Sports Medicine Research: In the Lab & In the Field: Coaches Influence Team and Player Adherence to Injury Prevention Programs (Sports Med Res)


Wednesday, April 24, 2013

Coaches Influence Team and Player Adherence to Injury Prevention Programs

Evaluation of how different implementation strategies of an injury prevention programme (FIFA 11+) impact team adherence and injury risk in Canadian female youth football players: a cluster-randomized trial

Steffen K, Meeuwisse WH, Romiti M, Kang J, McKay C, Bizzini M, Dvorak J, Finch C, Myklebust G, and Emery CA. Br J Sports Med. 2013; [Epub Ahead of Print].

Take Home Message: Coaches who are well trained to implement injury prevention, warm-up programs are as effective as the supervision of a physiotherapist at training sessions.

Injury prevention programs typically are multifaceted warm-up programs which focus on neuromuscular recruitment. While many programs exist it is difficult to assess their efficacy due to varying levels of adherence to the injury prevention program. Therefore, Steffen and colleagues completed a cluster-randomized trial to determine if implementation strategies of an effective injury prevention program influenced adherence and injury risk among female youth soccer teams. The authors’ goal was to optimize both team and player adherence to the injury prevention program. A total of 29 football clubs (285 athletes, ages 13-18) were included. The authors’ excluded athletes if they had an injury, systemic disease, or neurological disorder. Teams were randomized into 1 of 3 groups; “unsupervised control group,” “regular, coach focused intervention group,” or “comprehensive, player-focused intervention group.” All groups completed the FIFA 11+ injury prevention program (approximately 20 minutes, 15 exercises). Coaches from the “unsupervised control group” were provided with the details of how to perform the 11+ but no additional details were given. Conversely  coaches in the “coach-focused intervention group” attended a preseason 11+ workshop with the research team and had access to the 11+ material on the website (posters, DVD’s, etc.). In the “comprehensive, player-focused intervention group” a physiotherapist assisted the coach in implementing the 11+ program. The physiotherapist attended training sessions weekly to implement correct technique and progression. Teams implemented the 11+ program over the course of 1 season (April to August) and chose a team designate to be responsible for exposure data (player attendance, number of 11+ sessions, number of 11+ exercises performed, etc.). Team designates also recorded injury exposure and injury severity data. Overall, the “regular, coach focused intervention group,” and “comprehensive, player-focused intervention group” may have had slightly higher team adherence (12% and 18%, respectively), when compared with the control group. The injury incidence rate ratios were not different between study groups, but there was a hint that higher adherence may reduce the risk of injury. Further, most injuries were considered to be mild resulting in no more than 7 days before a return to play.

This study presented clinicians with an interesting look at team and player adherence in terms of implementing a comprehensive neuromuscular warm-up program like the 11+. The data of this study may suggest that a coach workshop, detailing proper technique and succession of the program, can improve team and player adherence. Interestingly, this was no more successful than the regular presence of a physiotherapist at training sessions. This finding is of particular interest and may suggest that coaches, educated in program technique, can be as effective as clinicians when implementing injury prevention, warm-up programs. The key, however, will still ultimately lie in the hands of the clinicians, as they will be the ones educating the coaches.. Therefore, it  may be advantageous for clinicians to attend continuing education on how to best communicate and teach injury prevention programs to coaching staffs. Conceivably, cooperation between the clinician and coaching staff could optimize adherence to injury prevention programs, allowing the clinician to focus on other aspects of patient care. Tell us what you think. Do you try to educate and utilize your coaching staff in the implementation of injury prevention programs? Do you feel comfortable with the level of training they receive and their ability to carry out these programs?

Written by: Kyle Harris
Reviewed by: Jeffrey Driban

Related Posts:

Steffen K, Meeuwisse WH, Romiti M, Kang J, McKay C, Bizzini M, Dvorak J, Finch C, Myklebust G, & Emery CA (2013). Evaluation of how different implementation strategies of an injury prevention programme (FIFA 11+) impact team adherence and injury risk in Canadian female youth football players: a cluster-randomised trial. British Journal of Sports Medicine PMID: 23486935


Nicole Cattano said...

