Introduction

1 Several studies have analysed the Wiese-bjornstal 1998 model as a theoretical framework for understanding sports injuries. Since it investigates injury experiences in the context of personal factors (e.g., injury, individual differences, psychological, demographic, physical), situational factors (e.g., sport, social, environmental), cognitive appraisal, behavioural response, emotional response, and the outcome of the recovery, whether it is physical or psychosocial.

2 An athlete may experience a range of emotional reactions following an injury, including shock, denial, anger, sadness, or anxiety. An athlete’s emotional reaction to an injury is a normal reaction and may be triggered by a variety of factors, including the severity of the injury, their expectations, and their coping mechanisms (Johnson & Ivarsson, 2011). Some athletes may also experience depression (Roiger et al., 2015) and loss of identity (Von Rosen et al., 2018). Besides emotional reactions, sports injuries can also have a significant physiological impact on the athlete. As a result, inflammation, pain, swelling, and reduced range of motion can be experienced (Smith, 1991). Inflammation is the body’s natural response to injury, and this can cause pain and swelling. There is also the possibility that the athlete’s body will release stress hormones such as cortisol, which can further aggravate the physiological reaction (Koltyn, 2000). Additionally, athletes can use a variety of coping mechanisms to help them cope with the emotional and physical impact of an athletic injury. In addition to social support, positive self-talk, visualization, goal setting, and relaxation techniques, these techniques may also be helpful (Schwab Reese et al., 2012). A psychologist or sports counselor may also be beneficial to some athletes.

3 It has been recognized by some researchers, however, that returning to sport requires the use of other models or conceptions. It is noteworthy that among these models, the fear-avoidance model of Vlaeyen and Linton (2000) contributes to the understanding of the difficulties experienced by some athletes when they return to sport after an injury. As outlined in Vlaeyen and Linton (2012), the fear-avoidance model is a theoretical framework that describes how fear and avoidance behaviours can contribute to chronic pain development. It has been suggested that people with pain may develop fear and avoidance behaviours when they are exposed to activities associated with discomfort or pain (e.g., sprinting activities, changing directions). Consequently, the individual may become physically deconditioned and experience more discomfort and disability, thus resulting in a vicious cycle of fear, avoidance, and disability.

4 Beliefs and emotions play an important role in the development and maintenance of fear and avoidance behaviour (Vlaeyen & Linton, 2012). As well, the fear-avoidance model has been applied to different types of pain conditions, including chronic low back pain, fibromyalgia, knee pain, and osteoarthritis (Leeuw et al., 2007). Furthermore, movement compensation affects strength, range of motion, movement patterns, fear of re-injury and confidence in a joint (Di Stasi et al., 2013; Kvist et al., 2005; Tripp et al., 2007). Moreover, these variables contribute to the fear-avoidance model and will directly affect the function once an injury has occurred. According to a recent meta-analysis, pain catastrophizing, fear of pain, and pain vigilance can contribute to pain anxiety, pain intensity, and disability (Rogers & Farris, 2022). In the fear-avoidance model, kinesiophobia is one of the main psychosocial constructs. It is related to fear of movement/reinjury, which is sometimes called fear of reinjury (Hsu et al., 2017). Despite being considered a related psychological construct by Hsu et al. (2017), fear-avoidance models for chronic pain development do not emphasize re-injury anxiety. Nevertheless, re-injury anxiety is a concept that should be considered by athletes who have sustained an injury (Walker et al., 2007).

5 At the same time, some general studies on fear and anxiety have called for more clarity in this regard (Davis et al., 1997; Perusini & Fanselow, 2015; Sylvers et al., 2011). In these studies, the concept of fear is defined as a concrete and current threat, with three options: fight, flight or freeze (Cannon, 1929). The definition of the concept of anxiety is more “future-oriented” and refers to negative cognitive biases, worries and rumination that might appear even when the threat is not yet present (Sylvers et al., 2011). Furthermore, anxiety has been seen to arise from anticipation of the negative consequences of an event, whereas fear comes from exposure to an effective threat (Kemeny & Shestyuk, 2008). With regard to pain, anxiety and fear are often used interchangeably. Asmundson et al. (2004) attempted to differ between fear and anxiety in their study and proposed an updated model of fear-anxiety-avoidance. Based on this revised model, there is no longer a direct connection between fear and avoidance behaviour, since one cannot avoid a threat that already exists. As a result, they added an anxiety pathway to the fear pathway associated with pain anticipation.

