Sports Medicine Research: In the Lab & In the Field: The FIFA11+ Program Is Effective in Preventing Injuries in Elite Male Basketball Players (Sports Med Res)


Thursday, June 14, 2012

The FIFA11+ Program Is Effective in Preventing Injuries in Elite Male Basketball Players

The FIFA11+ Program Is Effective in Preventing Injuries in Elite Male Basketball Players: A Cluster Randomized Controlled Trial

Longo UG, Loppini M, Berton A, Marinozzi A, Maffulli N, & Denaro V. The American Journal of Sports Medicine. 2012; 40: 996-1005.

Basketball is a popular and competitive team sport across the world with injuries commonly occurring.  Across all sports, there has been a recent focus on warm-up programs designed to prevent injuries.  The purpose of this randomized cluster trial was to assess the effectiveness of a warm-up program involving running exercises, strengthing, balance, jumping and hamstring exercises, as well as speed training with sport specific changes in direction in elite male basketball players.  This warm-up program was previously proven to be successful in reducing the prevalence of injuries in a soccer population and the specific exercises can be found here.  Eleven elite men’s basketball teams (121 players) were randomized as a team to either the intervention (7 teams) or control group (4 teams).  The coaches and captains of the teams allocated to the intervention group were trained on how to perform a specific set of exercises that they would show their respective teams.  The control teams were instructed to warm-up as they normally would, and there was no standardization or instruction given to any of the control teams.  Injuries, body part, activity, and exposure hours were reported.  Throughout the course of the season, the intervention group had significantly lower overall injury rates (0.95 vs. 2.16), lower extremity injuries (0.68 vs. 1.4), training injuries (0.14 vs. 0.76), acute injuries (0.61 vs. 1.91) and severe (fracture) injuries (0 vs. 0.25) than the control group.

This study demonstrates that there are warm-up or training programs that can be introduced to help reduce the number of injuries that occur.  This is not uncommon territory for basketball athletes.  Injury (specifically ACL) prevention programs have commonly been attempted within various athletes.  It was interesting that they used the FIFA 11+ (which was previously found to be successful in female soccer players in reducing injuries) on a male basketball population. The FIFA 11+ was a modification of the FIFA 11, which was found to be successful at reducing injury rate among male soccer players.  It seems that there may be gender specific exercises that should be applied, which include an emphasis on the importance of avoiding knee collapse (into valgum) as well as soft landings and the introduction of controlled partner contact.  Knee collapse is often seen in the female population.  For instance, female basketball players are at a much higher risk for knee injuries, and as a result, this type of a program has the potential to be more beneficial in this population.  Interestingly enough, this study did not find any significant differences in ankle and knee injury rates between the two groups.  These are by far the two most common types of injuries suffered in a basketball population.  It is possible that these exercises were not specific enough to the functional activities that basketball athletes are performing when they suffer injuries.  These exercises may need to be further modified to be more appropriate for this specific population.  Clinically, it seems that the “warm up” has continually changed and evolved over time.  Enough time may not be dedicated to giving a certain program a chance to be modified/perfected in order to be effective.  Has anyone had any experiences using injury prevention programs with any of the teams that they work with clinically?  There is a significant amount of literature on the effectiveness of ACL prevention programs, but the answer does not seem clear.  What are your thoughts on whether a broader injury prevention program has the possibility to be effective in this population?
Written by: Nicole Cattano
Reviewed by: Stephen Thomas

Related Posts:

Longo, U., Loppini, M., Berton, A., Marinozzi, A., Maffulli, N., & Denaro, V. (2012). The FIFA 11+ Program Is Effective in Preventing Injuries in Elite Male Basketball Players: A Cluster Randomized Controlled Trial The American Journal of Sports Medicine, 40 (5), 996-1005 DOI: 10.1177/0363546512438761


Anonymous said...

Based off the given information I am doubtful as to the clinical usefulness of the findings in this research. A main reason for this is due to the fact that the warm up protocol was created for soccer players. While some exercises can pertain to the basketball populations not all exercises are sport specific for the given populations and therefore may not produce valid data. Also regarding exercise prescription, the control group was not offered any exercise program which may have created a placebo effect within the intervention group simply by completing a program compared to the control group.

Another question I have about the validity of this study includes how much control was implemented within this study. Did both groups wear the same prevention equipment? Did participants in each group have similar medical history regarding previous injuries? Equipment and previous history of injury can be strong predictors of future injuries.

While I am doubtful of the clinical implications of this study, I believe this study supports the need to further research the development of a sport specific warm up program for basketball players in order to reduce injuries.

Nicole Cattano said...

