-many athletes have created their whole self-image around their sport and so feel significant loss from not being able to perform or that role is threatened by injury/illness; this is especially true with injuries with long recovery times such as ACL tears

-injuries can impact daily quality of life as well as performance in sports

-exercise is an escape or coping mechanism for many athletes, so being unable to exercise and access their usual coping mechanism due to injury can worsen the emotional impact of the injury