Volume 11, Issue 3 (12-2025)                   J Sport Biomech 2025, 11(3): 252-268 | Back to browse issues page


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Rouhi M, Barati A, barzegar bafrouei M. The Relationship Between Performance Indicators, Mental Health, and Sports Injury Incidence During Pre- and Post-Preparation Periods of National Para-Taekwondo Athletes. J Sport Biomech 2025; 11 (3) :252-268
URL: http://biomechanics.iauh.ac.ir/article-1-383-en.html
1- Department of Health and Sports Rehabilitation, Faculty of Sport Sciences and Health Promotion, Shahid Beheshti University, Tehran, Iran.
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Extended Abstract
1.    Introduction

Para-taekwondo, as a competitive discipline within adaptive martial arts, has experienced remarkable global growth in recent decades and is now an official event in the Paralympic Games (1). Its inclusion in the Tokyo 2020 Paralympics significantly elevated the sport’s profile, intensifying expectations regarding athlete preparation, performance, and injury prevention (2). However, the demands of this sport—including rapid limb movements, high-impact contact, dynamic kicking techniques, and repeated pivoting and landing—present a substantial risk of both acute and chronic injuries, particularly to the lower extremities (3). Previous studies have reported high incidences of knee and ankle injuries among para-taekwondo athletes, often attributed to biomechanical stress, impaired neuromuscular control, and limb asymmetries (4). Despite the growing body of research in para-sports, comprehensive studies that integrate physiological, biomechanical, and psychological indicators in elite para-taekwondo athletes remain scarce. This study seeks to address that gap by evaluating key domains—specifically isokinetic strength, muscle balance, dynamic postural stability, injury prevalence, and mental health—during the critical preparatory phase leading up to major competitions. Gaining insights into how these factors interrelate can support the development of injury prevention strategies and inform the design of multidisciplinary, evidence-based training programs tailored to the unique needs of athletes with disabilities. Such efforts are essential for promoting safe and optimal performance at the elite level. 
2.    Methods
This study employed a descriptive-analytical and applied research design, targeting 12 elite para-taekwondo athletes (6 males, 6 females; mean age: 22.5 ± 5.1 years) from the Iranian national team. Data collection was conducted during two major preparatory phases: one for the 2022 Hangzhou Asian Para Games and another for the 2024 Paris Paralympics. For each event, assessments were performed at two time points: five months and one month prior to competition. This timeline allowed for the evaluation of performance adaptations resulting from structured training programs. Isokinetic strength of the knee and ankle joints (both flexion and extension) was measured using a Biodex System 4 Pro dynamometer at angular velocities of 60°/s, 180°/s, and 300°/s for both right and left limbs. Muscular balance was evaluated using the hamstring-to-quadriceps (H/Q) and dorsiflexion-to-plantarflexion (DF/PF) strength ratios. Dynamic postural stability was assessed using the Biodex Balance System (Model SD), which provided balance indices in the anterior-posterior, medial-lateral, and overall directions. Injury history and symptom severity were monitored weekly using the Oslo Sports Trauma Research Center Questionnaire (OSTRC), while psychological well-being was assessed using the 12-item Goldberg General Health Questionnaire (GHQ-12). Data were analyzed using SPSS version 27, employing paired t-tests, Wilcoxon signed-rank tests, and Pearson or Spearman correlation coefficients, depending on the normality of the data. A significance level of p < 0.05 was considered statistically significant.
3.    Results
As summarized in Table 1, the results showed significant neuromuscular improvements as summarized in Table 1, the results demonstrated significant neuromuscular improvements following the preparatory training period. Quadriceps strength increased from 149.8 ± 34.5 Nm to 212.0 ± 40.0 Nm (p = 0.014), while hamstring strength improved from 76.0 ± 15.9 Nm to 108.7 ± 20.0 Nm (p = 0.019), indicating substantial gains in lower limb power. Similarly, significant improvements were observed in ankle strength, with dorsiflexion increasing by 26.4% (p = 0.027) and plantarflexion by 24.0% (p = 0.021). Although slight improvements were noted in the hamstring-to-quadriceps (H/Q) and dorsiflexion-to-plantarflexion (DF/PF) strength ratios, these changes did not reach statistical significance (p = 0.091 and p = 0.084, respectively). The overall balance index decreased from 3.12 ± 0.51 to 2.73 ± 0.48, approaching significance (p = 0.058), suggesting a trend toward enhanced postural stability. Additionally, injury scores assessed using the Oslo questionnaire showed an 18.2% reduction (p = 0.045), and mental health, as measured by the GHQ-12, improved by 15.4%, nearing statistical significance (p = 0.052). 
Collectively, these findings suggest that the preparatory training program contributed not only to improvements in neuromuscular performance but also to reduced injury risk and enhanced psychological well-being. 

