Effectiveness of Psychological Skills Practice on Pain Perception in Taekwondo Players with Anterior Cruciate Ligament Injury

Sport, especially at the professional level, is associated with a high risk of injury. One of the high-risk sports is Taekwondo, which according to the World Taekwondo Federation (2020) is one of the most popular sports with 75 to 120 million practitioners in more than 174 countries. Like other martial sports, there is a lot of potential for injury in Taekwondo along with sports performance; In such a way, the surveys conducted in taekwondo competitions show that the total injury rate is 139-5/20 per 1000 competitions for men and 105-5-3/25 for women. Anterior cruciate ligament injury is one of the injuries that taekwondo athletes face. As a static and dynamic structure, the cruciate ligament plays an important role in the stability of the knee joint, and it is a very important injury in the knee joint that affects the physical and mental health of athletes. It occurs after an air strike. There are increasing changes in subjective outcomes following sports-related cruciate ligament treatment and surgery, so that psychological factors also play a role in post-treatment outcomes and affect how athletes perceive pain, as well as their willingness to return to their previous level of activity and participation. They affect rehabilitation. One of the psychological dimensions and related skills that are of interest to psychologists and sports officials and experts; Pain perception is related to people's sports performance and can play an important role in the athlete's decision not to return to sports, especially after procedures such as cruciate ligament reconstruction. Athletes may exhibit "pain catastrophizing," a tendency to exaggerate pain and ruminate on the pain experience. In fact, the perception of pain changes the mental and social performance of the athlete and can be considered as an important factor limiting the physical and mental health of the injured athlete. Subjective interpretation of injury-induced pain is influenced by injury history in athletes; As long as the person's assessment of the pain experience caused by the injury does not change, the person will remain in this vicious cycle, leading to fear of movement or fear of re-injury; In such a way that in this case, the person is very worried about possible injuries caused by physical activities. Sports injuries are associated with negative psychological responses; Psychological factors play a role in post-treatment outcomes and affect how athletes perceive pain as well as their willingness to return to their previous activity level and participate in rehabilitation. Therefore, the aim of the present study was the effectiveness of psychological skills training on mental strength and self-confidence in taekwondo athletes with anterior cruciate ligament injury.

The present study was a pre-test-post-test experiment with a control group in terms of its practical purpose and design. The statistical population included all male taekwondo athletes with cruciate ligament injury in Tehran in 1402. First, a list of taekwondo clubs in different areas of Tehran city was prepared and then 30 people were selected from among the athletes with cruciate ligament injuries using a random sampling method and completely randomly divided into two experimental groups (15 people) and the control group. (15 people) were replaced. Then, the experimental group was invited to participate in the psychological skills training course, and after the introduction, confidence building and description of the intended goals; It was explained to the athletes that this intervention is a part of a research activity and that the matters raised in the meetings and their identity information will not be included and discussed anywhere without their consent and will not be given to any unit. Next, the McGill Pain Perception Questionnaire (MPQ) was given to both groups as a pre-test. Then, the experimental group was trained in the psychological training program for 16 sessions (2 sessions per week and each session for 45 minutes). The control group did not receive any training. The data was analyzed based on univariate analysis of covariance (ANCOVA) by SPSS-26 software.

The result of covariance analysis test showed that the sum of squares of the independent variable is 102.612, which leads to the F test size of 74.717, which is reported to be significant at the 0.01 level. In other words, there is a significant difference between the two control and experimental groups in the amount of pain perception after adjusting the effect of the pre-test. According to the average scores of the experimental and control groups in the post-test, it can be concluded that the practice of psychological skills has an effect on the pain perception of taekwondo athletes with anterior cruciate ligament injury. The effectiveness rate was also reported as 0.79.

In explaining this finding, it can be said that the perception of pain changes the mental and social functioning of the athlete and can be considered an important factor limiting the physical and psychological health of the injured athlete. The perceptual evaluation of pain is more complicated than other sensory thresholds due to its subjective nature. Subjective interpretation of injury-induced pain is influenced by injury history in athletes. As long as the person's evaluation of the pain experienced from the injury does not change, the person will remain in this vicious cycle, leading to fear of movement or fear of re-injury. In such a way, in this case, the person is very worried about possible injuries caused by physical activities. It seems that psychological skills in the field of voluntary skills (to overcome pain and fatigue due to specific performance needs) leave a positive and significant performance. In fact, injured athletes use psychological interventions to increase satisfaction in the rehabilitation process, improve treatment time, and return to the original physical state after surgery, as well as prevent further injuries, manage pain, and improve the level of rehabilitation. Conscious and purposeful intervention is therefore a critical criterion for volitional regulation processes. By focusing on performance-related processes, performance is actively aligned and the distraction of performance barriers is reduced. Self-talk, visualization, and relaxation techniques in the field of psychological skills were used separately or in combination to control the focus on relevant processes during sports activity. The ability to manage pain with psychological processes has been considered since the 1970s and is considered a threat to the physical integrity of a person It is associated with increased arousal and anxiety, which makes it even more uncomfortable. The body stiffens, which makes physical effort even less effective and more painful. However, what athletes experience during training and competition can be considered discomfort and not pain. They can always control the pain by reducing or stopping physical activity. Athletes have a higher perception of their pain when playing due to their motor skills, sports history and higher self-confidence; The opiate-like systems in their frontal cortex are less active and as a result, their sensitivity to pain has decreased. In general, it can be said that the practice of psychological skills has an increasing effect on the perception of pain in taekwondo athletes with anterior cruciate ligament injury.