Motivation, Pain, and Social Support in Athletic Injury Rehabilitation: A Systematic Review and Narrative Synthesis

Summary

This review suggests that social support facilitates rehabilitation following athletic injury by fostering motivation and adaptive pain coping. This interconnected relationship may help athletes distinguish harmful pain from therapeutic progress, thereby supporting the transition from recovery to peak performance.

Abstract

The rehabilitation process from athletic injury to peak performance is influenced by complex psychosocial factors. This systematic review synthesizes evidence regarding the effects of training motivation, pain, and social support on rehabilitation outcomes. The review was conducted and reported in accordance with the PRISMA 2020 guidelines. A comprehensive search of PubMed, PsycINFO, SPORTDiscus, and Web of Science was performed. Following duplicate removal, two independent reviewers screened titles, abstracts, and full-text articles according to predefined eligibility criteria. Fifteen studies met the inclusion criteria and were included in a narrative synthesis. The findings suggest that motivation, pain, and social support are dynamically interconnected. Social support from family members, clinicians, and particularly peers may serve as a foundational resource that promotes autonomous motivation. In turn, this motivated engagement appears to facilitate adaptive pain coping. Based on the interpretive synthesis of the included studies, athletes who learn to distinguish between “good” pain (indicative of therapeutic progress) and “bad” pain (signaling potential harm) may experience a more favorable rehabilitation trajectory. Available evidence further suggests that such a trajectory is associated with sustained performance outcomes. Conversely, inadequate support may undermine motivation and promote fear-avoidance responses to pain, potentially contributing to poor rehabilitation outcomes or premature career termination in some cases. The therapeutic alliance and peer support emerged as critical mechanisms through which social support may exert its enabling effects. Interventions should therefore adopt a holistic approach that simultaneously strengthens support networks, nurtures autonomous motivation, and promotes adaptive pain appraisal. However, given the interpretive nature of this synthesis and the limitations of the available evidence, these conclusions should be interpreted cautiously. This review proposes an integrated conceptual model illustrating the potential reciprocal interplay among motivation, pain, and social support throughout the rehabilitation process.

Introduction

Sport participation, while conferring numerous physical and psychological benefits, inherently carries a significant risk of injury¹. Epidemiological data indicate that injury rates remain substantial across competitive and recreational athletic populations, with musculoskeletal injuries representing the most prevalent category². For the affected athlete, injury represents not merely a physical disruption but a profound psychological challenge, threatening athletic identity, social connections, and carefully cultivated performance trajectories³. The subsequent rehabilitation process requires not o....