Great post Kyle. I think it is really important to get coaches "buy in" on any interventions that we may be attempting to do. I think the concern at the collegiate level may be does this mandatory program count against their contact hours per week. There have been a few coaches that I've worked with who wouldn't want to "waste counted practice time" on something like this. Any advice on how to effectively combat this?

Kyle said...

Nicole, great comment. I agree that coaches need to "buy in" to what we as clinicians are trying to accomplish and how we are planning to go about that. Your point about contact hours is very interesting. Firstly, I think the most effective way to combat this is to try and prevent it. Good, clear and consistent communication will be key. In my experience, I try to focus on the "why" a treatment will be helpful rather than the "what" I am going to do. This helps the coach see that I understand their restrictions and that I am trying to take them into account. Secondly, I try with all my athletes to communicate with the coach and try to figure out how the athlete can stay involved with practice and drills without sacrificing treatment. This isn't always easy to do but at times it can go a long way with coaches "buying in." Hopefully once a good line of communication is open and working coaches will be more willing to trust the clinician. In your past experiences how have you, or your colleagues handle these issues? Would you say that there was already good lines of communication open?

Kelsey Croak said...

I think this post really illustrates the importance of working with coaches instead of just alongside them in athletics. The sports medicine staff functions as a team, not as individuals. One person is not capable of carrying out all of the roles necessary for proper care and injury prevention. Clinicians need to utilize everyone possible, especially coaches, to implement proper injury prevention programs. I believe that by educating coaches on proper protocol for injury prevention programs and making sure they understand why it is important is the key to successful implementation. Coaches want the best for their athletes just as clinicians do and I believe that they would be willing to put in the extra time and effort if they understood why they were doing it and how it would benefit their athletes.

Kyle said...


Thanks for the comment. I couldn't agree more. I agree with your point that coaches understanding "why" certain strategies are important is the key. Perhaps we as clinicians need to expand our focus on who needs to be properly educated with regard to the treatment we give. We understand fully the impact that good communication and explanation have on our patients, and in some cases the parents of those athletes, yet coaches may not always fall under those we seek to educated. Perhaps this is due to the coaches already being involved as a member of the sports medicine team. Regardless of the reason why, clinicians should be of the mindset that just because someone is a member of our sports medicine team, they may not fully grasp the "why." This then becomes our duty to the team to educated and communicate our thoughts, and evidence behind our decisions. Hopefully this will not only eliminate any miss-communication that may occur, but further enhance how the other members of your sports medicine team view us.

Franki said...

Great post!! Educating coaches on current evidence based practices that can improve the health and well-being of their team is essential. Too many coaches get "stuck in the way its always been done" because that is what has worked for them in the past. This is not always the best way! I am not sure how many coaches would comply to mandatory instruction session but it is still a good idea in theory. The athletes would receive the best care and get the most out of their sport if their coaches, strength and conditioning staff and their medical staff were working together to stay relevant and up to date on current practices and standards.

Kyle Harris said...


I couldn't agree with your comment more. I agree that some coaches can become "stuck in their way." What I have tried to do with coaches that I feel are reluctant to try something new is that the mentality of "that's the way its always been done" has no implication on if it it the best thing for the success of their athlete and the team. Sometimes they see that my goal is really the same as theirs, optimizing an athlete's potential. This often will get a coach interested in what I am suggesting enough to begin dialogue. Is this something that you have run into? What have you done to try and mitigate this?

Kaitlyn Kelly said...

Great post Kyle! As an athlete I agree that sometimes coaches don,t want to change their old coaching habits. I also know that sometimes they think doing strength and conditioning work at practice could be wasting their practice time. I do feel that they should have to all go through mandatory instruction sessions. This would not only help the athletes but in turn help the coaches because hopefully with a program like this there would not be as many injuries. I also think that school who have the resources of Strength and Conditioning coaches would also benefit from something like this instead of worrying about injury prevention strength and conditioning they could focus on other important aspects such as increasing strength, speed and agility.
Thank you

Marisa Rizzo said...

Great post kyle, I really believe that getting the coach on your side is huge! Being an athlete myself i have had many coaches over the years, some who a willing to work with the athletic training staff and others who think they are just their to keep there kids off the field. I really think that more coaches should be open to the fact of learning new things about training and the body because science changes everyday as well as what is recommended for training so by them continuing their education with it can be very beneficial.

Marisa Rizzo

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