Anxiety-related responses after sports injury in adolescent athletes: from protective caution to kinesiophobia, sport avoidance and depressive symptoms - a narrative review
DOI:
https://doi.org/10.12775/QS.2026.63.73259Keywords
Adolescent athletes, adolescent mental health, athlete injury, Kinesiophobia, fear of reinjury, sport avoidance, depressive symptoms, anxiety, athlete mental healthAbstract
Background. Sports injuries are frequent among adolescent athletes, especially in organized and competitive sport. Although often treated mainly as orthopedic problems, they may also have psychological consequences. Kinesiophobia, fear of reinjury, sport avoidance and depressive symptoms should be considered within a broader post-injury context.
Aim. This narrative review described anxiety-related responses after sports injury in adolescent athletes as a continuum from protective caution to kinesiophobia, sport avoidance and depressive symptoms.
Material and methods. A narrative review was conducted using publications on adolescent athletes, sports injury, kinesiophobia, fear of reinjury, fear-avoidance mechanisms, psychological readiness, return to sport, sport avoidance, depressive symptoms, anxiety symptoms, athletic identity and quality of life after injury. Reviews, clinical papers, observational and qualitative studies relevant to sports medicine and sport psychology were included.
Results. The literature suggests post-injury responses may include fear of reinjury, kinesiophobia, anxiety, negative mood, loss of motivation and depressive symptoms. Caution after injury may be protective when reinjury risk is relevant or rehabilitation is incomplete. However, persistent fear of movement or reinjury may become maladaptive when it leads to rehabilitation avoidance, delayed sport reintegration, reduced participation or team withdrawal. Adolescents may be vulnerable because injury absence can disrupt athletic identity, peer relationships and future opportunities.
Conclusions. Anxiety-related responses in injured adolescents should be understood as a continuum involving physical recovery, psychological readiness, developmental vulnerability, social context and mental health. Rehabilitation should include physical assessment, psychological screening and support when fear, avoidance, low confidence, social withdrawal, loss of motivation or mood symptoms persist.
References
1. Räisänen AM, Kokko S, Pasanen K, Leppänen M, Rimpelä A, Villberg J, et al. Prevalence of adolescent physical activity-related injuries in sports, leisure time, and school: the National Physical Activity Behaviour Study for children and Adolescents. BMC Musculoskelet Disord. 2018 Feb 15;19:58. doi:10.1186/s12891-018-1969-y PubMed PMID: 29448928; PubMed Central PMCID: PMC5815200.
2. Haraldsdottir K, Watson AM. Psychosocial Impacts of Sports-related Injuries in Adolescent Athletes. Curr Sports Med Rep. 2021 Feb 1;20(2):104–8. doi:10.1249/JSR.0000000000000809 PubMed PMID: 33560034.
3. Jeong L, Li D. Psychological Well-Being From Sports Injuries in Adolescence: A Narrative Review. Cureus. 16(7):e64018. doi:10.7759/cureus.64018 PubMed PMID: 39109136; PubMed Central PMCID: PMC11302481.
4. Hsu CJ, Meierbachtol A, George SZ, Chmielewski TL. Fear of Reinjury in Athletes. Sports Health. 2016 Sep 20;9(2):162–7. doi:10.1177/1941738116666813 PubMed PMID: 27590793; PubMed Central PMCID: PMC5349388.
5. Albishi W, Alajlan F, Alshehri S, AbuDujain NM. Athlete’s Mental Health and Quality of Life After Sports Injuries. JBJS Reviews. 2025 Sep;13(9):e25.00123. doi:10.2106/JBJS.RVW.25.00123
6. Ambegaonkar JP, Jordan M, Wiese KR, Caswell SV. Kinesiophobia in Injured Athletes: A Systematic Review. J Funct Morphol Kinesiol. 2024 Apr 19;9(2):78. doi:10.3390/jfmk9020078 PubMed PMID: 38651436; PubMed Central PMCID: PMC11036235.
7. Podlog L, Wadey R, Stark A, Lochbaum M, Hannon J, Newton M. An adolescent perspective on injury recovery and the return to sport. Psychology of Sport and Exercise. 2013 Jul 1;14(4):437–46. doi:10.1016/j.psychsport.2012.12.005
8. Palisch AR, Merritt LS. Depressive Symptoms in the Young Athlete after Injury: Recommendations for Research. J Pediatr Health Care. 2018;32(3):245–9. doi:10.1016/j.pedhc.2017.11.003 PubMed PMID: 29289408.
