Injured Athlete Research Articles

The effectiveness of application of ice massage to accelerate fatigue recovery in football athletes

Introduction. Injuries in soccer players frequently range from minor ones like abrasions, hematomas, grade one strains and sprains, and muscle cramps, where players can continue to play, to severe injuries such as torn ligaments, dislocations, and fractures that prevent players from continuing the game. Based on field observations, some trainers apply ice massage treatments to injured athletes. Aim. This study aimed to determine the effect of ice massage on accelerating muscle fatigue recovery in soccer athletes, specifically in relation to blood lactate levels. Method. The research methodology employed in this study is a True Experiment. Result. Findings indicate that ice massage therapy provided to injured soccer athletes can expedite the healing process and alleviate pain. Conclusion. Based on data processing and analysis, it's concluded that ice massage significantly accelerates recovery from muscle fatigue in soccer athletes when considering lactate levels and the results from the Visual Analog Scale (VAS) test.

A Study of Recognition about Sport Injury and Rehabilitation by Perfectionist Tendencies of an Injured Athlete

A Study of Recognition about Sport Injury and Rehabilitation by Perfectionist Tendencies of an Injured Athlete

Examining Lower Quadrant Overuse Injury Using Wearable Sensors: A Case Series in Indoor Team-Based Court Sports

BACKGROUND: There is increasing literature about using wearable sensors to predict sports-related injury at the team- or league-level; however, minimal research has focused on single cases. Sports-related injury involves a complex interaction of multiple variables, and analysis should also be explored on the individual level. The purpose of this case series is to evaluate differences in on-court volume, as measured by whole-body accelerometry, of 3 court-sport athletes who sustained lower quadrant overuse musculoskeletal injuries to respective healthy matched controls. CASE PRESENTATION: A retrospective review of 3 collegiate athletes (2 males, 1 female) who developed lower quadrant overuse injuries and comparisons to healthy matched controls. OUTCOME AND FOLLOW-UP: The injured female volleyball athlete had greater accumulated player load per minute, jumps per minute, and duration of on-court time compared to the healthy athlete across the 8 weeks prior to injury. For basketball, both injured male athletes had greater player load per minute compared to their controls; however, jumps per minute were less than the healthy athletes over the 8 weeks prior to injury. DISCUSSION: Differences in accelerometer data were found between injured athletes and healthy matched controls. Analyzing the data to focus on single cases in a longitudinal framework allows for contextual factors to be included and temporal precedence to remain intact. JOSPT Cases 2023;3(3):174-184. Epub: 10 July 2023. doi:10.2519/josptcases.2023.11636

Poster 330: Quadriceps Autograft Leads to Improved Psychological Readiness for Return to Play Compared to Hamstring and Bone-Patellar Tendon-Bone Autografts Following ACL Reconstruction

Poster 330: Quadriceps Autograft Leads to Improved Psychological Readiness for Return to Play Compared to Hamstring and Bone-Patellar Tendon-Bone Autografts Following ACL Reconstruction

Poster 392: Analysis of Musculoskeletal Injuries Among Collegiate Varsity Esports Athletes

