Levent Bayram
1
,
Deniz Ozge Yuceloglu Keskin
2
,
Ustun Turker
3
1
Yaşar Doğu Faculty of Sport Sciences, Ondokuz Mayıs University, Samsun, 55200, Türkiye
2
Yaşar Doğu Faculty of Sport Sciences, Ondokuz Mayıs University, Samsun, 55200, Türkiye
3
Faculty of Sport Sciences, Gümüşhane University, Gümüşhane, 29000, Türkiye
Abstract
Athlete-specific vascular pathologies are uncommon but high-impact disorders in which sport-specific biomechanical, positional, and training loads interact with vascular anatomy to generate exertional ischemia, neurovascular compression, or thrombosis. These conditions often present with ambiguous, exercise-induced symptoms that mimic musculoskeletal injury, delay diagnosis, and prolong time away from sport. A literature review was conducted using databases including PubMed, PsycINFO, and SPORTDiscus, covering sources published between 2015 and 2025. This review defines the scope of athlete-specific vascular pathologies and synthesizes evidence on psychological mechanisms that shape symptom burden, rehabilitation engagement, and Return-To-Play (RTP) outcomes. Target pathologies include External İliac Artery Endofibrosis (EIAE) in endurance athletes, Popliteal Artery Entrapment Syndrome (PAES) including functional PAES, Thoracic Outlet Syndrome (TOS) in overhead athletes, effort thrombosis/Paget–Schroetter Syndrome (PSS), and Iliac Vein Compression Syndrome (May–Thurner spectrum) as an athlete-relevant venous disorder. Then integrated evidence on pain catastrophizing, fear-avoidance, stress physiology, adherence, identity disruption, RTP anxiety, and sleep as modifiable rehabilitation determinants, primarily extrapolated from chronic pain, rehabilitation, and sports injury psychology. Finally, proposed a multidisciplinary, staged pathway in which Cognitive-Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), mindfulness-based approaches, relaxation/breathing, biofeedback, guided imagery, Motivational Interviewing (MI), Psychoeducation/Pain Neuroscience Education (PNE) are embedded alongside medical care. Evidence is graded by direct athlete-vascular relevance versus extrapolation, and a future research agenda is presented with testable questions and feasible designs.
Bayram, L., Yuceloglu Keskin, D. O., & Turker, U. (2026). The role of psychological interventions in symptom management and rehabilitation of athlete-specific vascular pathologies: A comprehensive review. Journal of ROL Sport Sciences, 7, 1–11. https://doi.org/10.70736/jrolss.2239
📄Abraham, C. Z. (Ed.). (2021). Clinical scenarios in vascular surgery (2nd ed.). Wolters Kluwer.
📄Ardern, C. L., Glasgow, P., Schneiders, A., Witvrouw, E., Clarsen, B., Cools, A., ... et al. (2016). 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. British Journal of Sports Medicine, 50(14), 853-864. [Crossref]
📄Beck, J. S. (2012). Cognitive Behavior Therapy: Basics and Beyond (2nd ed.). Guilford Press. [Crossref]
📄Cherkin, D. C., Sherman, K. J., Balderson, B. H., Cook, A. J., Anderson, M. L., Hawkes, R. J., … et al. (2016). Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain: A randomized clinical trial. JAMA, 315(12), 1240–1249. [Crossref]
📄Clement, D., Arvinen-Barrow, M., & Fetty, T. (2015). Psychosocial responses during different phases of sport-injury rehabilitation: A qualitative study. Journal of Athletic Training, 50(1), 95–104. [Crossref]
📄Collins, T., Geana, M., Overton, K., Benton, M., Lu, L., Khan, F., … et al. (2022). Use of a smartphone app versus motivational interviewing to increase walking distance and weight loss in overweight/obese adults with peripheral artery disease: Pilot randomized trial. JMIR Formative Research, 6(2), e30295. [Crossref]
📄Cunningham, A., Swanson, V., O'Caroll, R. E., & Holdsworth, R. J. (2012). Corrigendum: Randomized clinical trial of a brief psychological intervention to increase walking in patients with intermittent claudication. British Journal of Surgery, 99(6), 854-854. [Crossref]
