Background and Purpose
Participation in any form of physical activity and sports inherently involves the risk of injury. Sports injuries can have physical, psychological, social, and economic consequences, with the psychological aspect often receiving inadequate attention. Body image, as a psychological characteristic, possesses a multidimensional structure that includes perceptions, attitudes, thoughts, beliefs, feelings, and behaviors related to oneself and the body. Sports injuries and their consequences, such as prolonged absences from training and competition, can lead to negative changes in both the physical and psychological capabilities of athletes, which may subsequently alter body image and its subscales. Given the complex relationship between sports, injuries, and body image, it is essential to investigate body image in injured athletes.
The aim of this study is to compare body image and its subscales between healthy and injured athletes, as well as to evaluate the impact of injury severity on body image.
 
Methods
This study is a cross-sectional, descriptive-comparative research. The statistical population consists of all athletes in Arak city. According to Cochran's formula for a population of 13,517 athletes, a sample size of 374 was estimated. An athlete is defined as an individual who has a minimum of two years of continuous participation in a selected sport. An injured athlete is defined as someone who has been away from training and competition for at least one month due to an acute injury to the lower extremities and has not yet returned to sports. The participants were aged between 14 and 30 years. Exclusion criteria included physical disabilities, movement disorders and limitations, visible deformities, specific diseases, psychiatric disorders, musculoskeletal diseases, skeletal muscle abnormalities, and pregnancy in women. Considering the inclusion and exclusion criteria, a total of 403 athletes participated in this study (282 healthy athletes and 121 injured athletes) across various sports: football (n=82), futsal (n=49), volleyball (n=52), basketball (n=43), gymnastics (n=26), karate (n=44), taekwondo (n=34), and bodybuilding (n=73).
Prior to conducting the research, ethical approval (IR.UT.SPORT.REC.1403.087) was obtained from the Ethics Committee of the Faculty of Physical Education at the University of Tehran on 29/07/1403. For measuring body image, the short-form Body Self-Description Questionnaire developed by Marsh (2010) was utilized. The questionnaires were created on the Irandoc (Porsa) website, allowing participants to complete them electronically. Participants voluntarily took part in this study and were permitted to withdraw their participation at any time. Data were analyzed using independent t-tests, one-way multivariate analysis of variance, and Bonferroni post-hoc tests (p < 0.05).
 
Results
In this study, 403 athletes participated, comprising 282 healthy athletes and 121 injured athletes across team sports (soccer, futsal, volleyball, and basketball) and individual sports (gymnastics, karate, taekwondo, and bodybuilding). The findings revealed that the average body image of injured athletes was significantly lower than that of healthy athletes, indicating a significant difference between the body images of the two groups. Chaouch (2013) did not find a significant difference in body image between healthy and injured athletes; however, he noted that the perceived body image of the athletes studied increased after their return to sport, suggesting that injury can lead to changes in body image. Similarly, Morgan Miller (2021) observed a decline in body image among injured athletes. Ruiz-Bueno et.al (2023) reported that body image may be adversely affected by long-term injuries, leading to a decline. They generalized the conditions and experiences of cancer patients and amputees to injured athletes, indicating that athletes are at greater risk for injury and higher levels of body image disturbance.
The results of this study also demonstrated significant differences in subscales of strength, endurance, flexibility, coordination, physical activity, athletic competence, health, self-esteem, and overall body status between healthy and injured athletes. However, no significant differences were found in the subscales of physical appearance and body fat between the two groups. Myer (2014) noted in his studies that injured athletes often experience undesirable physical changes, such as weight gain or loss of muscle mass. In a study by Ghasemi et al. (2010) on individuals with disabilities, it was found that disabled athletes scored significantly better than both non-athletic disabled and non-disabled individuals in the subscales of body image (strength, endurance, coordination, flexibility, self-esteem, physical activity, sport or athletic competence, and general physical). This study also indicated that the average body image and its subscales (except for physical appearance and body fat) decreased with increasing injury severity. The effect of injury severity on body image and its subscales (excluding physical appearance) was significant, with a high effect size observed for the impact of sports injury severity on body image and its subscales, particularly in strength, self-esteem, and overall body. Pargman (2007) found a significant negative correlation between self-concept and injury severity in their study on football athletes. Studies on cancer patients and amputees indicate that the greater the severity of injury or illness, the more negative the impact on an individual's body image.
 
Conclusion
Injury is a significant risk that threatens athletes during their participation in sports and is regarded as a stimulus and a challenging process for them, leading to both physical and psychological consequences. These consequences shape the athlete's interpretation of the events that have occurred, which is influenced by their perceptions, emotions, beliefs, and attitudes toward their body—essentially, their body image in response to the injury. This body image, in turn, affects their cognitive, emotional, and behavioral responses.
The findings of this study indicate that sports injuries can have a negative impact on body image and its subscales. Just as training induces positive changes in body image, inactivity resulting from injury can also lead to negative alterations. As the severity of the injury increases, athletes require a longer period to return to their sport. Prolonged absence from training and physical activity diminishes physical abilities and fitness factors, thereby affecting subscales of body image such as endurance, strength, and flexibility. Consequently, athletes may also experience a range of psychological and social challenges.
 
Article Message         
Body image, as a psychological characteristic, is influenced by sports injuries and can change temporarily or permanently. With an increase in the severity of the injury and the duration of time away from training and physical activity, there is a greater reduction in the subscales and ultimately in the perceived body image.
Ethical Considerations
Before conducting the research, the ethics code IR.UT.SPORT.REC.1403.087 dated 10/20/2024 was received from the Ethics Committee of the Faculty of Physical Education, University of Tehran. guidelines of ethics in research.
Authors’ Contributions   
Conceptualization: H.Heidari Nik (Student) with the guidance of. M.H.Alizadeh (Supervisor)
Data Collection and Analysis: H.Heidari Nik
Manuscript Writing: H.Heidari Nik
Review and Editing: M.H.Alizadeh, Sh. Tahmasebi Borujeni, M. Ebrahimi Varkiani
Literature Review: H.Heidari Nik
Project Manager: M.H.Alizadeh
Conflict of Interest
The author(s) have no financial or non-financial conflicts of interest in relation to this research. This declaration is provided to maintain the transparency and validity of the research.
 
Acknowledgments
I would like to thank the clubs, coaches and athletes who collaborated in the implementation of this research.