Objectives: Electronic sports (esports) have grown tremendously in the past decade with an estimated market value of $493 million in 2017 and an expected growth to $2.3 billion dollars by the end of 2022. Additionally, colleges are embracing this growing culture with over 200 varsity esports programs as of May 2022, up from 7 varsity programs just two years earlier. Despite its growing success, little has been studied on the injuries of these athletes. Prior studies have noted that injuries to professional esports players have forced them to miss significant time and in some instances, into an early retirement. Due to poor posture, a sedentary lifestyle, and repetitive hand motions, the most common injuries to esports athletes include injuries to the hand, wrist, back and neck. The purpose of this study is to investigate the prevalence of injuries sustained through collegiate esports players and explore the injuries’ impacts on their careers. The authors hypothesized that athletes who spend more time practicing and playing competitively in esports will report an increased history of musculoskeletal injury. Methods: A list of collegiate esports athletes was collected from publicly available sources. Athletes with available contact information were sent a self-reporting questionnaire. The questionnaire examined variables including length of time playing esports, hours/day playing esports, esports-related injury history, surgeries needed, and missed competition time. Demographic and workload data were then compared between injured and uninjured athletes. Results: Overall, 153 collegiate esports athletes (88% male, aged 18-42 years) were included, with 41 (26.8%) having experienced at least one injury from esports. As demonstrated in Table 1, of the 41 injured athletes, 3 (7.3%) required surgery, 17 (41.5%) had multiple injuries, and 7 (17.1%) missed competition time for an average of 3.0 ± 2.3 weeks. Athletes who have been on their respective college team longer (1.7 ± 0.9 vs. 2.0 ± 1.0 years, p=0.026) and who spent more hours per day practicing had a higher injury incidence (p=0.012). There was no difference in current age, sex, age at which athletes began competing in esports, and scholarship status between groups (all p>0.05). When analyzing the 41 athletes who experienced an injury, the most common injury was to the wrist with 25 total injuries. There were 11 neck, 10 back, 9 finger, 8 hand, 6 elbow, and 4 thumb injuries. Conclusions: Collegiate esports players who trained for more hours per day and played competitive collegiate esports for more years were more likely to have experienced an esports-related injury. Interestingly, while hours per day was a significant risk factor for injury, the number of days per week had was not a significant risk factor for injury, possibly indicating that injuries are sustained through continuous and excessive playing rather than intermittent playing over a longer period. The three most common injury locations were to the wrist, back, and neck, while shoulder and thumb injuries were the least common. Fortunately, only a small portion of athletes who experienced an injury were forced to miss competition time, and even fewer required surgery. With this being the largest investigation into collegiate esports-related injuries, future medical research can help collegiate and professional programs place a greater emphasis on the management and prevention of esports-related injuries. [Table: see text]

A comparison of the range of motion and dynamic stability of the ankle joint of athletes with an ankle sprain as compared to healthy controls: A cross-sectional study.

Ankle sprains are the most common lower-leg musculoskeletal injuries, frequently occurring among athletes and other physical activity individuals. The objective of this study was to compare the ankle range of motion and dynamic stability of healthy and injured athletes for their dominant and nondominant legs. A cross-sectional study design was selected to investigate this study with 32 male soccer players with average age: 22.6 ± 3.3 years, weight: 69.6 ± 5.7 kg, height: 176.8 ± 5.32 cm, with a history of a lateral ankle sprain on the dominant leg for the past 2 years. Ankle range of motion was determined using dorsiflexion and plantar flexion by a goniometer. The dynamic stability was determined using the SWAY medical system. An independent t-test was used to study the differences between healthy and injured groups and between dominant and nondominant legs for dynamic stability, dorsiflexion, and plantar flexion range. There were higher significant differences for dynamic stability in healthy participants than in injured participants for their dominant (P = 0.001) and nondominant (P = 0.001) legs. There were significant differences in dynamic stability in the dominant and nondominant leg (healthy [P = 0.033] and injured [P = 0.000] participants). The dominant leg shows higher dynamic stability in healthy group, whereas nondominant leg shows higher dynamic stability in the injured group. The study found significant differences between the injured and sound legs. The injured dominant and nondominant leg revealed a striking disparity in the ankle range of motion. Therefore, the study demonstrated that ankle sprain causes due to less stability of the ankle joint, which limits ankle movements.

The Pattern of NSAIDs Drugs Use by Libyans Patients for Acute Tissue Injury

Introduction: NSAIDs are a family of drugs that have achieved widespread use in sports medicine in both prescription and over-the counter (OTC) forms. NSAIDs are often administered after acute soft tissue injury in an effort to reduce pain and inflammation and thus speed an injured athlete's return to competition. However, recent evidence suggests that the short term benefits of NSAID therapy may adversely affect the long-term healing of injured soft tissues. Method: The study was performed to test pattern of NSAIDs use by Libyan patients. Patients were asked to complete a self-report questionnaires while attending orthopedic clinic at Al-Haraysh hospital at Darna City (Libya) during the period from March to May 2022. Result: Panadol (acetaminophen) consumption was reported by 6 (40%). Equivalent data for ketoprofen (Fastum gel) were 6 (40%) for topical preparation. Tewinty percent (3) of the participants consumed Muscadol (Paracetamol 450mg + Orphenadrine citrate 35mg)-based drugs. These were ibuprofen (ketoprofen)-based drugs used by 3 (20%) of respondent . The 2 (13%) consumed Naproxen (Nopain) and only the 1 (6.6%) used Aspirin for their injuries. Conclusion: NSAIDs are commonly used in the treatment of acute soft tissue injuries in athletes. Because of the diverse of adverse effects associated with NSAIDs, athletic trainers must be aware of the potential benefits and liabilities of NSAIDs use by injured.

