Unfortunately, injuries cause more than pain and lost playing time for athletes. In many cases, an injury negatively impacts self-esteem and creates fear and anxiety. For competitive athletes, the injury often separates them from their familiar role and identity with respect to their teammates, coaches and peers.

It seems rather obvious that injured athletes would want to return to sport as soon as possible, right? Based on my clinical observations and experience, most athletes are motivated to return after their first injury. The more serious the injury (e.g. ACL tear, Achilles tendon rupture or UCL tear), the longer the road to get back. The speed and ease of the process is affected by the patient’s response to injury and surgery (coper vs. non-coper), degree of injury, skill of the surgeon, effectiveness of rehab, and patient compliance.

Much of the research done to date with fear of re-injury has centered on athletes undergoing ACL reconstruction. Over the last decade, methods for measuring kinesiophobia (fear of movement associated with sport/injury) such as the Tampa Scale of Kinesiophobia. I routinely use the TSK-11 with my athletes. In addition, the ACL-RSI is another tool for evaluating psychosocial readiness to return to sport. As sports medicine practitioners, we must pay attention to our clients’ fears and mental status.

Invariably, not all athletes want to return to sport. Factors that may hinder return to sport are:

  • Chronic pain
  • Fear of re-injury
  • Fear or anxiety about long term pain, injury or future disability (such as osteoarthritis)
  • Anxiety about not being able to return to their prior level of performance


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