Thanks for your comments and you bring up some extremely valid points. The original intentions of the warm up program was originally created for soccer players. However, the exercises do not only apply to soccer activities. There are some dynamic agility activities as well as dynamic balancing activities that are very beneficial for many sports. Anyone should look at some of the exercises on the website and try to see the benefit and application to the basketball population. There may be some potential activites that could be modified or added based on the needs of a basketball population, however, there is definitely applicability to this group.

You make a great point about the lack of control group exercise program and the potential for a placebo effect. As well as the lack of reporting of use of preventive equipment or previous injury.

This study helps to set the stage for future studies, and I think gives a good idea of where to start in regards to the sport specific program for basketball players.

Aaron said...

I think you both make excellent points regarding the validity of this study, and I hope future research emerges pertaining to the effectiveness of the FIFA 11+ or other specific warm-up protocols.

I believe that there is a massive demand across many sports, both youth and elite level, for effective warm-up protocols. While certain aspects of the FIFA 11+ can be adapted for other sports, I feel its underlying purpose remains true and effective. It is too common in youth and high school sports to have improper and ineffective warm-up and conditioning routines. Improper form during exercises or poor compliance only increases the prevalence of injuries.

There are many potential longterm benefits for implementing something similar to the FIFA 11+, especially in youth sports. Teaching kids proper biomechanics when they are still learning the sport may improve longterm outcomes, which was mentioned as a limitation in the end of the article. That would make for a great study.

Zahida M said...

I agree with the fact that there was no regulation with braces and other protective equipment and that could have made a difference. However, I really like the direction the researchers are heading with this article. Like Aaron said, there is a need for preventative warm-up routines in all levels of athletics not just with elite athletes. I do not think the warm-ups necessarily need to be sports specific. I like this study for the reason that they took a soccer warm-up and used it on basketball players, because the broader the warm-up, the more useful it is. Youth athletes have been specializing in sports at younger and younger ages, which causes overuse issues. If they had a warm-up implemented that targeted broader concepts it would be very beneficial. I am excited to see where further research leads!

Nate said...

All very good points and counterpoints. Building off of what Aaron had mentioned about starting prevention programs at an early age; personally that is where I have seen the greatest effect. I do not have very much experience in prevention programs but just comparing the effects of a jump program on a girls high school basketball team vs a prevention warm-up for a high level division I soccer team the intervention at the high school level had a much more robust effect. I understand this is just one example but it would make sense. I also agree with Zihida that crosstraining is important in prevention programs. Just as the overload principle must be applied to facilitate strength gains I believe the prevention programs must take the athletes out of their comfort zones to prepare them for the unanticipated movements that could cause injury.

Nicole Cattano said...

Thanks to everyone for their comments! THis is a great conversation. I completely agree with all of you regarding the importance of early intervention. Nate, you stated it superbly in stating that the earlier that we start the intervention, the more robust of an effect we will have. Prevention is key! Youths seem to be participating in more organized sporting activities at younger and younger ages. It is critical that we address appropriate biomechanical developments earlier in life due to the increased risk from the increased exposure. A broad sweeping program would be ideal, however, I wonder if we know enough about what deficits exist? There have been plenty of ACL prevention research studies at the high school and collegiate levels, but perhaps we are not looking early enough when the poor biomechanical behaviors develop. It is very difficult to teach an "old dog new tricks" so I think you all are really thinking in the right direction. This line of research is exciting, but do you think we need more discovery of potentially hazardous tendencies prior to developing the intervention program?

Jake Marshall ATC CES said...

I would love to see injury prevention programs implemented in youth sports. Preferably even before high school. The problem being who is going to implement them? Very few are willing to pay to have some one come and teach these ideas to the kids. So should we be working more towards a coach education system? If any one who reads this lives in the Tacoma Seattle area I would love a chance to discuss this kind of stuff. I have been trying to develop a solid plan for implementation. I see this as an area that has a lot of potential for the growth. The whole Athletic Training profession could benefit from finding a way to jump on this before others do. I also believe there is a desire for this service out there if we can find a way to make it cost effective.

Nicole Cattano said...

Than you for your comment Jake-Your point about early intervention is of monumental importance. And I agree that this area has the potential for growth. I thing educating coaches about appropriate warm ups may be key. The other possibility is athletic training researchers focusing some attention here. I am in complete agreement about ATs needing to take own of this before others do. There are a lot of strength and conditioning people changing gears towards being "injury prevention specialists." I think it is critical for an AT to be involved in this process. Recently I had a coach that was approached by one of these specialists, and the specialist asked not to include the AT staff. This is just seems crazy in my opinion. I am on the east coast though, but would love to continue dialogue regarding what you may be involved in around your area.

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