6 Given the diversity of predictors considered in these different studies, literature reviews on return to sport (RTS) have simultaneously taken the concepts of reinjury anxiety, fear of reinjury and kinesiophobia into consideration (Hsu et al., 2017; Kori et al., 1990; Kvist et al., 2005; Walker et al., 2007). These include specific reviews on the association between psychosocial factors and the recovery of athletes with ACL tear (te Wierike et al., 2013). While some of these studies show that fear of reinjury is one of the most widely cited reasons for the absence of RTS (Ardern et al., 2011; Langford et al., 2009), others have noted that RTS is predicted by low levels of kinesiophobia (Chmielewski et al., 2008; Flanigan et al., 2013) or low levels of reinjury anxiety (Wadey et al., 2014). Similar results for reinjury anxiety and fear of reinjury have also been found when examining its effect on the risk of reinjury when returning to sport (Creighton et al., 2010). More surprisingly, some research on kinesiophobia concluded that fear of reinjury might be considered as an example of kinesiophobia (Cozzi et al., 2015). Thus, in spite of the existence of several specific definitions of reinjury anxiety, fear of reinjury and kinesiophobia, confusion between these three concepts is frequent since they appear to be used to describe the same emotional response (Ross et al., 2017).

7 Given these limitations, the aims of this systematic literature review are, first, to investigate the determinants and correlates of reinjury anxiety, fear of reinjury, and kinesiophobia and, second, to identify the similarities and differences between these three terms according to their definitions.

1. Materials and Methods

8 A systematic review was conducted using the following databases: “Medline”, “PsycINFO”, “PsycARTICLES”, “Psychology and Behavioral Sciences Collection”, “SPORTDiscus” and “SocIndex”, which ended in February 2022 with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (Liberati et al., 2009). For greater precision, we used a thesaurus (in PsycINFO) and a filter containing Medical Subject Headings (MeSH in Medline) to obtain all possible synonyms related to reinjury anxiety/fear in order to complete our search. There was a first stage of sorting by title followed by a stage of sorting by abstract (Liberati et al., 2009). The database search was performed by the first Author who screened for studies with the following keywords: “Re-injury” “Reinjury” “Wound” “Physical harm” “Hurt” “Injury” “Relapse” “Recurrence” “Anxiety” “Concern” “Uncertainty” “Restlessness” “Worry” “Apprehension” “Doubt” “Mistrust” “Angst” “Disquiet” “Misgiving” “Unease” “Uneasiness” “Fear” “Dread” “Jitters” “Panic” “Despair” “Scare” “Dismay” “Kinesiophobia” “Sportsman” “Athlete” “Sporty” “Sportsperson” “Sports” “Competitor” and “Player”. A boolean formulation was used to search for articles in the databases [1]. The gray literature (i.e., books) was also taken into account. Finally, bibliographies were inspected for each of the articles identified, allowing us to widen the search as far as possible.

9 The inclusion criteria were as follows: (i) articles published in English or French, (ii) focusing on re-injured athletes, (iii) quantitatively measuring fear of reinjury or reinjury anxiety, and (iv) articles focusing on kinesiophobia (fear of movement) and RTS.

10 The exclusion criteria were as follows: (i) studies published in a language other than French or English, (ii) qualitative studies, literature reviews, letters to the editor or validation studies, (iii) studies that did not focus on kinesiophobia, fear of reinjury or reinjury anxiety.

11 Summary tables were used to extract the study characteristics of selected articles: design, population, instruments used, determinants, principal concept, and definition (Table 1).

12 All of the articles were blindly evaluated by two of the authors, with particular focus on the Level of evidence criteria (Wright et al., 2003). The authors considered five levels of study reliability, from Level 1 (as the most relevant) to Level 5 (as the least relevant). Papers ranked as Level 1, 2 and Level 3 were taken into account in the present study. In case of disagreement between evaluators for any of the articles, the opinion of a third Author was sought (Table 2).