Return to play and performance guidelines in rugby union

Models and guidelines on factors associated with the safe return to play (RTP) of an injured athlete have been established, but very limited research has been conducted on components necessary for returning an athlete to their previous level of performance, known as return to performance (RTPerf). The study aimed to establish guidelines applicable to RTP and RTPerf in rugby union. A mixed-methods study design using an e-Delphi survey was conducted to obtain the opinions of medical team members of the Currie Cup rugby unions across South Africa on RTP (Part 1 of the study). In Part 2, medical team members and coaches of the Free State Rugby Union were consulted for RTPerf guidelines. Part 1 of the study comprised a three-step decision-based RTP model used to identify RTP components in rugby. The e-Delphi questionnaire was compiled based on literature analyses and vast experience of the authors. Part 1 involved three steps of integrated guidelines for RTP decision-making in rugby union established by agreement (>80%) (first or second round): Step 1: medical history; Step 2: evaluation of participation risk; and Step 3: decision modifiers. Part 2 focused on components to consider during the RTPerf decision-making process, including psychological readiness, limb symmetry index, acute:chronic training load, external load and internal load. Twelve key performance indicators (KPIs) to measure RTPerf in rugby reached consensus (>80%). The comparison of performance profiles and current KPIs of a rugby player could be used to evaluate the player's performance level and whether they truly achieved RTPerf.

Efficacy of topical versus oral analgesic medication compared to a placebo in injured athletes: A systematic review with meta-analysis.

Athletes are injured frequently and often take analgesic medication. Moreover, athletes commonly use non-prescription topical and oral medications with little guidance. Despite wide use, relatively few studies exist on the efficacy of pain medication in injured athletes compared to a placebo. To determine efficacy of topical or oral medications in pain reduction compared to a placebo in injured athletes. A systematic review and meta-analysis. We conducted an electronic search using Medline/Pubmed, Web of Science, Ovid, and SportDiscus for all literature relating to topical or oral medications in athletes for pain management post-injury. Two reviewers screened the studies and measured their quality. To determine efficacy, we calculated the Hedges' g value. We created forest plots with 95% CI to graphically summarize the meta-analyses. There was a significant pooled effect size reflecting a reduction in pain outcomes for the topical treatment versus placebo (g = -0.64; 95% CI [-0.89, -0.39]; p < 0.001). There was not a significant reduction in pain outcomes for the oral treatment versus placebo (g = -0.26; 95% CI [-0.60, 0.17]; p = 0.272). Topical medications were significantly better at reducing pain compared to oral medications versus a placebo in injured athletes. These results are different when compared to other studies that used experimentally induced pain versus musculoskeletal injuries. The results from our study suggest that athletes should use topical medications for pain reduction, as it is more effective, and there are less reported adverse effects compared to oral medication.

Characteristics of injuries in Polish elite Taekwondo athletes during the COVID-19 pandemic

BACKGROUND: Studies about the injury risk in Taekwondo (TKD) focused mainly on WTF (World Taekwondo Federation) style as an Olympic discipline, but not on ITF (International Taekwondo Federation) that differ in the manner of fighting. Moreover, SARS-CoV-2 pandemic negatively affected people’s lives worldwide, including athletes. The aim of our study was to assess injury occurrence among TKD-ITF athletes during the COVID-19 pandemic. METHODS: An anonymous questionnaire survey was conducted among Polish TKD-ITF elite athletes, competitors at national and international level, aged 14 years and over. The obtained information concerned the first year of SARS-CoV-2 pandemic, during the most severe social restrictions. RESULTS: The data was collected from 119 ITF athletes: 59 men (50%) and 60 women (50%), mean age 19.4±7.7 years. Thirty-two respondents (27%) reported sport-related injury. The most common injury was joint sprain or dislocation, and lower limb as location. Independent risk factors of TKD-related injury were male sex (OR=3.38, P=0.023), number of prior injuries (OR 4.47, P<0.0001), and participation in competitions (OR=7.78, P<0.011). The majority of injured athletes reported long-lasting post-injury symptoms and recurrence of an injury in the same location. Moreover, post-COVID symptoms, such as rapid fatigue and chest pain were more often reported by athletes from the injury group.CONCLUSIONS: Taekwondo-ITF is associated with a significant prevalence of sport-related injuries. Additionally, Sars-CoV-2 pandemic has resulted in the appearance of new factors which had a negative influence on the athletes’ health.

