Trait Sport Anxiety as the Only Consistent Predictor Across Injury Mechanisms in Young Taekwondo Athletes: A 6- to 10-Month Prospective Cohort Study

Background: Injury prevention in combat sports has focused primarily on physical and biomechanical factors, whereas psychological determinants remain understudied. Because taekwondo involves both contact and noncontact injury mechanisms, a biopsychosocial approach may better explain injury risk. Hypothesis: Biological, psychological, and training-related factors, including trait sport anxiety (TSA), aggression, training load, and functional performance deficits, would predict injury risk independently in young taekwondo athletes. Study Design: Prospective cohort study. Level of Evidence: Level 3. Methods: A total of 167 taekwondo athletes were enrolled; 156, aged 15 to 30 years, completed the 6- to 10-month follow-up and were included in the final analysis. Baseline assessments included anthropometric measures, training characteristics, TSA, aggression profiles, and functional performance tests, including Landing Error Scoring System and triple crossover hop asymmetry. Injury occurrence and training exposure were recorded biweekly according to international consensus injury definitions. Generalized estimating equations with a binomial distribution, logit link function, and an exchangeable correlation structure to account for within-subject clustering identified predictors of total, contact, and noncontact injuries. Results: Overall, 67.3% (95% CI, 60.0-74.7) of athletes sustained ≥1 injury, with an incidence density of 5.77 injuries per 1000 exposure hours (95% CI, 5.09-6.50); most injuries were mild lower-extremity injuries. TSA was the only predictor consistently associated with all 3 injury outcomes (odds ratio [OR] = 1.03). Total injuries were also predicted by female sex (OR = 1.69), left-leg dominance (OR = 1.53), higher weekly training frequency (OR = 1.15), and participation in other sports (OR = 0.65). Contact injuries were associated with greater foul-play aggression (OR = 1.07), higher training frequency (OR = 1.15), and shorter stature (OR = 0.96), whereas noncontact injuries were predicted independently by female sex (OR = 2.26) and greater interlimb asymmetry (OR = 1.06). Conclusion: TSA represents a consistent biopsychosocial determinant of injury risk in young taekwondo athletes, independent of injury mechanism. Injury risk appears multifactorial, with psychological, training, and functional factors contributing modest but meaningful effects. Clinical Relevance: Routine psychological screening, alongside monitoring of training load and correction of functional asymmetries, may enhance injury prevention strategies in youth taekwondo and similar combat sports.