Comparison of 10 vs. 20 min neuromuscular training for the prevention of lower extremity injuries in male youth football: A cluster randomised controlled trial
Rahlf AL, Zech A. J Sports Sci. 2020Epub Ahead of Print.

Take-Home Message

Modifying the 20-minute 11+ injury prevention program to be only 10 minutes may not undermine the effectiveness of the program among youth football players.


Injury prevention programs decrease injury rates; however, poor compliance/adherence undermines their effectiveness. One reason for poor compliance/adherence may be the duration of the warm-up program. Hence, there is growing support for programs that require only 10-15 minutes. However, we need more clinical trials to test if shortening an injury prevention program compromises the benefits of the original program. Therefore, the authors randomized 18 youth football (soccer) teams (U14-U19) to either a 10-minute or a 20-minute version of the 11+ lower extremity injury prevention program to compare lower extremity injury rates. The coaches learned to perform the 20-minute youth football 11+ program or a modified 10-minute version. The team’s coaches also received a manual to refer back to when necessary. Each program was performed twice per week over 5 months. Both versions of the 11+ program had the same 15 exercises (only the reps or times were changed). Lower extremity injuries that resulted in time loss were recorded during the season (~5 months). The authors defined time loss as a player unable to continue training or continue/participate in match play.

Two teams stopped performing the 10-minute program (44 athletes), and one team stopped doing the 20-minute program (16 athletes). Another team that did the 10-minute program stopped the intervention after 4 months. The 10-minute training group completed 30 out of 77 sessions (39%), and the 20-minute training group completed 36 out of 94 training sessions (39%). During the season, 145 lower extremity injuries were recorded in 101 athletes. The lower extremity injury incidence for the 10-minute and 20-minute training programs were 6.4/1000 hours and 7.2/1000 hours, respectively. The authors observed no group differences between injury rates.


The authors found that modifying the 11+ program to be only 10 minutes may not undermine the effectiveness of the program among youth football players. While this study supports prior analyses and recommendations for programs that are 10-15 minutes in duration, there are several limitations worth noting. First, 3 teams that performed the 10-minute program stopped using the program before the end of the season. Furthermore, the authors only analyzed people who completed the study, which limits our ability to judge how the shorter program may work in real practice. Finally, both programs had low compliance. Teams completed less than 40% of sessions. While this study builds on prior evidence that shorter programs are acceptable, we need to ask why so many teams dropped out or failed to complete the majority of their training sessions? One answer may be that a “one-size-fits-all” prevention program may not be ideal. When we encourage teams to adopt an injury prevention program, it may help to avoid prescribing a “one-size-fits-all” injury prevention protocol. Instead, we should encourage coaches to adapt their existing warm-up program to include exercises consistent with a 10-minute multicomponent injury prevention program.

Questions for Discussion

What barriers impede implementing a prevention program? Do you think more specific recommendations and shorter time frames would be helpful?

Written by: Jane McDevitt
Reviewed by: Jeffrey Driban

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