Participation in sports demands extraordinary effort, countless hours of training, calculated and uncalculated risks, and frequent exposure to high-pressure situations and uncertainty. Despite these challenges, sport offers moments of intense satisfaction, enthusiasm, and passion — experiences rarely found elsewhere! Injury, however, is an inherent part of sport. Whether minor or severe, it can affect any athlete. According to the literature, over 17 million injuries are reported annually in the United States alone, attributed to factors such as physical strain, equipment failure, and training overuse (Fernandes et al., 2014). Notably, the risk of injury increases with the level of professionalism. For example, in windsurfing, amateur athletes experience an injury rate of 0.22 per 1,000 hours of practice, compared to 13 injuries per 1,000 hours among professionals (Perez-Turpin et al., 2012a).

In CrossFit, studies report an injury rate of 19.4%, with men sustaining injuries more frequently than women. The most commonly affected areas are the shoulders, lower back, and knees (Weisenthal et al., 2014). Additional research supports these findings, reporting injury rates ranging from 0.27 to 3.3 per 1,000 training hours and highlighting key risk factors such as training frequency, experience level, and competition participation (Gardiner et al., 2020). A recurring theme across studies is the role of supervision or, more specifically, the lack of it, as a significant contributing factor regardless of the athlete’s experience. The literature suggests that the risk of injury in CrossFit is comparable to that in other sports, including Olympic weightlifting, distance running, track and field, rugby, football, ice hockey, soccer, and gymnastics (Klimek et al., 2018).

The bottom line is clear: the deeper one ventures into professional sports, the higher the likelihood of injury. This is the paradox of sport-related injury — no one wants it, yet it often seems inevitable. 

Athletes must act with professionalism, follow preventive protocols, and understand that the goal is not merely to avoid injury, but to recover stronger when it occurs.

Importantly, injury affects more than just the physical body, it impacts the psychological and contextual dimensions of an athlete’s life. An injury may mean the loss of income leading to financial stress, emotional distress, fear of reinjury, and most critically a loss of identity. These psychological consequences can severely undermine an athlete’s motivation and commitment to recovery, potentially delaying or even sabotaging a successful return to sport (Santi & Pietrantoni, 2013).

While physical rehabilitation guided by a physiotherapy team is essential, it represents only one part of the recovery process. Equally vital is the development of psychological resources to help athletes cope with the emotional and social toll of injury. To better understand the nature of sports injuries, we can refer to well-established theoretical frameworks such as the biopsychosocial model and the cognitive appraisal model. The biopsychosocial model posits that injuries are not solely physical or psychological but are multifactorial in nature, shaped by interrelated biological, psychological, and social-contextual components (Brewer, 2009). According to this model, there are two relatively stable and known dimensions: injury characteristics (such as location, cause, and severity) and sociodemographic factors (including age, gender, ethnicity, and socioeconomic status), that significantly influence three dynamic domains

The biological (e.g., endocrine response, respiration, metabolism, neurochemistry, tissue repair),

The psychological (e.g., personality traits, emotions, behavioral responses)

The social-contextual (e.g., support systems, life stressors, rehabilitation environment).

These three domains interact to shape intermediate outcomes such as range of motion, strength, and endurance, and ultimately determine long-term rehabilitation outcomes like functional performance, quality of life, treatment satisfaction, and readiness to return to sport.

                     Injury characteristics - Sociodemographic factors

                                               ▼                                       ▼

                      Biological - Psychological – Social/contextual              ◁     Intervention                                                              

                                                              ▼

                                            Intermediate outcomes

                                                              ▼

                                            Rehabilitation outcomes

This model emphasizes that by effectively addressing biological, psychological, and social factors, athletes, ideally with the assistance of professional practitioners can significantly influence intermediate and eventually rehabilitation outcomes. 

Meaning that one can focus on promoting positive input in the above domains and effectively improve the course and the results of the rehabilitatation. Injury may be inevitable in sports, but with a comprehensive biopsychosocial approach, athletes can build resilience and return stronger both physically and mentally.

From another perspective, cognitive appraisals shape the emotional responses that emerge, which can be either constructive or destructive. In other words, the way athletes perceive themselves in terms of mental and physical abilities, and their environment during injury influences their emotions. These emotional responses ultimately affect athletes’ behavior. 

What you choose to do when you are injured, how you treat your injury, how you communicate with the rehabilitation team, and the extent to which you adhere to the recovery plan are essential (Wiese-Bjornstal et al., 1998).

Having a clear understanding of the theoretical framework is crucial for athletes to comprehend the psychological mechanisms of injury. This is an important first step toward successful coping. Nevertheless, not everyone can relate to theoretical concepts. From a more practical standpoint, the condition of being injured has been found to share certain characteristics that most athletes can relate to. One such aspect is the negative emotional impact, such as negative affect, anhedonia, and a sense of loss, which often stems from a loss of identity. Athletes and especially professionals who dedicate their lives to sport invest immense time and energy into achieving excellence. In many cases, sport becomes their identity; it defines who they are. Therefore, an injury that physically distances an athlete from their sport can trigger an identity crisis.

The ability to maintain multiple identities throughout one’s athletic career is crucial. Being a father or son, mother or daughter, spouse, friend, artist, student or engaging in any other meaningful role serves as a psychological lifeline. 

