Early and middle adolescent age athletes have higher athletic identities and lower fear avoidance than late adolescent age athletes during the return to sports phase of rehabilitation

Background: Early (11-14 years of age) and middle (15-17 years of age) adolescent athletes (EMA) may be more likely to sustain musculoskeletal injury or re-injury than late adolescent (LA) athletes (>18 years of age), and strong athletic identity (AI) is a factor. This study evaluated the influence of adolescent age on fear avoidance (FA) and AI during the return to sports (RTS) phase of rehabilitation. Materials and Methods: From 159 patients, 60 (32 females, 28 males) (16.9 ± 3 years of age) completed the 7-item Athletic Identity Measurement Scale (AIMS), the 10-item Athletic Fear Avoidance Questionnaire (AFAQ), and the AFAQ with two added movement-related fear and pain questions (AFAQ+). EMA (n = 40) and LA (n = 20) groups were compared (p <0.05). Results: EMA athletes had higher AIMS scores than LA athletes (40.74 ± 5.24 vs. 34.85 ± 7.12, Cohen’s d = 0.94, p = 0.002). EMA athletes had higher “social identity” (20.13 ± 1.30 vs. 18.00 ± 2.71, Cohen’s d = 1.00, p = 0.006) and “exclusivity” (10.30 ± 2.98 vs. 7.29 ± 2.97, Cohen’s d = 1.01, p = 0.002) AIMS subscale scores than LA athletes. LA athletes had higher AFAQ (25.7 ± 8 vs. 19.2 ± 5, Cohen’s d = 0.97, p = 0.001) and AFAQ+ scores (31.70 ± 9.04 vs. 23.42 ± 6.21, Cohen’s d = 0.94, p = 0.003) than EMA athletes. Conclusion: Athletes with stronger AI had weaker FA. From early-to-late adolescence, AI weakened, and FA strengthened. Early identification and surveillance of the subset with stronger, more exclusive AI and weaker FA may decrease re-injury risk through adjusted rehabilitation progressions and RTS timing.