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Introduction
In the past few years, epidemiological evidence on injury rates, patterns and potential risk factors, have been established for athletics contestants, and track and field athletes. At international athletics championships, about 10 injuries occur per 100 participating athletes. 1 The few studies available that cover an entire athletics season have reported that about two out of three athletes sustain at least one injury each year, 2 3 and most of these injuries have been classified as from 'overuse'.
The cause of overuse injuries is different from the mechanisms that lead to acute injuries. Overuse injuries result from the interplay between functional over-reaching, repeated exposure to microtrauma and the periodicity of recovery. 4 5 There are several theories on how athletes experience and psychologically manage acute injuries including, for example, the stress and injury model, 6 and various cognitive appraisal models. 7 8 Psychological risk factors have been investigated for acute injuries. 9-11 Regarding factors associated with successful return to sport after an acute injury, fear of relapse is a prominent emotional response at the time of transition back to sport. 12 This research suggested that clinicians should address fear, autonomy and competence-related psychological factors in rehabilitation. The authors also recommended that routine screening of injured athletes during the rehabilitation was to identify those at risk of developing maladaptive psychological responses. 12
There is increasing evidence that psychological factors may contribute to the processes that lead to overuse injuries. 13 14 The affective adaptation framework, 15 a relatively recent account of cognitive appraisal theory, is based on the premise that a person becomes cognitively aware of sensory information, such as perception of the body, predominantly if it is not expected. After a bodily sensation has been noticed, an explanatory process takes place in which the individual tries to make sense of the world. Here, explanation serves to suppress fear and anxiety.
If the sensation cannot be explained, an affective reaction is initiated, activating additional cognitive functions. The consequential thought patterns and behaviours may range from escape and avoidance, to increase and overuse. 16 For example, an athlete can be frightened of experiencing a new type of bodily sensation not previously recognised. If the sensation is interpreted as non-threatening (eg, considered a temporary nuisance), the athlete...