2. Results

13 The results considered 3408 articles identified on ‘Medline’ (N = 1533), ‘SPORTDiscuss’ (N = 1165), ‘PsycINFO’ (N = 574), ‘Psychology and Behavioral Sciences Collection’ (N = 79), ‘SocINDEX’ (N = 40) ‘PsycARTICLES’ (N = 12). After conducting a review by title, a total of 147 articles were taken into consideration. The step of sorting the article abstracts was performed from the 147 articles, then one hundred and eight articles were excluded based on the inclusion and exclusion criteria (8 for (i); 78 for (ii) and 30 for (iii)). This left a total of twenty-nine articles that met all the inclusion criteria (Figure 1), with 4301 participants included in the 29 studies reviewed. Population size ranged from 19 to 434 participants, including 2605 athletes, 1080 injured patients, 330 football players, 100 soccer players, and 186 gymnasts. Fifteen studies focused on ACL injury, 10 on general injury, 2 on concussion, and one on chronic low back pain, and one on patellofemoral pain. Eighteen studies were cross-sectional, 10 were longitudinal and one was a case-control study. When considering the assessment procedures, the results show that 4 studies used STAI-Trait (Spielberger et al., 1970) to assess reinjury anxiety (Covassin et al., 2014; Reuter & Short, 2005; Vago et al., 2013; Yang et al., 2014), despite the fact that STAI proposes a general measure which does not assess the specific nature of reinjury anxiety. The other studies created or used specific questionnaires to assess reinjury anxiety, kinesiophobia or fear of reinjury. Measures of reinjury anxiety were collected from questionnaires such as the Reinjury Anxiety Inventory (RIAI) (Walker et al., 2010), the Causes of Re-Injury Worry Questionnaire (CR-IWQ) (Christakou et al., 2011), the Sport Injury Trait Anxiety Scale (SITAS) (Kleinert, 2002) or the Risk of Injury in Sport Scale (RISSc) (Kontos et al., 2000). Studies focusing on kinesiophobia refer to the use of the Tampa Scale of Kinesiophobia (Swinkels-Meewisse et al., 2003). Four of them used its short form (TSK-11) (Chmielewski et al., 2008; Hartigan et al., 2013; Luc-Harkey et al., 2018; Tajdini et al., 2021) and two of them its long form (TSK-17) (Pazzinatto et al., 2022; Theunissen et al., 2020). TSK was also the most widely used questionnaire in the studies focusing on fear of reinjury: 3 studies used TSK-17 (Anderson et al., 2019; Kvist et al., 2005; Tripp et al., 2007) and 3 used TSK-11 (Lentz et al., 2015; Paterno et al., 2018; Trigsted et al., 2018). Several other questionnaires were also used in the studies on fear of reinjury. Two studies (Ardern et al., 2012; Gignac et al., 2015) used the ‘Anterior Cruciate Ligament Quality of Life’ (ACL-QoL) (Mohtadi, 1998) , one study (Thibodeau et al., 2013) used the Injury Sensitivity Index-Revised (ISI-R) (Carleton et al., 2006) and 3 other studies used the Fear of Avoidance Beliefs Questionnaire (FABQ) (Barchek et al., 2021), Worry about Injury in Sports Scale (WISSc) (Reuter & Short, 2005) and the Gymnast Fear Inventory (GFI) (Cartoni et al., 2005). Finally, three studies created specific questionnaires to assess the fear of reinjury (Covassin et al., 2015; Filbay & Kvist, 2022; Flanigan et al., 2013).

Figure. 1. Results of search based on the preferred reporting items for systematic reviews and meta-analyses statement

Figure. 1. Results of search based on the preferred reporting items for systematic reviews and meta-analyses statement

i: Studies published in language other than French or English, ii: Qualitative studies, literature reviews, letters to the editor or validation studies, iii: Studies that did not focus on kinesiophobia, fear of reinjury or reinjury anxiety, NA: Not available
Liberati et al., 2009

