Effects of the ’11+ Kids’ injury prevention program on severe injuries in children’s football: a secondary analysis of data from a multicentre cluster-randomized controlled trial.
Florian Beaudouin, Roland Rössler, Karen aus der Fünten, Mario Bizzini, Jiri Chomiak, Evert Verhagen, Astrid Junge, Jiri Dvorak, Eric Lichtenstein, Tim Meyer, Oliver Faude. Br J Sports Med. 2018. [Epub ahead of print]
https://bjsm.bmj.com/content/early/2018/10/02/bjsports-2018-099062
Take Home Message: A youth football (soccer) player performing the 11+ Kids program was 58% less likely to have a serious injury during one season compared with a player doing a usual youth soccer warm-up regimen.
An injury prevention program can increase performance and decrease the risk of injury. We recently described two reports from a randomized clinical trial where the authors found that the 11+ Kids program reduced the risk of injury in youth soccer players (7 to 13 years of age) and reduced healthcare costs. It remains unclear if the 11+ Kids program can specifically reduce the risk of severe injuries that prevent a patient from practicing/competing for 28 days or more and increase the risk for poor long term health outcomes. Therefore, the authors performed a secondary analysis of a cluster-randomized trial to assess the effect of the 11+ Kids program on reducing severe injuries in 7 to 13-year-old football (soccer) players during 1 season (2014/2015). The authors included 3,895 athletes that participated in under-9, under-11, or under-13 football in 4 European countries. The athletes randomized into the 11+ Kids program (2066 athletes) completed the 11+ Kids program (15 20 minutes, 7 exercises; 5 levels; focused on balance, cores stability, and optimization of falling technique) 2 times a week in lieu of a regular warm-up. The control group (1829 athletes) followed their regular warm-up regimen. The control group experienced about 1 severe injury every 3000 soccer hours (50 injuries overall) compared with only 1 severe injury for every 6,667 soccer hours among athletes performing the 11+ Kids program (21 injuries overall). This represented a 58% injury rate reduction. Fractures were the most common injury in both groups. Fractures were reduced by 49% among athletes performing the 11+ program compared with their peers in the control group.
The authors found that the 11+ Kids program had a large preventive effect on severe injuries in young athletes. This is a simple program that can be performed in only 15 to 20 min just twice per week. Many severe injuries that are sustained in this age group are due to fall on outstretched hand mechanisms as well as muscle and ligament injuries due to poor technique and stability. This program may be effective in reducing injuries due to the focus of the program on falling technique, balance, and core stability. Severe injuries can be traumatic in this age group because they increase the risk of long-term health problems and time away from sport and/or school activities. It should be noted that less than 5% of the population were; therefore, more research is needed to determine if this program is effective among girls participating in sport. Currently, medical professionals should encourage parents and coaches to adopt the 11+ Kids program, which can be easily implemented.
Questions for Discussion: What is the best way to disseminate this information to youth leagues? Does your youth athlete perform a structured warm-up? Do you think this would be easy to implement?
Written by: Jane McDevitt
Reviewed by: Jeffrey Driban
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This article was a great read and I thought it brought up a very important topic. It's something as simple as warm-up techniques that have the ability to provide preventative measures when looking at injury risk.
I found it very interesting that implementing the 11+ Kids warm-up twice a week had an effect on reducing the chance of sustaining an injury by 58%. With this amount of a reduction and the small amount of time the 11+ Kids program takes, I think it should be looked at implementing.
I think if the 11+ Kids program is implemented at a young age it has the potential to provide greater advantages to individuals as they get older. If they are trained using this type of regimen chances are they will carry these warm-up exercises with them throughout their sporting events. This will be beneficial because they will have a proper warm up that will continue to reduce their risk for injury.
For future research I think it would be interesting to perform a study looking at individuals over a greater period of time. Starting with the kids when they are first introduced to the 11+ Kids program following them all the way through their high school sport years. This would allow researchers to see how the 11+ Kids program makes a long-term impact. In theory this may even help to advocate for changes made to warm-up programs, since it shows continual benefits over time.
I think it is important to educate parents and coaches of the benefits of implementing a consistent warm up as a part of young athletes' routines. Informing them that these warm up programs can reduce the risk of sustaining an injury may increase the likelihood of the programs being used.
As well, introducing structured warm ups early in youth athletics may help to ensure that they will continue these injury preventative habits throughout their lifetime of physical activity.
Thank you for your comments. I was also surprised to see the drastic reduction in injury risk with such a simple program. Again, like you had said it was not even implemented every day, just twice a week. I think with the growing concern of early onset OA preventing injuries that could increase risk as well as educating athletes about proper mechanics and warm up could lead to potential healthier quality of life later in life. I really like that study idea to follow those that do follow the prevention program and those that do not. I would imagine there would be a pretty drastic difference.
How do we get the word out to get these programs implemented at this level? How do we reach out to educate these parents and coaches on the benefits?