The aim of this study was to compare the results of the psychological profile of athlete’s suffering from Coper ankle sprain individuals and those who demonstrate chronic ankle instability. Based on the results, as expected, we found that Coper group participants scored higher than the chronic instability group in a structure related to their basic psychological skills, psychosomatic skills, and cognitive skills. In particular, our study was consistent with Kelly et al study. They showed that participants with lower ankle instability scored lower in the depression short form, which contributes to the general mental domain of Patient-Reported Outcomes Measurement Information System (PROMIS). This suggests that factors associated with CAI may play a role in increasing feelings of sadness or negative feelings (11). Using a questionnaire from the American Academy of Lower Limb Orthopedic Surgeons (Form SF-36, version 2), Simon Docherty reported reduced ankle function and poorer physical health among middle-aged adults with ankle instability than the non-injured control group (22). In a systematic review, Houston et al. found that people with CAI reported lower regional health-related quality of life than Coper and the injury control group (23). Most previous studies on people with ankle injuries have been in the area of quality of life, but in the present study the Ottawa Mental Skills Assessment Questionnaire (OMSAT-3) was used. This version includes 48 items and 12 mental skill scales that are placed in three broader conceptual components of basic, psychosomatic and cognitive skills, indicating that the proposed model fits well with the data (21). The results showed that there was a significant difference between the two groups in all three mental skills (basic mental skills, psychosomatic and cognitive) and Coper athletes scored higher than CAI athletes. In previous studies, OMSAT-3 has significantly differentiated between competitive and elite athletes (21).
It has been shown that differences in mental skills are a determining factor that creates elite and non-elite athletes, successful and unsuccessful, national or club (24-26) Findings show that higher levels of mental skills in elite players may be one of the reasons for their success. A review of research conducted in the field of sports psychology shows that mental skills play an important role in achieving excellent performance and this issue has been confirmed multiple times in various studies(25-27).Thus many sports psychologists in recent years have focused on psychological and cognitive preparation through the training of mental skills, a comparison to muscle memory can be achieved and lead to an increase in developed mental skills (26, 27). Consistent with the above, the study found that people with CAI scored lower on mental skills. Therefore, it is important to be aware of the mental states of athletes and their relationship with the field of injury in them. It will be much easier to prevent injuries by identifying psychological factors that increase or decrease the risk of injury in athletes. For example, one of the techniques that psychologists work with injured athletes is relaxation techniques that are used in the physical and mental rehabilitation of athletes (28). Several studies have addressed the importance of psychological interventions in preventing injury and reducing the level of injury in athletes, and the results of studies have shown that these interventions and planning in the rehabilitation stages of athletes, reduce and prevent re-injury (29, 30). In a meta-analysis conducted by Rao et al. (2015) on injured athletes, it was found that mental training is effective in regaining techniques and tactics (32) and also promotes the acceleration of the injured athlete to exercise (31).There was a significant difference between the two groups in examining the components of mental skills in goal-setting skills, commitment, relaxation, fear control and stress reactions, Focusing, Refocusing, and Mental practice (P <0.05) and athletes with CAI has lower scores than Coper athletes. To prioritize each dimension of mental skill in athletes with chronic ankle instability, their ranking was determined.
In order to rank the components of mental skills according to the level of significance, goal setting, Imagery, relaxation, activation, self-confidence, competition design, stress reactions, Focusing, mental practice, and Refocusing, commitment and fear control were respectively. Arranging these mental skills will make psychologists and sports coaches more aware of the main components involved in ankle injuries, and using the information obtained can be helpful in rehabilitating injured people. Johnson et al. found that goal-setting skills and self-confidence training were effective in reducing sports injuries (32) and it was found that injured athletes have less self-confidence than healthy athletes (33) which was consistent with the results of the present study. Also, the goal setting component, which increases the skill of competition design, mental training and self-confidence, can reduce sports injuries (32). Imagery, which was the second component in terms of prioritization of mental skills, can be effective in reducing sports injury (36, 37) and it has been argued that skilled people use imagery more than beginners (34). Other important priorities are activation or relaxation. Increasing the strength will probably increase the athletes' ability to get up pre-race and ultimately improve their performance, which in turn will reduce the sports injuries caused by fatigue (35). On the other, relaxation techniques and rest of players in matches are directly related to the prevalence of injury. It has been found that relaxation exercises have been useful among professionals more so than non-professionals, and the study of relaxation techniques on self-esteem has shown that these exercises have caused psychological peace and elevated self-esteem in athletes (36, 37). One of the other things that should be paid special attention to is the competition plan. Dominikus et al. (2009) stated that athletes who have a high level of competition design skills are better able to cope with different situations that occur in sports (38)and based on the findings of Tranaeus U (2015) match designing helps prevent re-injury (29). In conclusion, it should be said that considering the role of psychological training in controlling the incidence of sports injuries, it seems that the use of knowledge of sports psychology and the application of athletes' mental rehabilitation program can be useful to prevent and reduce sports injuries. This study, like all studies, had its limitations. The impossibility of examining the issues related to the daily life of the participants in the questionnaire was one of the limitations of the research and the researcher was satisfied with the score that the person had from his body. However, due to the methodological limitations of cross-sectional questionnaire design, there are significant warnings, and one of these cases is that the possibility of bias, like other questionnaire-based studies, is inevitable. Finally, according to the research findings, the study of the perceived effects of ankle sprain on mental health should be suggested through qualitative research and more longitudinal group studies. It is also suggested that the screening and evaluation of a larger sample and different sports teams and more diverse age groups be studied to increase the generalizability and confirm the results of this study. Also, the use of mental skills rehabilitation exercises in injured athletes should be prioritized in order to achieve uniform and valid results through various studies.