14 When focusing on the sociodemographic determinants, the results show that fear of reinjury tends to gradually decline over time (Chmielewski et al., 2008; Filbay & Kvist, 2022; Gignac et al., 2015; Hartigan et al., 2013; Theunissen et al., 2020), while other studies indicate that socio-demographic factors might be taken into account. Gender was considered a predictor of fear/anxiety of reinjury by several authors who found that fear/anxiety levels were higher in women (Ardern et al., 2012; Filbay & Kvist, 2022; Short et al., 2004; Theunissen et al., 2020). However, studies with a lower Level of evidence did not produce the same results (Cartoni et al., 2005; Covassin et al., 2015). Age was identified as a predictor of fear of reinjury and RTS (Lentz et al., 2015), in contrast to one study that did not find any link between age and fear of reinjury (Kvist et al., 2005). When considering the specific nature of a sport, risk activity is a strong predictor of injury anxiety/fear (Gignac et al., 2015; Kleinert, 2002) and lower levels of fear of reinjury are reported especially in sports with high risk of knee injury (Gignac et al., 2015). The Level of sports participation when athletes return to a sport is also associated with fear of reinjury (Kvist et al., 2005): before RTS, athletes who report intense fear of reinjury are less likely to play at preinjury level. However, after returning to the sport, individuals who reach their preinjury Level are less likely to report fear of reinjury compared to those who play at a lower Level of sport participation (Ardern et al., 2012). Finally, Barchek et al. (2021) found no relationships between fear-avoidance beliefs and physical activity.

15 With regard to the specific nature of the injury, one study revealed the link between the nature of injury and reinjury anxiety, with fractures and tendinopathies appearing to increase anxiety (Vago et al., 2013). Injury severity is another predictor of injury anxiety (Covassin et al., 2015; Kleinert, 2002). Athletes with major injuries had significantly greater fear of reinjury compared to athletes who sustained minor injuries (Taylor, 1985). Previous injury may be linked to reinjury concerns/worry (Reuter & Short, 2005; Short et al., 2004). In fact, athletes who injured their ipsilateral ACL express greater fear of reinjury when returning to sport than those who did not return to sport (Paterno et al., 2018). Studies including medical factors show that preoperative pain is a predictor of a high Level of kinesiophobia with athletes who underwent ACL reconstruction (Theunissen et al., 2020), in contrast to previous findings on the same population (Kvist et al., 2005). Moreover, delay before surgery may influence fear of reinjury: injured sportsmen who had to wait a long time before surgery reported greater fear of reinjury (Ardern et al., 2012; Theunissen et al., 2020). Although specific knee symptoms are not related to fear of reinjury among injured athletes (Kvist et al., 2005), a study on concussed athletes (Anderson et al., 2019) indicated a positive correlation between post-concussion symptoms (e.g., nausea, headaches) and fear of reinjury. Moreover, studies in kinesiology and exercise physiology also established links between fear of reinjury and knee flexion, trunk flexion kinematics, hip adduction, and hip flexion kinematics (Trigsted et al., 2018). Other authors have also observed the role of knee functions in kinesiophobia (Chmielewski et al., 2008; Flanigan et al., 2013; Hartigan et al., 2013) or in fear of reinjury (Filbay & Kvist, 2022). No association was found between kinesiophobia and walking gait (Luc-Harkey et al., 2018) but was shown by Tajdini et al. (2021). These two previous studies are reported as Level 3 evidence. Therefore, better methodology is needed to confirm or refute these results. Moreover, greater self-reported disability was related to greater kinesiophobia in a study conducted by (Pazzinatto et al., 2022).

16 The findings on psychological determinants and consequences show that fear of reinjury is related to athletes confidence in avoiding injury (Reuter & Short, 2005; Short et al., 2004), and that lack of confidence and fear of reinjury can explain why some injured athletes might be unable to return to their preinjury Level (Lentz et al., 2015). In fact, athletes who were less confident, less attentive and more worried were more at risk to reinjured (Christakou et al., 2022). Moreover, while social support has been identified as a protective factor against general anxiety among injured athletes (Covassin et al., 2014), the effectiveness of social support on reinjury anxiety has also been noted (Wadey et al., 2014). However, specific social support interventions during rehabilitation had no impact on reinjury anxiety (Yang et al., 2014). General self-efficacy is considered as a protective factor. In a longitudinal study on ACL injury, Filbay & Kvist (2022) showed that self-efficacy was related to a lower fear of reinjury 12 months after injury. Several coping strategies may predict reinjury anxiety, especially behavioral disengagement, suppression of competitive activities, venting of emotions, humor, wishful thinking, and denial (Wadey et al., 2014). Fear of reinjury is correlated with fear anxiety sensations and pain anxiety (Thibodeau et al., 2013). In addition, fear of reinjury directly predicted pain-related anxiety and indirectly predicted impairment through pain-related anxiety (Thibodeau et al., 2013). Moreover, there is a relationship between fear of reinjury and knee-related quality of life (Kvist et al., 2005) and pain (Kvist et al., 2005; Pazzinatto et al., 2022; Thibodeau et al., 2013). Kinesiophobia was related to lower health related quality of life, and greater pain catastrophizing (Pazzinatto et al., 2022).

