Effect of Progressive Muscle Relaxation Training in Fear of Re-injury in Professional ‎Athletes after Anterior Cruciate Ligament‏ ‏Reconstruction

Document Type : Original Article

Authors

1 Department of Sport Injury and Corrective Exercise, Faculty of Physical Education and Sport Sciences, Shahid Bahonar University of Kerman, Kerman, Iran

2 Department of Motor Behavior, Faculty of Physical Education and Sport Sciences, Shahid Bahonar University of Kerman, Kerman, Iran

Abstract

Purpose:
Fear of reinjury can have a devastating effect on an athlete's performance and can be a reason for an athlete to quit and compete. On the other hand, those who are more afraid of injury show greater landing error, so the aim of the present study was to investigate the effect of progressive muscle relaxation training in fear of re-injury and landing error of professional athletes with after Anterior Cruciate Ligament(ACL) reconstruction.
Methods:
Twenty-six professional athletes (13 women and 13 men) with a history of ACL reconstruction (weight average 66.80±1.75 kg, age average 22.47±2.45 years, heigh average 167.84±7.18 cm) were selected as accessible and purposeful and were randomly divided into control (13 athletes) and experimental (13 athletes) groups. Subjects completed their rehabilitation after a sports injury. In the first step, athletes with history of ACL reconstruction completed the Tempa scale fear of injury (Tempa Scale Kensiophobia; TSK-11) questionnaire. In second step, the subjects' landing error was measured by the Landing Error Scoring System (Landing Scoring Error System; LESS). The experimental group performed progressive muscle relaxation exercises. In the experimental group, the progressive muscle relaxation training was performed in 12 sessions (3 days a week) for 4 weeks and each session was 30-45 minutes. The control group did not perform any special activity during this time. The experimental group performed progressive muscle relaxation exercises in 12 sessions for 4 weeks and each session for 30-45 minutes. The control group did not participate in any of the therapeutic activities during this period and were engaged in normal daily activities. After the training sessions, all subjects participated in the post-test and the indicators were measured. Data were analyzed using Repeated measures (p < 0.05).
Results:
The findings indicated that fear of reinjury and landing error decreased after intervention and also there was a significant difference between the groups in fear of re-injury (p=0.001) and landing error (p=0.001) are statistically significant.
Conclusion:
According to the research findings, it can be concluded that the progressive muscle relaxation exercises used in the research are an effective and low-cost method to reduce the fear of re-injury and also reduce the amount of landing error. According to the present study and the research conducted in this field, it can be concluded that the reduction of landing error and fear of re-injury may be accompanied by improved movement and kinematic mechanics of the joint, which can prevent re-injury and Athletes with a history of ACL injury can also help prevent recurrence. Therefore, it is recommended that professional athletes use psychological exercises to reduce the risk of re-injury following ACL surgery and rehabilitation.