4.    Discussion
The results underscore the complex interplay between neuromuscular strength, postural control, and psychological health in para-taekwondo athletes. While strength parameters improved significantly after structured preparation (7), the lack of change in muscle balance ratios such as H/Q and DF/PF suggests a need for targeted neuromuscular training to correct functional asymmetries (10). Persistent imbalances may elevate the risk of non-contact injuries, particularly in high-impact sports such as taekwondo, where dynamic stability is critical during kicking, pivoting, and landing maneuvers (4). The significant reduction in injury scores post-training reflects the effectiveness of comprehensive preparatory programs in minimizing overuse and acute injuries (15). However, the data also highlight the influence of psychological variables on injury risk and motor control. The positive correlations between poor GHQ-12 scores and both injury severity and impaired balance suggest that psychological stress may exacerbate neuromuscular inefficiency and increase vulnerability to injury (22). These findings advocate for a holistic training model that integrates physical conditioning, psychological support, and neuromuscular rehabilitation to enhance overall readiness (18). For coaches, therapists, and sport scientists working with para-athletes, incorporating mental health screening and individualized corrective exercises may be essential for sustainable performance and injury prevention at elite levels (13). Moreover, this study demonstrated that significant improvements in quadriceps, hamstrings, dorsiflexor, and plantarflexor strength following the preparatory phase, along with a moderate enhancement in postural stability, had a positive impact on athletic performance in para-taekwondo. However, the non-significant changes in the hamstring-to-quadriceps and dorsiflexion-to-plantarflexion ratios highlight that general strength training alone may not be sufficient, and more targeted interventions are needed to address muscular balance. Furthermore, the significant associations found between lower muscle ratios, poorer balance, weaker mental health, and higher injury scores emphasize the need for a multidimensional approach to athlete preparedness, encompassing physical, neuromuscular, and psychological domains. These relationships suggest that mental health can play a determining role in how athletes perceive injuries and respond to physical limitations. Athletes with better psychological well-being may demonstrate greater resilience and coping ability, whereas those with poorer mental health might experience heightened injury perception and diminished functional recovery. Although the preparatory program led to a moderate improvement in mental health scores, this change did not reach statistical significance, indicating that physical training alone may not be sufficient to enhance psychological well-being. Therefore, integrating structured psychological interventions into athlete preparation could be critical.
Overall, the findings highlight the importance of a multidimensional training framework for para-taekwondo athletes—one that goes beyond improving physiological indices and actively supports mental health and neuromuscular coordination. Such an approach may reduce injury risk, enhance psychological adjustment to physical limitations, and ultimately improve athletic performance. Accordingly, it is recommended that para-taekwondo training programs be designed to not only strengthen the major lower limb muscles but also include specific interventions to improve muscular ratios, dynamic balance, and psychological resilience. Routine assessment of mental health using validated tools such as the Goldberg GHQ should be considered an integral part of athlete preparation. Future research with larger sample sizes and controlled experimental designs will be essential to further validate these findings and advance the field. 

Ethical Considerations
Compliance with ethical guidelines

This study was non-interventional and observational in nature, involving no experimental manipulation or invasive procedures. As such, it did not require formal approval from a biomedical ethics committee. However, the project was officially registered and conducted under the supervision of the National Paralympic Committee of the Islamic Republic of Iran. All participants were informed of the research objectives and procedures, and verbal informed consent was obtained. Participant confidentiality was strictly maintained throughout the study, and all ethical principles regarding human subjects were fully observed.
The authors confirm that the research was conducted in accordance with the ethical standards outlined in institutional and national guidelines. All relevant ethical protocols concerning informed consent, data confidentiality, and the protection of participant rights were adhered to throughout the duration of the study.
Funding
This research received no specific funding from any organization. 
Authors' contributions
All authors contributed equally to the study design, data collection, analysis, manuscript writing, and final review.
Conflicts of interest
The authors declare that there are no conflicts of interest associated with this article. 
Type of Study: Research | Subject: Special
Received: 2025/05/10 | Accepted: 2025/07/12 | Published: 2025/07/12

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