The aims of the present review were to (i) provide a critical overview of the current literature on the effects of mental imagery on muscular strength in healthy participants and patients with immobilization of the upper extremity (i.e., hand) and anterior cruciate ligament (ACL), (ii) identify potential moderators and mediators of the "mental imagery-strength performance" relationship and (iii) determine the relative contribution of electromyography (EMG) and brain activities, neural and physiological adaptations in the mental imagery-strength performance relationship. This paper also discusses the theoretical and practical implications of the contemporary literature and suggests possible directions for future research. Overall, the results reveal that the combination of mental imagery and physical practice is more efficient than, or at least comparable to, physical execution with respect to strength performance. Imagery prevention intervention was also effective in reducing of strength loss after short-term muscle immobilization and ACL. The present review also indicates advantageous effects of internal imagery (range from 2.6 to 136.3%) for strength performance compared with external imagery (range from 4.8 to 23.2%). Typically, mental imagery with muscular activity was higher in active than passive muscles, and imagining "lifting a heavy object" resulted in more EMG activity compared with imagining "lifting a lighter object". Thus, in samples of students, novices, or youth male and female athletes, internal mental imagery has a greater effect on muscle strength than external mental imagery does. Imagery ability, motivation, and self-efficacy have been shown to be the variables mediating the effect of mental imagery on strength performance. Finally, the greater effects of internal imagery than those of external imagery could be explained in terms of neural adaptations, stronger brain activation, higher muscle excitation, greater somatic and sensorimotor activation and physiological responses such as blood pressure, heart rate, and respiration rate.
Keywords: ACL; Imagery; rehabilitation; strength gains; strength loss.