Peak Performance in Sports Requires Psychological Preparation

This paper attempt to make an overview of various techniques, sport psychologist adopt in psychological preparation of athletes for peak performance. To attain peak performance in sports competitions, coaches and athletes should not base their prospect on physical training on sport skills alone rather should integrate both the mental and physical aspects of performance. During sport competitions athlete should enter the competition with the proper mindset so as to achieve optimum performance. The importance of a sport psychologist to athletes or sports team in this respect cannot be overemphasized, therefore the sport psychologist is in a position to provide the needed therapy to athletes who have been psyched-out by personal, motivational and environmental factors. The paper therefore recommended among others that athletes should be advised for practice mental and psychological skill training and, faster rehabilitation of an injured athlete should be done as this would help to achieve success in peak performance.

Don't Miss Me: Midfoot Sprains, A Point-of-Care Review.

Athletes practicing high-contact sports are exposed to an increased risk of midfoot injuries, namely midtarsal sprains. The complexity of reaching an accurate diagnosis is clearly depicted in the reported incidence of midtarsal sprains, ranging from 5% to 33% of ankle inversion injuries. Because the focus of the treating physician and physical therapist is on lateral stabilizing structures, midtarsal sprains are missed at initial evaluation in up to 41% of patients, with delayed treatment as a result.Detecting acute midtarsal sprains requires a high degree of clinical awareness. Radiologists must become familiar with the characteristic imaging findings of normal and pathologic midfoot anatomy to avoid adverse outcomes such as pain and instability. In this article we describe Chopart joint anatomy, mechanisms of midtarsal sprains, clinical importance, and key imaging findings with a focus on magnetic resonance imaging. A team effort is essential to provide optimal care for the injured athlete.

An Observational Case Series Measuring the Energy Expenditure of Elite Tennis Players During Competition and Training by Using Doubly Labeled Water

An understanding of an athlete's total daily energy expenditure (TEE) is necessary to inform nutritional strategies, particularly where daily training and competitive demands are highly variable. This observational case series assessed the TEE of elite tennis players during high-level competition. Senior female singles participants (FS: n = 3; 21 [1]y; ranked Women's Tennis Association [WTA] top 125-375), an FS junior (n = 1; 16y; ranked WTA top 350), and a men's doubles player (n = 1; 26y; ranked Association of Tennis Professionals [ATP] top 5) were assessed for TEE (using the doubly labeled water method) during a 9- to 14-day period, which included training, Wimbledon Championships, WTA/ATP International Tournaments, Junior/Senior International Tennis Federation, and Wimbledon Junior Championships. One female (FS3) did not exercise from day 4 following injury. TEE for men's doubles was 4586kcal·d-1 (67kcal·kg-1 fat-free mass [FFM]; daily activity 98 [74]min). Noninjured adult female participants' TEEs were 3396 and 3948kcal·d-1 (66 and 81kcal·kg-1 FFM; daily activity durations were 139 [84]min and 150 [66]min, respectively), while TEE for the injured athlete was 2583kcal·d-1 (45.7kcal·kg-1; daily nonexercise activity duration was <45min). The junior player TEE was 3988kcal·d-1 (78.2kcal·kg-1 FFM; daily activity of 131 [66]min). This observational case series positions tennis as a highly energetically demanding sport with variability evident between individuals (ie,TEE between 60 and 90kcal·kg-1 FFM). Accordingly, nutritional strategies that promote sufficient energy availability should be emphasized with individual variability suitably assessed prior to prescription.