📄Dorstyn, D. S., Mathias, J. L., Bombardier, C. H., & Osborn, A. J. (2020). Motivational interviewing to promote health outcomes and behaviour change in multiple sclerosis: A systematic review. Clinical Rehabilitation, 34(3), 299-309. [Crossref]
📄Fullagar, H. H. K., Skorski, S., Duffield, R., Hammes, D., Coutts, A. J., & Meyer, T. (2015). Sleep and athletic performance: The effects of sleep loss on exercise performance, and physiological and cognitive responses to exercise. Sports Medicine, 45, 161–186. [Crossref]
📄Galea Holmes, M. N., Weinman, J. A., & Bearne, L. M. (2019). A randomized controlled feasibility trial of a home-based walking behavior-change intervention for people with intermittent claudication. Journal of Vascular Nursing, 37(2), 135–143. [Crossref]
📄Garraud, T., Pomares, G., Daley, P., Menu, P., Dauty, M., & Fouasson-Chailloux, A. (2022). Thoracic outlet syndrome in sport: A systematic review. Frontiers in Physiology, 13, 838014. [Crossref]
📄Halson, S. L. (2014). Sleep in elite athletes and nutritional interventions to enhance sleep. Sports Medicine, 44 (Suppl 1), 13–23. [Crossref]
📄Hooper, T. L., Denton, J., McGalliard, M. K., Brismée, J. M., & Sizer Jr, P. S. (2010). Thoracic outlet syndrome: A controversial clinical condition. Part 2: Non-surgical and surgical management. Journal of Manual & Manipulative Therapy, 18(3), 132-138. [Crossref]
📄Hsu, C. J., Meierbachtol, A., George, S. Z., & Chmielewski, T. L. (2017). Fear of reinjury in athletes: Implications for rehabilitation and return to sport. Sports Health, 9(2), 162–169. [Crossref]
📄Hughes, L. S., Clark, J., Colclough, J. A., Dale, E., & McMillan, D. (2017). Acceptance and commitment therapy (ACT) for chronic pain: A systematic review and meta-analyses. The Clinical Journal of Pain, 33(6), 552–568. [Crossref]
📄Illig, K. A., Thompson, R. W., Freischlag, J. A., Donahue, D. M., Jordan, S. E., & Edgelow, P. I. (Eds.). (2013). Thoracic outlet syndrome. Springer. [Crossref]
📄Levy, A. R., Polman, R. C. J., & Clough, P. J. (2008). Adherence to sport injury rehabilitation programs: An integrated psycho-social approach. Scandinavian Journal of Medicine & Science in Sports, 18(6), 798–809. [Crossref]
📄Loucks, E. B., Schuman-Olivier, Z., Britton, W. B., Fresco, D. M., Desbordes, G., Brewer, J. A., … et al. (2015). Mindfulness and cardiovascular disease risk: State of the evidence, plausible mechanisms, and theoretical framework. Current Cardiology Reports, 17(12), 112. [Crossref]
📄Louw, A., Diener, I., Butler, D. S., & Puentedura, E. J. (2011). The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Archives of Physical Medicine and Rehabilitation, 92(12), 2041–2056. [Crossref]
📄Louw, A., Zimney, K., Puentedura, E. J., & Diener, I. (2016). The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiotherapy Theory and Practice, 32(5), 332–355. [Crossref]
📄Lovelock, T., Claydon, M., & Dean, A. (2021). Functional popliteal artery entrapment syndrome: An approach to diagnosis and management. International Journal of Sports Medicine, 42(13), 1159-1166. [Crossref]
📄Mall, N. A., Van Thiel, G. S., Heard, W. M., Paletta, G. A., Bush-Joseph, C., & Bach Jr, B. R. (2013). Paget-Schroetter syndrome: A review of effort thrombosis of the upper extremity from a sports medicine perspective. Sports Health, 5(4), 353-356. [Crossref]
📄McDermott, M. M., Spring, B., Berger, J. S., Treat-Jacobson, D., Conte, M. S., Creager, M. A., … et al. (2018). Effect of a home-based exercise intervention of wearable technology and telephone coaching on walking performance in peripheral artery disease: The HONOR randomized clinical trial. JAMA, 319(16), 1665–1676. [Crossref]
📄Moseley, G. L., & Butler, D. S. (2017). Explain Pain Supercharged. NOI Group.