9. Prieto-González P, Martínez-Castillo JL, Fernández-Galván LM, Casado A, Soporki S, Sánchez-Infante J. Epidemiology of Sports-Related Injuries and Associated Risk Factors in Adolescent Athletes: An Injury Surveillance. International Journal of Environmental Research and Public Health. 2021 Jan;18(9):4857. doi:10.3390/ijerph18094857
10. von Rosen P, Heijne A, Frohm A, Fridén C, Kottorp A. High Injury Burden in Elite Adolescent Athletes: A 52-Week Prospective Study. J Athl Train. 2018 Mar;53(3):262–70. doi:10.4085/1062-6050-251-16 PubMed PMID: 29412695; PubMed Central PMCID: PMC5894377.
11. Piątek PW, Gołąbek N, Szymański Ł, Mordarska M, Merc A, Kodura A, et al. Cumulative Psychopathology and the Return-to-Sport Gap in Non-Elite Athletes: A Narrative Review of Injury vs. Forced Detraining. Quality in Sport. 2026 Mar 19;53:69777–69777. doi:10.12775/QS.2026.53.69777
12. Rusiłowicz R, Peszt MJ, Szaryński M, Jakubowska P, Prokopczyk K, Wasilczuk A, et al. The Impact of anterior cruciate ligament rupture on athletes return to sport - A Literature review. Quality in Sport. 2025 Dec 12;48:66870–66870. doi:10.12775/QS.2025.48.66870
13. Juggath C, Naidoo R. The influence of psychological readiness of athletes when returning to sport after injury. S Afr J Sports Med. 36(1):v36i1a16356. doi:10.17159/2078-516X/2024/v36i1a16356 PubMed PMID: 38384858; PubMed Central PMCID: PMC10878413.
14. Podlog L, Gao Z, Kenow L, Kleinert J, Granquist M, Newton M, et al. Injury rehabilitation overadherence: preliminary scale validation and relationships with athletic identity and self-presentation concerns. J Athl Train. 2013;48(3):372–81. doi:10.4085/1062-6050-48.2.20 PubMed PMID: 23675797; PubMed Central PMCID: PMC3655751.
15. Lethem J, Slade PD, Troup JD, Bentley G. Outline of a Fear-Avoidance Model of exaggerated pain perception--I. Behav Res Ther. 1983;21(4):401–8. doi:10.1016/0005-7967(83)90009-8 PubMed PMID: 6626110.
16. Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000 Apr;85(3):317–32. doi:10.1016/S0304-3959(99)00242-0 PubMed PMID: 10781906.
17. Leeuw M, Goossens MEJB, Linton SJ, Crombez G, Boersma K, Vlaeyen JWS. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2007 Feb;30(1):77–94. doi:10.1007/s10865-006-9085-0 PubMed PMID: 17180640.
18. Suzuki S, Mattson CL, Obermeier MC, Casanova AD, Doda AK, Sayles LA, et al. Athletic Fear Avoidance in Athletes Receiving Rehabilitation for Sport-Related Concussion: A Preliminary Study. Sports Health. 2023 May 19;16(3):457–64. doi:10.1177/19417381231172513 PubMed PMID: 37208905; PubMed Central PMCID: PMC11025521.
19. Piussi R, Krupic F, Senorski C, Svantesson E, Sundemo D, Johnson U, et al. Psychological impairments after ACL injury - Do we know what we are addressing? Experiences from sports physical therapists. Scand J Med Sci Sports. 2021 Jul;31(7):1508–17. doi:10.1111/sms.13959 PubMed PMID: 33772890.
20. Marshall AN, Snyder Valier AR, Yanda A, Lam KC. The Impact of a Previous Ankle Injury on Current Health-Related Quality of Life in College Athletes. J Sport Rehabil. 2020 Jan 1;29(1):43–50. doi:10.1123/jsr.2018-0249 PubMed PMID: 30526298.
21. McGuine TA, Winterstein AP, Carr K, Hetzel S. Changes in Health-Related Quality of Life and Knee Function After Knee Injury in Young Female Athletes. Orthop J Sports Med. 2014 Apr;2(4):2325967114530988. doi:10.1177/2325967114530988 PubMed PMID: 26535324; PubMed Central PMCID: PMC4555590.
22. Nyland J, Ferman B, Elliott R, Lewis J, Richards J, Krupp R. Athletic identity-fear avoidance relationships of high musculoskeletal injury risk adolescent athletes during return to sport rehabilitation: a pilot study. Eur J Orthop Surg Traumatol. 2025 Jul 25;35(1):324. doi:10.1007/s00590-025-04445-8 PubMed PMID: 40715846.
