Successful extreme and adventure sports participation requires unique, individually tailored physical training regimens, the ability to assess and accommodate in situ variables such as weather and personal readiness, and proper knowledge of equipment use and handling specific to the sport. All facets of physical and mental preparation are instrumental not only to avoid injuries and fatalities, but also for optimal performance. Injury patterns, rehabilitation, and overall skills are specific to each individual activity and therefore require individualized plans tailored to the sport and athlete. Once an athlete, whether at the recreational or professional level, has sustained an injury, a combination of recovery and guided realistic approach to return to play to achieve goals within physical and psychosocial competency thresholds is requisite to achieve safe outcomes. Extrinsic factors, such as monetary incentives, social exposures, and livelihood dependence, may affect sound decision-making. Additionally, intrinsic factors such as perception of self-worth for the injured professional athlete, use of the sport as a coping mechanism, or outlet for underlying psychological stresses need to be considered during the rehab/recovery of the injured extreme/adventure sports patient. The success of extreme sports participation relies on a baseline understanding of these motivations, honest assessment of the participants capabilities, and how these factors affect rational decision-making in the setting of each activity goal. Both participants and treating medical professionals need to be aware of the initial treatment, injury severity, and the above factors in returning to play which differ from conventional sports injuries.