This may seem at odds with the pursuit of athletic excellence, given the common and mostly false belief that “an athlete must be fully dedicated and make sacrifices.” While it is true that meaningful achievements require effort and sacrifice, being more than an athlete is not a distraction, it is a source of strength. When an athlete confines themselves to a narrow athletic role, they risk limiting their psychological flexibility and undermining their sense of self. Conversely, investing in multiple roles allows other areas of life to provide stability when athletic performance falters (Lally, 2007). This becomes especially important during significant transitions such as injury or retirement.

Delving deeper into the injury experience, athletes often compare it to a form of loss. Research in rehabilitation has revealed stages that resemble those of grieving: denial, anger, bargaining, depression, and acceptance (Kübler-Ross, 1969). Contemporary research has refined this model into what is known as the “affective cycle of injury” (O’Connor et al., 2005). It proposes that athletes tend to respond to injury in three main ways: denial, distress, and determined coping.

Denial refers to the tendency of some athletes to downplay or reject the consequences of injury, whether that pertains to severity, impact on quality of life, or rehabilitation duration. Denial often occurs early and can significantly hinder the athlete’s willingness to take necessary steps toward recovery and a safe return to sport.

Distress is associated with the emotional burden of loss and the accompanying crisis of self-worth. The resulting negative thoughts can demotivate the athlete or make them resistant to cooperating with the rehabilitation process.

Determined coping is the stage at which the athlete begins to accept the situation and actively engages in managing it. Similar to the final stage in the grief model, this phase involves logical assessment of available resources (e.g., the rehab team, alternative training options), goal setting, increased focus on the recovery process, and improved cooperation with staff (O’Connor et al., 2005).

Being aware of these emotional stages and the responses they may trigger is essential for making informed decisions throughout rehabilitation. Ultimately, the goal is to ensure adherence to the rehabilitation program and foster constructive collaboration with the support team.

Elaborating on affect, a notion that often arises when discussing injury is the “fear of reinjury.” This fear is referred to as kinesiophobia. Kinesiophobia describes an individual's tendency to avoid movements or activities that might lead to injury, due to pain or the psychosocial burden stemming from injury-related consequences, such as rehabilitation, time away from sport, etc. (Vlaeyen & Linton, 2000). The impact this has in sport includes reduced participation, delayed return to play, or, upon return, distraction that can impair performance. While an in-depth exploration of this concept is beyond the scope of this review, discussing effective coping strategies is worthwhile.

There are several tools that can help athletes cope with the fear of reinjury. One commonly used by physiotherapists, since it also supports physical recovery, is graded exposure. This involves gradually exposing the athlete to fear-inducing situations, starting from less threatening ones (e.g., standing on the injured knee) and progressing to more challenging ones (e.g., practicing in the stadium where the injury occurred). 

Education about the injury and guided recovery are also important, as greater knowledge of the process reduces uncertainty and the anxiety it induces. Additionally, proper goal setting (i.e., specific, measurable, and achievable goals) provides direction and reinforces a positive perception of the treatment’s effectiveness. Other useful strategies include psychological skills such as imagery, self-talk, and relaxation techniques (Hsu et al., 2017).

Psychological techniques are well known in the field of sport psychology and are considered essential tools recommended by professionals and used by athletes. Why is that? Because athletes can eventually learn to apply these techniques autonomously without constant guidance from a professional, requiring only periodic supervision. Imagery involves visualizing the performance of an action and experiencing it using all the senses (touch, feeling, vision, smell). The goal is for the athlete to relive moments kinesthetically and to stimulate the neuromuscular system as effectively as possible. Research has shown that, when performed correctly, imagery activates the chain of neural signals all the way to the muscles without actual muscle movement (Rodriguez et al., 2019). The combination of physical rehabilitation and imagery is considered a highly effective approach for returning to sport, practicing movements, or enhancing focus. 

The following simple principles make this clear: 

Physical training is better than mental imagery. Physical training combined with mental imagery is better than physical training alone. Mental imagery is better than no training at all. (Green, 1992).

The last point is especially relevant during injury recovery. It’s a valuable tool when physical training is limited. Imagery should be incorporated into physical training as soon as the body allows, offering a recipe for a more efficient return to sport.

Lastly, self-talk interventions include techniques such as cognitive restructuring, positive thinking, and self-monitoring. These interventions help athletes recognize and replace negative thoughts with more constructive ones (Podlog et al., 2011). A recommended protocol following a sport injury includes the following steps: 

1. Athletes express their sensations and thoughts about various areas of life (health, athletic condition, academic situation, social environment)

2. They identify and write down the negative thoughts that may hinder the recovery process

3. They explore and note the positive aspects of injury recovery—such as social support, increased resilience, and improved coping skills

4. Based on these positive elements, they create affirming self-statements (e.g., “I’m getting healthier and stronger every day”)

5. These statements are then used to develop mental resilience 

(Naoi & Ostrow, 2008)

Conclusion

In conclusion, it is important to return to the article's initial statement: Athletes must understand that the goal is not merely to avoid injury, but to recover stronger when it occurs. Achieving this relies heavily on how athletes perceive the injury, their level of resilience, and—crucially—the social support available to them (from family, teammates, coaches, physiotherapists, mental health professionals, and others). These factors together shape their ability to cope with adversity and return not only stronger, but also better and wiser.