# Motor Imagery and Sport Performance: A Systematic Review on the PETTLEP Model
## 3 Results
### Motor Imagery and Pain Management  
MI during relaxation was found to be helpful in reducing the feeling of pain [102; 123], both by maintaining a positive attitude and by promoting recovery [124; 125]. Furthermore, performing relaxation alone was found to be helpful in reducing musculoskeletal pain [126] and reducing anxiety [127]. In fact, studies that involved relaxation before motor imagery [128] found a significant reduction in pain, while the study of [PERSON] et al. [129], which did not use relaxation, found increased levels of pain in participants. [PERSON] et al. [130] found that participants who performed MI during immobilization maintained their strength and experienced an increased EMG signal despite muscle atrophy. In another study, subjects performing MI during immobilization attenuated strength loss by 50% [131].  
A meta-analysis of these findings suggested that MI training could help athletes to preserve their strength when they are unable to engage in physical exercises 104. [PERSON] et al. [132] studied the effects of MI in dancers with a history of low back pain (LBP). Individuals with recurrent LBP exhibit greater stiffness and less damping in their trunk dynamics [133], and this could be the result of an altered recruitment and morphology of trunk muscles, which are associated with LBP [134]. In the study of [PERSON] et al. [132], dancers with LBP exhibited less damping but the same trunk stiffness compared to dancers without LBP. When dancers responded to trunk perturbations with imagined fluid and gentle movements, those with LBP performed the same amount of damping as those without, demonstrating their ability to improve trunk control [132]. The study from [PERSON] et al. [135] found that motor imagery improved reaching and grasping abilities but not dexterity, suggesting that gross tasks could benefit more from MI than complex tasks. However, more research is needed to confirm this hypothesis. [PERSON] and [PERSON] [136] suggested that research about MI in rehabilitation should focus on the type of tasks and aspects of physical practice such as timing and intensity. Furthermore, it is crucial for studies to report the specific content of interventions, allowing replication and better comparison between studies. From pure static motor imagery to dynamic motor imagery, MI is conceptually defined as being performed in the absence of any movement [137], but if the aim is not to study MI but to increase the performance, MI could be coupled with actual movements as simplified versions of the real movements to perform during the task. This practice is referred to as dynamic motor imagery (dMI) [97]. Furthermore, there is evidence showing that, during MI, a subliminal muscular activity is possible, suggesting that the motor control is not completely inhibited [105; 138], and some motor output should be included during MI [139]. [PERSON] et al. [140] found that dMI, such as performed coupling imagery and stepping in place, was more accurate than \"static\" motor imagery (sMI) for running or lateral walking toward a target. Another study by the same authors was the first in defining the application of the PETTLEP model to dMI, finding dMI more spatially and temporally accurate than sMI in both young and older adults [141].