Biomechanical Properties of Knee Medial Collateral Ligament Compared to Palmaris Longus for Ulnar Collateral Ligament Reconstruction

Ulnar collateral ligament reconstruction (UCLR) is frequently performed among injured overhead-throwing athletes. One of the most common graft choices when performing a UCLR is the ipsilateral palmaris longus tendon (PL). The purpose of this study was to investigate the material properties of aseptically processed cadaveric knee collateral ligaments (kMCL) as a potential graft source for UCLR and compare them to the gold standard PL autograft. Each PL and kMCL cadaveric sample was subjected to cyclic preconditioning, stress relaxation, and load-to-failure testing, and the mechanical properties were recorded. PL samples exhibited a greater average decrease in stress compared to the kMCL samples during the stress-relaxation test (p < 0.0001). PL samples also demonstrated a greater average Young’s modulus in the linear region of the stress–strain curve compared to the kMCL samples (p < 0.01). The average yield strain and maximum strain of kMCL samples were significantly greater than the PL, p = 0.03 and 0.02, respectively. Both graft materials had comparable maximum toughness and demonstrated a similar ability to deform plastically without rupture. The clinical significance of our result is that prepared knee medial collateral ligament allografts may provide a viable graft material for use in the reconstruction of elbow ligaments.

An HBCU track-and-field student-athlete perspective on the role of the pharmacist and physical therapist in sports

BackgroundPharmacy is a profession with the capacity to provide services in a variety of venues, including sports and sporting events. The physical therapy profession is often involved in treating the injured athlete; however, direct interactions with collegiate sport teams is limited and inconsistent. A literature review showed a limited and inconsistent role of the pharmacist and physical therapist in sports, especially at Historically Black Colleges and Universities (HBCU). ObjectiveTo examine collegiate track-and-field student-athlete perceptions related to the role of the pharmacist and physical therapist. MethodsA cross-sectional study using a convenience sample was conducted to assess the perceptions of NCAA track-and-field student-athletes from a HBCU. A survey utilizing modified Likert-scale and open-ended questions was administered electronically to fifty-four student-athletes via email. Inclusion criteria were age ≥ 18 years old and a current track-and-field student-athlete. Descriptive statistics were used for data analysis. ResultsThis study, one of the first to examine an HBCU student-athlete population, yielded a 100% response rate. About 80% want to discuss the directions for use and side effects of certain medications or dietary supplements with a team pharmacist. Over 75% of student-athletes desired to consult with a physical therapist about injury management and prevention. Overall, most respondents felt that pharmacists (81.5%) and physical therapists (78.8%) should have a role with NCAA sports to benefit student athletes. ConclusionInterprofessional collaboration and communication among healthcare professionals is essential to improve student-athlete health knowledge and performance. The student-athletes expressed interests in receiving consultation and educational sessions from pharmacists and physical therapists.

Physiotherapy First Aid Training for Injured Athletes in the Field

Sports injury is a condition of damage that occurs to the muscular and skeletal systems of the body during exercise due to an accident. Some cases of injury are often ignored by athletes and assume that the injury will recover by itself, even though if the injury is not treated properly it can lead to more serious injuries and impact on the athlete's performance. Physiotherapy is a health professions that can provide assistance to injured athletes. The lack of knowledge about the handling of injuries in athletes often has an impact on the occurrence of repetitive injuries. The aim is to provide knowledge to coaches and athletes about the types of injuries, the level of injury (onset), how to reduce the risk of further injury or repetitive injury and how to overcome injuries in the field.

Features of physical and sports rehabilitation of football players 20-25 years after surgical intervention on the connective apparatus of the knee joint

The article, based on the study of scientific literature, analyzes the peculiarities of physical culture and sports rehabilitation of football players aged 20-25 years after surgical intervention on the ligamentous apparatus of the knee joint. On the basis of the obtained data, a program of physical culture and sports rehabilitation of football players aged 20-25 years after surgical intervention on the ligamentous apparatus of the knee joint in the adaptation and training period was developed and substantiated using the following means and methods: physical exercises, therapeutic massage and cryo-massage, kinesiotaping. It was found out that the means and methods of physical culture and sports rehabilitation of football players 20-25 years old after surgical intervention on the ligamentous apparatus of the knee joint proposed in the program contributed to the restoration of the functional state of both the operated link of the musculoskeletal system and the functional state of the entire nervous system. muscular apparatus.&#x0D; The peculiarities of the use of means and methods of physical culture and sports rehabilitation of football players aged 20-25 years after surgical intervention on the ligamentous apparatus of the knee joint were analyzed. It was found that physical culture and sports rehabilitation is a restorative training activity, an injured athlete can be admitted to such activities only after the recovery of motor abilities and a sufficient level of strength capabilities of the weakened muscles of the thigh and lower leg of the injured limb. Therapeutic massage is aimed at improving blood circulation, lymph flow and strengthening the muscles of the thigh and lower leg. Kinesiotaping is used to restore the physiological normal tone and bioelectrical activity of the thigh and lower leg muscles, which mostly suffer from hypodynamia at the first stage of early rehabilitation; restoration of the athlete's working movement pattern.

