Effectiveness of an injury prevention programme for adult male amateur soccer players: a cluster-randomized controlled trials trial
van Beijsterveldt AMC, van de Port IGL, Krist MR, Schmikli SL, Stubbe JH, Frederiks JE, Backx FJ. Br J Sports Med. 2012, Epub Ahead of Print.
Incidence of injuries in soccer is among the highest of all team sports. FIFA developed an exercise program, called the 11, that focuses on injury prevention. This program has been tested among younger soccer players but not among male adults, which represents a large number of soccer players. Therefore, van Beijsterveldt and colleagues completed a cluster-randomized controlled trial to investigate the effectiveness of The 11 program to reduce the incidence and severity of injuries among adult male amateur soccer players. High-level amateur soccer teams from two regions in the Netherlands were invited to participate in the study. The included players were male and between 18 and 40 years old. In general, all teams had 2-3 practices and 1 match per week. A total of 487 players (on 23 teams) were randomized by team (241 players among 11 teams in the intervention (The 11 program) group, 246 players among 12 teams in control group). During the 2009-10 season all of the coaches, whose team was in the intervention group, were instructed to incorporate The11 into the warm-ups of practices at least twice a week. Exercises took approximately 10-15 minutes for the teams to perform and the exercises included core stability exercises, eccentric exercises for the thigh muscles, proprioceptive training, dynamic stabilization, and plyometric exercises. Coaches were trained in applying The 11 by the research staff, received various supplemental materials (DVD’s, posters, etc.), and attended a familiarization session prior to the start of the season. Throughout the season, researchers visited each team every month to monitor the implementation of the program. During the 2009-10 season, each individual’s exposure to soccer was recorded by the coaches and any injuries were recorded by that team’s medical coverage. Following the intervention season, a total of 31 players (18 intervention, 13 control) were lost to follow-up. The investigators analyzed the data from the remaining players and reported a total exposure time of 44,252 hrs and 427 injuries during the season. Overall, the total injury incidences between the two groups were not significantly different (intervention group: 9.6 injuries per 1000 hrs, control group: 9.7 injuries per 1000 hrs). There was also no difference between groups in regards to injury severity. There was some evidence that the incidence of knee injuries may have been lower in the intervention than the control group.
Overall, this study presents an interesting view into injury prevention among soccer players. While this study showed that implementing The 11 program into the warm-ups of high-level amateur male soccer players did little to affect the injury incidence or severity, it had some evidence of decreasing the number of knee injuries. Unfortunately, no study has shown a similar affect among a female population, which is interesting in itself. Why has this program not had an effect on the female soccer population? Conceivably, The 11 should show some injury prevention in this population as it encompasses the type of exercises which are used in female anterior cruciate ligament (ACL) injury prevention programs (proprioception, plyometrics, etc.). If this program does not work among females, this would be particularly important for clinicians to know. Perhaps a study comparing The 11 to an ACL rupture prevention program would also be clinically helpful. It would also be interesting to record more detail regarding specific diagnosis of injuries occurred rather than categorizing by anatomic location or severity by time lost to injury. Do you have any experience with The11? Have you noticed less knee injuries after implementing an injury prevention warm-up program like The 11?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban