Introduction Athletes adopt different coping mechanisms with injury. Differences and links between fear avoidance (FA), pain self-efficacy (PSE), and mental toughness (MT) might affect injury outcomes. Aim To examine the relationship between Fear Avoidance, Pain Self-Efficacy and Mental Toughness in injured elite and competitive athletes in Lebanon. Methods This is a cross-sectional study that included 172 athletes. Different questionnaires were used to determine the three pre-mentioned concepts. FA, PSE, and MT were measured using AFAQ—Athletic Fear Avoidance Questionnaire, PSEQ—Pain Self-Efficacy Questionnaire, and SMTQ—Sports Mental Toughness Questionnaire respectively. The data was collected and analyzed using IBM SPSS software. Results Athletes who practiced boxing reported the highest SMTQ score. Age and training hours predicted higher scores in mental toughness while athletes returning to practice within the last month showed higher PSEQ scores. A negative relationship was found between SMTQ and AFAQ (r = -0.47, p < 0.001) as well as between PSEQ and AFAQ (r = -0.44, p < 0.001). However, a positive relationship was seen between SMTQ and PSEQ (r = 0.36, p < 0.001). Conclusion By incorporating insight into FA, PSE, and MT, sports professionals may enhance their ability to assess both physical and psychological predicaments of injured athletes.
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