Detection of visuomotor dysfunction in mild traumatic brain injury using binocular retinal polarization scanning

ABSTRACT Objective The head and intraocular trauma tool (HITT) is a portable, binocular retinal polarization scanner (RPS) that detects ocular fixation with high precision to assess visuomotor function. We conducted a pilot evaluation of a prototype binocular RPS device to evaluate alterations in fixation stability, binocularity (convergence), and saccadic latency after mild traumatic brain injury (mTBI). Methods Two groups were studied prospectively: (1) single observation study of mTBI patients in a hospital ER (n = 7) and age-matched controls (n = 43); (2) high-school athletes preseason (n = 28), after sports-related mTBI (n = 3), and at season end (n = 5). Subjects were asked to fixate on an internal target and track randomly presented peripheral and central targets as fixation was assessed using binocular RPS. Results There were clinically and statistically significant alterations in the hospital ER group after mTBI, including a decrease in fixation stability (54.6% in patents vs 90.2% in controls, p = 0.014) and binocularity (28.7% in patients vs 86.6% in controls; p = 0.004). Similar trends, not statistically significant, were observed in saccadic latency in the hospital ER group as well as in the injured high school athletes. Conclusion The HITT device shows promise as an objective, noninvasive method for assessment of the impact of mTBI on visuomotor function. Additional studies with larger patient populations are required to evaluate efficacy for clinical use.

Perceived Barriers and Facilitators of Sports Rehabilitation Adherence in Injured Volleyball Athletes: A Qualitative Study From Greece

Adherence to exercise rehabilitation has been shown to be an important factor that may influence successful treatment. In professional athletes, a significant reduction in exercise adherence delays recovery. The aim of this study was to explore barriers to and facilitators of exercise rehabilitation adherence in injured volleyball athletes. Eight professional volleyball athletes were recruited, and qualitative data were collected using semistructured interviews. All athletes had completed their rehabilitation program after they had suffered a musculoskeletal injury. All data were analyzed using thematic analysis after the investigators ensured that saturation had been reached. Pain was identified as a significant barrier to exercise adherence by all athletes. The provision of social support, including mental, practical, and task related, also had a significant positive impact. The athletes’ ability to develop the necessary coping strategies and confidence on performing exercises at home was also mentioned as a factor that affected exercise adherence, although less often.

Longitudinal Validation of a Specific Measure of Fear Avoidance in Athletes: Predicting Time from Injury to Return to Sports Competition.

We developed the Athlete Fear Avoidance Questionnaire (AFAQ) to measure fear avoidance in athletes. Previous fear avoidance scales were developed for the general population and have demonstrated significant predictive capabilities regarding rehabilitation. No research to date has examined the association between athlete fear avoidance as measured by the AFAQ and the rehabilitation time in athletes. Fifty-nine athletes who were injured during sport season participated in the study (40 males and 19 females). At injury onset, all participants completed self-report functional questionnaires. In addition, we measured multiple aspects of fear avoidance including athlete fear avoidance (AFAQ), kinesiophobia (TSK), and pain catastrophizing (PCS). Finally, we assessed pain severity and interference, as well as depression. Once the athletes were able to return to competition all participants answered the questionnaires again. Pearson correlations and a regression analysis were used to identify relationships between function, psychological variables, pain, and return to competition time. The AFAQ yielded the strongest correlation with return to competition time (r=0.544, p<0.001). In addition, function at initial injury time and pain interference were also significantly correlated with return to competition time (r=0.442, p<0.001 and r=0.356, p=0.006 respectively). Athlete fear-avoidance combined with function at the time of injury explained 34% of the variance of return to competition time in the multivariate regression model (p<0.001). Athlete fear-avoidance as measured by the AFAQ is associated with rehabilitation time and returning to competition in injured athletes. Psychosocial factors including athlete fear avoidance may explain why some athletes take longer to rehabilitate than others and should be evaluated in athletes who are taking longer than anticipated to complete their rehabilitation. Reducing athlete fear avoidance may facilitate rehabilitation in future studies.