Keywords


  1. Mok K-M. Reliability and methodological concerns of vertical drop jumping and sidestep cutting tasks: implications for ACL injury risk screening 2015.
  2. Heijne A, Axelsson K, Werner S, Biguet G. Rehabilitation and recovery after anterior cruciate ligament reconstruction: patients’ experiences. Scand J Med Sci Sports 2008; 18(3): 325-335.
  3. Barber-Westin SD, Noyes FR. Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy: the journal of arthroscopic & related surgery. 2011 Dec 1;27(12):1697-705.
  4. Ellman MB, Sherman SL, Forsythe B, LaPrade RF, et al. Return to play following anterior cruciate ligament reconstruction. J Am Acad Orthop Surg 2015; 23(5): 283-296.
  5. Feller J, Webster KE. Return to sport following anterior cruciate ligament reconstruction. Int Orthop 2013; 37(2): 285-290.
  6. Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, et al. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 2: a review of prevention programs aimed to modify risk factors and to reduce injury rates. Knee surgery, sports traumatology, arthroscopy 2009; 17(8): 859-879.
  7. Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med 2011; 45(7): 596-606.
  8. Trigsted SM, Cook DB, Pickett KA, Cadmus-Bertram L, et al. Greater fear of reinjury is related to stiffened jump-landing biomechanics and muscle activation in women after ACL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2018; 26(12): 3682-3689.
  9. Ardern CL. Anterior cruciate ligament reconstruction—not exactly a one-way ticket back to the preinjury level: a review of contextual factors affecting return to sport after surgery. Sports health 2015; 7(3): 224-30.
  10. Forsdyke D, Smith A, Jones M, Gledhill A. Psychosocial factors associated with outcomes of sports injury rehabilitation in competitive athletes: a mixed studies systematic review. Br J Sports Med 2016; 50(9): 537-544.
  11. Te Wierike SC, Van Der Sluis A, van den Akker‐Scheek I, Elferink‐Gemser MT, Visscher C. Psychosocial factors influencing the recovery of athletes with anterior cruciate ligament injury: a systematic review. Scand J Med Sci Sports 2013; 23(5): 527-540.
  12. Forsdyke D, Smith A, Jones M, Gledhill A. Psychosocial factors influencing the recovery of athletes with anterior cruciate ligament injury: a systematic review. Scand. J. Med. Sci. Sports 2013; 23(5):527-540.
  13. Burland JP, Lepley AS, Cormier M, DiStefano LJ, et al. Learned helplessness after anterior cruciate ligament reconstruction: an altered neurocognitive state?. Sports Medicine 2019; 49(5):647-657.
  14. Mozafari zadeh M, Heidari F, Khabiri M. The Effect of a Mind fullness-Based Training Program on Sport Injury Anxiety and Performance of Soccer Players. Intrnational Conference on Sports Sciences. Rademan Innovative Institute 2019; 8(1): 95-108. [Persian]
  15. Vairo GL, Myers JB, Sell TC, Fu FH, Harner CD, Lephart SM. Neuromuscular and biomechanical landing performance subsequent to ipsilateral semitendinosus and gracilis autograft anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 2008; 16(1):2-14.
  16. Razi M, Sadeghi H, Ebrahimi takamejani E, Shariatzade M. Effect of Lower Limb Muscle Fatigue on Knee Joint Control Strategies during Landing in Young Men. The Scientific Journal of Rehabilitation Medicine. 2018. 7(2): 1-10 [Persian]
  17. Athan A, Sampson U. Coping with pre-competitive anxiety in sports competition. European Journal of Natural and Applied Sciences 2013; 1(1): 1-9.
  18. Emery CF, France CR, Harris J, Norman G, VanArsdalen C. Effects of progressive muscle relaxation training on nociceptive flexion reflex threshold in healthy young adults: a randomized trial. Pain 2008; 138(2): 375-379.
  19. Zehtab Najafi A, Vaez Mousavi SMK, Taheri HR. Effectivness of selected psycological interventions on reducing competitive state anxity of athletes. Research in Sport Management & Motor Behavior 2018; 8(15): 19-27. [Persian]
  20. Khabiri M, Moghadam Zadeh A, Mehrsafar A, Abrisham-kar H. Comparison of the effectiveness of progressive muscle relaxation with imagery-based relaxation on cortisol levels, competitive anxiety and self-confidence in elite athletes. Journal of Research in Psychological Health 2017; 11(1): 62-73. [Persian]
  21. Jafari H, Ebrahimi I, Salavati M, Kamali M, Fata L. Psychometric properties of Iranian version of Tampa Scale for Kinesiophobia in low back pain patients. Archives of Rehabilitation 2010; 11(1): 15-22. [Persian]
  22. Onestak DM. The effects of progressive relaxation, mental practice, and hypnosis on athletic performance: A review. Journal of Sport Behavior 1991; 14(4):247.
  23. Padua DA, DiStefano LJ, Beutler AI, De La Motte SJ, et al. The landing error scoring system as a screening tool for an anterior cruciate ligament injury–prevention program in elite-youth soccer athletes. Journal of athletic training. 2015; 50(6): 589-595.
  24. Hashim HA, Hanafi H, Yusof A. The effects of progressive muscle relaxation and autogenic relaxation on young soccer players’ mood states. Asian journal of sports medicine 2011; 2(2): 99-105.
  25. Sakhare N, Physiotherapy K, Sharma K, Syal A. Effect of progressive muscular relaxation technique and autogenic relaxation technique on pre competitive state anxiety and self-confidence in athletes. International Journal of Advance Research, Ideas and Innovations in Technology 2018; 4(6): 403-409.
  26. Aghebati N, Mohammadi E, Esmaeil ZP. The effect of relaxation on anxiety and stress of patients with cancer during hospitalization. Iran Journal of Nursing 2010; 23(65):15-22. [Persian]
  27. Pelka M, Heidari J, Ferrauti A, Meyer T, et al. Relaxation techniques in sports: A systematic review on acute effects on performance. Performance Enhancement & Health 2016; 5(2): 47-59.