📄Ohman, J. W., & Thompson, R. W. (2020). Thoracic outlet syndrome in the overhead athlete: Diagnosis and treatment recommendations. Current Reviews in Musculoskeletal Medicine, 13, 457–471. [Crossref]
📄Padilla, C., Katikineni, V., Park, Y., Freno, L., Laffoon, M., Reichbaum, L., … et al. (2025). Effects of audio-guided imagery on Raynaud phenomenon in connective tissue disease. ACR Open Rheumatology, 7(8), e70074. [Crossref]
📄Pagaduan, J. C., Chen, Y. S., Fell, J. W., & Wu, S. S. X. (2020). Can heart rate variability biofeedback improve athletic performance? A systematic review. Journal of Human Kinetics, 73, 103. [Crossref]
📄Peach, G., Schep, G., Palfreeman, R., Beard, J. D., Thompson, M. M., & Hinchliffe, R. J. (2012). Endofibrosis and kinking of the iliac arteries in athletes: A systematic review. European Journal of Vascular and Endovascular Surgery, 43(2), 208-217. [Crossref]
📄Podlog, L., & Eklund, R. C. (2006). A longitudinal investigation of competitive athletes' return to sport following serious injury. Journal of Applied Sport Psychology, 18(1), 44–68. [Crossref]
📄Quartana, P. J., Campbell, C. M., & Edwards, R. R. (2009). Pain catastrophizing: A critical review. Expert Review of Neurotherapeutics, 9(5), 745–758. [Crossref]
📄Radaideh, Q., Patel, N. M., & Shammas, N. W. (2019). Iliac vein compression: Epidemiology, diagnosis and treatment. Vascular Health and Risk Management, 15, 115–122. [Crossref]
📄Reese, L. M. S., Pittsinger, R., & Yang, J. (2012). Effectiveness of psychological intervention following sport injury. Journal of Sport and Health Science, 1(2), 71-79. [Crossref]
📄Rollnick, S., Miller, W. R., Butler, C. C., & Aloia, M. S. (2008). Motivational interviewing in health care: Helping patients change behavior. [Crossref]
📄Schwartz, M. S., & Andrasik, F. (2017). Biofeedback: A practitioner's guide (4th ed.). Guilford Press.
📄Sidawy, A. N., & Perler, B. A. (Eds.). (2019). Rutherford’s Vascular Surgery and Endovascular Therapy (9th ed.). Elsevier.
📄Tew, G. A., Humphreys, L., Crank, H., Hewitt, C., Nawaz, S., Al-Jundi, W., ... et al. (2015). The development and pilot randomised controlled trial of a group education programme for promoting walking in people with intermittent claudication. Vascular Medicine, 20(4), 348-357. [Crossref]
📄Treat-Jacobson, D., McDermott, M. M., Bronas, U. G., Campia, U., Collins, T. C., Criqui, M. H., ... & American heart association council on peripheral vascular disease; council on quality of care and outcomes research; and council on cardiovascular and stroke nursing. (2019). Optimal exercise programs for patients with peripheral artery disease: A scientific statement from the American Heart Association. Circulation, 139(4), e10-e33. [Crossref]
📄Turk, D. C., & Gatchel, R. J. (Eds.). (2018). Psychological Approaches to Pain Management: A Practitioner’s Handbook (3rd ed.). Guilford Press.
📄Vlaeyen, J. W. S., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 85(3), 317–332. [Crossref]
📄Weinman, J., Bieles, J., Bearne, L. M., Volkmer, B., Peacock, J., Sekhon, M., ... et al. (2022). Effect of a physical therapist-led, home-based, walking exercise behavior change intervention vs usual care on walking in adults with peripheral artery disease: The MOSAIC randomized clinical trial. JAMA, 327(14), 1344-1355. [Crossref]
📄Young, S. E., Henderson, C. A., & Couperus, K. S. (2020). The effects of electronic nicotine delivery systems on athletes. Current Sports Medicine Reports, 19(4), 146-150. [Crossref]