The role of psychological interventions in symptom management and rehabilitation of athlete-specific vascular pathologies: A comprehensive review

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.