17 When trying to identify how the concepts of reinjury-anxiety, fear of reinjury and kinesiophobia are defined in these studies, it appears that definitions for reinjury anxiety and kinesiophobia tend to be consensual, whereas this is not the case for the definition of fear of reinjury. Definition of reinjury anxiety is, according to the authors who refer to the concept, a “negatively toned emotional response, with cognitive (e.g., negative thoughts and images) and somatic symptoms (e.g., feeling nauseous and tense) that arise due to the possibility of an injury reoccurring after an initial injury of the same type and location.” (Christakou et al., 2022, p. 22; Wadey et al., 2014, p. 257). Several studies on kinesiophobia (Anderson et al., 2019; Theunissen et al., 2020; Tripp et al., 2007) refer to the definition of kinesiophobia as “an irrational and debilitating fear of physical movement resulting from a feeling of vulnerability to painful injury of re-injury” from Kori et al. (1990) and Swinkels-Meewisse et al. (2003, p. 30). Subsequent studies have proposed a shorter version of this definition, considering kinesiophobia as a “fear of movement or of (re)injury” (Chmielewski et al., 2008; Flanigan et al., 2013; Hartigan et al., 2013). An other study conducted by Pazzinatto et al. (2022), defined kinesiophobia as “pain-related fear, who can be divided into beliefs that activity may result in increased pain (activity avoidance focus) and that pain is a sign of body damage (somatic focus)” (p. 1). When considering studies on fear-of reinjury, six different definitions can be retrieved. The first definition about fear of reinjury seems to be Taylor’s definition in 1985, who stated that fear of reinjury might “lead to attentional distractions which in turn can inhibit sport performance and increase the chance for re-injury”^. This definition was updated by Johnston and Carroll (1998) as the “fear manifested in athletes as hesitation, holding back, not giving 100% effort, being wary of injury-provoking situations and strapping the injured body part when participating in sport” (p. 215), which was subsequently used in two other studies (Ardern et al., 2012; Covassin et al., 2015). Two different definitions were also published in 2004, describing fear of reinjury as “the unpleasant feeling of apprehension or distress caused by the anticipation of physical damage to the body part of the body” (Short et al., 2004) or a “three way fear of injury characterized by loss of confidence, worry or concern of being injured and risk of being injured” (Reuter & Short, 2005). Another definition of fear of reinjury as “negative emotions and lack of self-confidence because of reduced physical ability experienced by most athletes with injuries” (Johnson, 1997) has also been used by researchers (Kvist et al., 2005). Finally, a recent study suggested reducing the concept to the “feared consequences of (re)injury” (e.g., limited mobility, long-term pain and disability, and work absenteeism resulting from injury) (Thibodeau et al., 2013).

18 With regard to the findings from this systematic review, we can also note that one study (Tripp et al., 2007) investigating fear of re-injury suggested referring to Kori et al.’s definition of kinesiophobia, and that 14 of the 29 studies did not provide any definition or clarification of the concepts.

