Trait Sport Anxiety as the Only Consistent Predictor Across Injury Mechanisms in Young Taekwondo Athletes: A 6- to 10-Month Prospective Cohort Study
Sports health · 2026
Trait anxiety was the only variable that tracked with injury across all mechanisms in young taekwondo athletes, but the effect's real-world size is unclear and it hasn't been replicated.
Part of: Training load and injury risk: what the evidence says · Injury prevention and screening in sport · Female athlete health: the evidence base · Youth and adolescent athletes: training, injury and development
The paper
Prospective cohort study, n=156 (of 167 enrolled) young taekwondo athletes aged 15-30, followed 6-10 months.
What they found
67.3% (95% CI 60.0-74.7) of athletes sustained at least one injury, with an incidence density of 5.77 per 1000 exposure hours (95% CI 5.09-6.50). Trait sport anxiety (TSA) was the only variable significantly associated with all three injury outcomes (total, contact, noncontact), with a per-unit OR of 1.03, though without the anxiety scale's range or a reported confidence interval, the real-world size of that effect can't be judged. Other predictors were mechanism-specific: female sex (OR=1.69-2.26), training frequency (OR=1.15), interlimb asymmetry (OR=1.06), and foul-play aggression (OR=1.07).
Study design
Single-arm prospective cohort (Level 3 evidence), not a controlled or comparative trial, in 156 competitive youth/young-adult taekwondo athletes followed biweekly for 6-10 months for injury occurrence.
Methodology
Injuries were tracked biweekly using consensus definitions and exposure hours, which is a methodological strength for a psychology-focused injury study, and GEE modelling appropriately handled repeated within-athlete clustering. However, the abstract reports no confidence intervals around any odds ratio, so precision cannot be judged and some 'significant' effects may be fragile; testing multiple predictors across three overlapping outcome sets (total, contact, noncontact) in a modest sample also raises the risk of chance findings; and there is no mention of adjustment for baseline injury history, other psychosocial stressors, or how aggression/TSA were scored, which limits confounding control.
The appraisal
An OR of 1.03 per unit of trait sport anxiety looks modest, but without the scale's range or a confidence interval, a clinician can't tell whether this is a trivial or meaningful shift in risk across real athletes. TSA being the only variable significant across three separate models (total, contact, noncontact) is a genuinely interesting pattern, but with this many predictors tested across three outcomes in one cohort, some findings will reach significance by chance, so this needs treating as hypothesis-generating rather than confirmed. The design is associative, not causal: 'TSA predicts injury' is a correlation in one cohort, not evidence that treating anxiety prevents injury.
The gap
No confidence intervals are given for any odds ratio, and the anxiety-scale units behind OR=1.03 aren't specified, so the actual magnitude and certainty of the 'consistent' TSA effect can't be judged from this abstract alone; external replication in an independent taekwondo or combat-sport cohort is needed before treating this as robust.
Landmark context
This extends the long-standing psychosocial stress-and-injury framework from sport psychology (the biopsychosocial injury risk model most associated with Andersen and Williams' stress-injury model) into combat sports, an area where injury prevention research has been dominated by biomechanical and load-based models rather than psychological screening.
What to do Monday
Not yet a Monday-morning change: clinicians working with youth combat-sport athletes could reasonably add a brief trait-anxiety screen alongside existing training-load and asymmetry monitoring, but this single cohort study does not justify overhauling screening protocols or prioritizing psychological over biomechanical assessment.
In practice
This applies to youth and young-adult combat-sport athletes (taekwondo specifically, and cautiously to other striking/grappling sports) going through pre-season or in-season screening. In clinic, I'd add a brief trait-anxiety questionnaire to the existing pre-season battery, not as a gatekeeper but as a flag: an anxious athlete showing up alongside training-load spikes or asymmetry is someone to check in on more often, since anxiety tracked with contact injuries too, a nervous athlete fights defensively and eats more kicks. On the S&C floor, the more actionable lever is the interlimb asymmetry finding, so baseline and periodically re-test limb symmetry with something like the Single Leg Jump or Single Leg Broad Jump, since that's the piece you can actually load-manage and retrain, unlike a personality trait. Caveat: this is one cohort in one sport with small per-unit effects, so use the anxiety screen to prompt conversation and closer monitoring, not to pull an athlete from training or competition.
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