23. Kvist J, Silbernagel KG. Fear of Movement and Reinjury in Sports Medicine: Relevance for Rehabilitation and Return to Sport. Phys Ther. 2022 Feb 1;102(2):pzab272. doi:10.1093/ptj/pzab272 PubMed PMID: 34971375.
24. Sheehan N, Summersby R, Bleakley C, Caulfield B, Matthews M, Klempel N, et al. Adolescents’ experience with sports-related pain and injury: A systematic review of qualitative research. Physical Therapy in Sport. 2024 Jul 1;68:7–21. doi:10.1016/j.ptsp.2024.05.003
25. Yang J, Peek-Asa C, Lowe JB, Heiden E, Foster DT. Social Support Patterns of Collegiate Athletes Before and After Injury. J Athl Train. 2010;45(4):372–9. doi:10.4085/1062-6050-45.4.372 PubMed PMID: 20617912; PubMed Central PMCID: PMC2902031.
26. Ferman B, Nyland J, Richards J, Krupp R. Adolescent Athletes with Stronger Athletic Identity Perceptions Have Weaker Fear Avoidance Perceptions During Musculoskeletal Injury Rehabilitation Return to Sports Preparation. J Pediatr Orthop. 2024 Sep 1;44(8):489–96. doi:10.1097/BPO.0000000000002723 PubMed PMID: 38767118.
27. Forsdyke D, Madigan D, Gledhill A, Smith A. Perceived Social Support, Reinjury Anxiety, and Psychological Readiness to Return to Sport in Soccer Players. J Sport Rehabil. 2022 Aug 1;31(6):749–55. doi:10.1123/jsr.2021-0181 PubMed PMID: 35405636.
28. Appaneal RN, Levine BR, Perna FM, Roh JL. Measuring postinjury depression among male and female competitive athletes. J Sport Exerc Psychol. 2009 Feb;31(1):60–76. doi:10.1123/jsep.31.1.60 PubMed PMID: 19325188.
29. Park AL, Furie K, Wong SE. Stronger Athlete Identity Is a Risk Factor for More Severe Depressive Symptoms After Musculoskeletal Injury in Pediatric Athletes: a Systematic Review. Curr Rev Musculoskelet Med. 2023 Mar 30;16(5):220–8. doi:10.1007/s12178-023-09828-0 PubMed PMID: 36991172; PubMed Central PMCID: PMC10188729.
30. Wiese-Bjornstal DM. An integrated model of response to sport injury: psychological and sociological dynamics. Journal of applied sport psychology. 1998;10(1):S. 46-69.
31. Bae M. Biopsychosocial approach to sports injury: a systematic review and exploration of knowledge structure. BMC Sports Sci Med Rehabil. 2024 Dec 18;16:242. doi:10.1186/s13102-024-01025-x PubMed PMID: 39695836; PubMed Central PMCID: PMC11658233.
32. Carson F, Polman RCJ. Self-determined motivation in rehabilitating professional rugby union players. BMC Sports Sci Med Rehabil. 2017 Jan 18;9:2. doi:10.1186/s13102-016-0065-6 PubMed PMID: 28116102; PubMed Central PMCID: PMC5241994.
33. Podlog L, Heil J, Schulte S. Psychosocial factors in sports injury rehabilitation and return to play. Phys Med Rehabil Clin N Am. 2014 Nov;25(4):915–30. doi:10.1016/j.pmr.2014.06.011 PubMed PMID: 25442166.
34. Butler L, Baez S, Walker C, Roman D, Douthit T, Kuenze C, et al. The relationship between psychological readiness to return to sport and kinesiophobia in teens and young adults after anterior cruciate ligament reconstruction. Front Psychol. 2025 Oct 10;16:1623398. doi:10.3389/fpsyg.2025.1623398 PubMed PMID: 41143025; PubMed Central PMCID: PMC12549314.
35. Ardern CL, Taylor NF, Feller JA, Webster KE. A systematic review of the psychological factors associated with returning to sport following injury. Br J Sports Med. 2013 Nov;47(17):1120–6. doi:10.1136/bjsports-2012-091203 PubMed PMID: 23064083.
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Copyright (c) 2026 Anna Agnieszka Gąska, Marta Gutkowska, Joanna Jabłońska, Joanna Wasik, Marta Armuła, Claire Bongege, Arkadiusz Piechowiak, Filip Napieraj, Bartosz Przemysław Herc, Małgorzata Tesla
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