3. Discussion

19 The present systematic literature review highlights the main findings from studies on reinjury anxiety, fear of reinjury, and kinesiophobia among injured athletes. First, we aimed to identify the determinants regarding these three concepts that describe the psychological reactions to injury when sportsmen are about to return to a sport. The main determinants of reinjury anxiety as stated in eight studies were social support, self-confidence, attention and coping. Severity and nature of the injury were also predictors of reinjury anxiety. All of these studies on reinjury anxiety investigated the role of sociodemographic factors, psychological factors, or the role of the specific injury characteristics. None of them investigated the role of medical or physiological factors. A multitude of tools strive to measure the construct of re-injury anxiety. There are some measures of anxiety that appear to be more general than specific (STAI, Spielberger et al., 1970), whereas others attempt to be more specific but represent a wide range of different measures of anxiety (RIAI, Walker et al., 2010; RISSc, Kontos et al., 2000 ; SITAS, Kleinert, 2002 ; CR-IWQ, Christakou et al., 2011). Despite the fact that a tool has been developed to measure re-injury anxiety (Caumeil et al., 2022) in the RIAI, few studies have utilized it to date. Fifteen studies investigated the relationship between fear of reinjury and other variables. The main determinants of fear of reinjury were severity of injury, time spent in higher risk activities, physical activity, knee-related quality of life, knee function, perception of risk, self-efficacy and pain. Furthermore, gender, age, timing of surgery and Level of sport were also related to fear of reinjury. These studies mainly investigated the role of sociodemographic factors and that of medical and physiological factors. Psychological factors were taken into account in only 4 studies on fear of reinjury, and only one study took the characteristics of the injury into account. There have also been several tools used to measure fear of re-injury, although two tools have been primarily used to measure fear: TSK (Swinkels-Meewisse et al., 2003) and ACL-QoL (Mohtadi, 1998). Six additional studies investigated the determinants of kinesiophobia, showing the relationship with knee function over time, gait symmetry and pain. These studies mainly focused on sociodemographic and physiological factors. None of them investigated the role of psychological factors or the nature of the injury except one study on quality of life factor. It should also be noted that unlike studies measuring re-injury anxiety or fear of re-injury, kinesiophobia has been assessed solely with the TSK (Swinkels-Meewisse et al., 2003).

20 Given this, we suggest that psychological studies are more likely to refer to the concept of reinjury anxiety compared to medical studies which are more likely to investigate sociodemographic, medical and physiological factors, and mainly refer to the concepts of fear of reinjury or kinesiophobia. Apart from one study (Wadey et al., 2014), none of them attempted to test an integrative model involving sociodemographic, psychological, medical, physiological or injury factors. This gap in the literature makes it difficult to determine whether reinjury anxiety, fear of reinjury and kinesiophobia could be predicted by the same determinants, or if they are predicted by specific factors as Hsu et al. (2017) suggested. Further studies are required in order to test such a hypothesis. Moreover, the studies identified in this systematic review do not clarify the nature of the relations between the predictive factors when predicting reinjury anxiety, fear of reinjury or kinesiophobia. As previously suggested, it would be useful to test mediation and moderation models in future studies (Brewer, 2010). This information might be relevant when attempting to determine if reinjury anxiety, fear of reinjury or kinesiophobia should be treated with the same psychological interventions, or if specific interventions are required, contributing to the interpretation of studies that focus on the efficiency of psychological interventions among injured sportsmen (Cupal & Brewer, 2001; Mahoney & Hanrahan, 2011; Mankad & Gordon, 2010).

21 In view of the findings from these reviews, the terminology of injured athletes reactions also needs to be clarified since the lack of terminology makes it difficult to clearly distinguish the concepts of reinjury anxiety, fear of reinjury and kinesiophobia. Among injured athletes, one additional study (Hsu et al., 2017) clarified the distinction between reinjury anxiety and fear of reinjury, respectively described as “a negative thought or worry of the consequences of injury” and a “specific fear of the injury itself” (p. 163). Consequently, given the findings of the studies reported in this systematic review, fear of reinjury could be considered as referring to the direct threat of injury (in terms of pain, severity of the injury and knee function), whereas, anxiety is more likely to refer to the perceived consequences of the injury that lead athletes to perceive a decrease in self-confidence and to adopt specific coping strategies in order to avoid the negative cognitions or to seek social support. Such a distinction might be useful when attempting to apply the general definitions of anxiety and fear to injured athletes. In addition, Kori’s et al. (1990) definition of kinesiophobia suggests that this third concept might be considered as an explicit fear that reflects the negative and painful consequences of specific movements. Consequently, interpretation of the findings presented in this study give rise to a new proposal that attempts to define the three terms more precisely, as set out below:

22 Reinjury anxiety is the cognitive and emotional reaction caused by anticipation of the negative consequences of the injury perceived by the athlete.

23 Fear of reinjury is the emotional reaction caused by the athlete’s exposure to an effective threat of being physically injured.

24 Kinesiophobia is defined as the fear of performing painful movements or movements that might lead to a physical injury.

Conclusion

25 This proposed distinction between reinjury anxiety, fear of reinjury, and kinesiophobia could help to inform better use and clearer definitions of these concepts, improving our understanding of such reactions and their common or respective predictors. Moreover, application of these definitions could improve the psychological care of injured athletes when considering the specific nature of their cognitive and emotional reactions.

Practical implications