sport and exercise medicine (SEM), context is key. By context we mean: 'What works?' 'for whom?' 'how?' and under 'what circumstances?' These are four key questions for clinicians who aim to prevent injuries, treat patients and guide return to sport with athletes. To answer real-world challenges, clinicians will often bow to the Oxford levels of evidence and rely on findings of randomised controlled trials, (RCTs), systematic reviews (SRs) or meta-analyses. These methods are gold standards, recent debate1 notwithstanding. However, in dynamic, changeable and less-controlled sports environments (eg, soccer, rugby) where we strive to achieve optimal performance and health gains, we should challenge our own thinking and traditions to meet the demands of this unique environment. © Author(s) (or their employer(s)) 2021.