Sports Medicine Research: In the Lab & In the Field: High Adherence to the FIFA 11+ Decreases Injury Risk Among Youth Female Soccer Players (Sports Med Res)


Wednesday, May 22, 2013

High Adherence to the FIFA 11+ Decreases Injury Risk Among Youth Female Soccer Players

High adherence to a neuromuscular injury prevention programme (FIFA 11+) improves functional balance and reduces injury risk in Canadian youth female football players: a cluster randomized trial 

Steffen K, Emery CA, Romiti M, Kang Jian, Bizzini M, Dvorak J, Finch CF, and Meeuwisse WH. Br J Sports Med. 2013; [Epub Ahead of print].

Take Home Message: High adherence to a neuromuscular injury prevention program like the FIFA 11+ decreases the risk of injury.

Injury prevention programs typically are multifaceted warm-up programs that focus on neuromuscular recruitment. Although various programs aim to improve performance and decrease injury risk no investigation has shown a link between improved physical performance and the quality and adherence of neuromuscular injury prevention training. Therefore, Steffen and colleagues completed a cluster-randomized trial to assess the influence of player adherence and delivery method of the FIFA 11+ injury prevention program (approximately 20 minutes, 15 exercises) on injury risk among females. The authors included 29 football clubs (226, female, ages 13-18 years) and excluded participants if they had an injury, systemic disease or neurological disorder. Teams were randomized into 1 of 3 groups: 1) “control group,” 2) “regular, coach focused intervention group,” or 3) “comprehensive, player-focused intervention group.” A description of the groups is provided in our other post describing this study but reported only the coach’s influence on team adherence and injury risk. Prior to randomization, all player participated in field-based performance test including single-leg eyes-closed balance on an Airex Balance Pad, the Star Excursion Balance Test, the single-leg triple hop, and the jump-over-a-bar test. The same testing procedure was also completed during the final 2-weeks of the season. In our previous post we noted that the “regular, coach focused intervention group,” and “comprehensive, player-focused intervention group” may have had slightly higher team adherence compared with the control group. These two groups also had better improvements in the Star Excursion Balance Test (anterior direction) compared with the control group, but no other performance improvements were different between groups. Players who highly adhered had improved balance, based on the Star Excursion Balance Test, but not any of the other performance tests. Finally, the athletes with high-adherence had a lower risk of injury compared to those of medium-adherence players and possibly the low-adherence players but there was not enough injured athletes to tell.

This study demonstrates the positive impact that a neuromuscular injury prevention program, particularly with good adherence, can have on an athlete’s performance and injury risk. Coach-led delivery methods for the FIFA 11+ influences overall team adherence with coaches who were more trained having greater team adherence. Players who had greater adherence to the injury prevention program had improved functional balance and were less likely to sustain an injury. Therefore, well trained coaches can deliver the injury prevention program and expect good adherence, which may promote improved balance and lower the risk of injury. Furthermore, if we communicate to our coaches that not only do these programs reduce the risk of injury but also improve performance (particularly functional balance) then this may further entice coaches and players to adhere to the program, thus optimizing the program’s benefits.

Questions for Discussion: Do you feel that training coaches on injury prevention programs would impact adherence, performance improvements, and injury risk? Why or why not?

Written by: Kyle Harris
Reviewed by: Jeffrey Driban

Related Posts:
Coaches Influence Team and Player Adherence to Injury Prevention Programs
The FIFA11+ Program Is Effective in Preventing Injuries in Elite Male Basketball Players
Coach-led Neuromuscular Warm-ups Reduce the Risk of Lower Extremity Injuries
Neuromuscular Training to Reduce ACL Injuries may be More Effective in Younger Athletes
The Effects of Neuromuscular Training on the Gait of ACL-deficient Patients

Steffen K, Emery CA, Romiti M, Kang J, Bizzini M, Dvorak J, Finch CF, & Meeuwisse WH (2013). High adherence to a neuromuscular injury prevention programme (FIFA 11+) improves functional balance and reduces injury risk in Canadian youth female football players: a cluster randomised trial. British Journal of Sports Medicine PMID: 23559666


Stephanie Huntsman said...

In light of many neuromuscular/ACL injury prevention programs that have emerged recently, as well as my experiences at a recent conference where a variety of these programs were discussed and evaluated, I believe this article brings up a number of excellent points. Providing a training protocol of sorts for coaches on these types of programs would be an excellent way to incorporate a very functional conditioning tool that also includes prevention. From the results of this study alone, it is unclear (as the author even stated) whether these coach and player run programs lowered injury risk; however, I cannot believe that there would not be a positive correlation between adherence (when the program is performed properly) and improvements, as well as a negative correlation between adherence and injury risk. From my own personal experience as an athlete, coach-monitored drills tended to be more successful and correctly performed than those mediated by players (Although, experienced players helping aid the less-experienced has shown, anecdotally, to work well and promote teamwork.)

Kyle said...


Great comment. I agree that one would imagine a correlation between adherence and improvements. Interestingly though, coaches do have influence over the adherence to such programs. You might find my previous post, "Coaches Influence Team and Player Adherence to Injury Prevention Programs" interesting. I'd love to hear your thoughts on that data.

Simon said...

The question you raise is an important one and I think relates to the standard and level of the sport participation.
For Fun and recreational sport the focus should always be on safe enjoyable fun.
However as the level of competition goes up, so does the risk of injury. It is a risk / reward offset.
Obviously health and safety is paramount and as professionals we need to promote this to the coaches and much as we can. But I feel the some coach will see the chance of injury against success as a risk they are willing to take.

Becca Burkhart said...

The fact that ACL injuries are extremely prevalent in sports it is surprising that more coaches are not expected to use ACL prevention programs. I think that it would be beneficial for coaches to be trained on injury prevention programs. These prevention programs will not only benefit the athletes, but the coaches as well. The number of players unable to play would decrease.It has been seen already that with high adherence to these prevention programs can decrease injuries. I'm curious of why there has not been more of a push for coaches to be trained? Also if coaches are trained in injury prevention programs what could be done to increase the teams adherence?

Brandon Green said...

The education of coaches in injury prevention can only yield positive results, especially if the players that are being coached are at a younger age. The athletes would in turn be educated in injury prevention and would consider the injury prevention program a certain norm when warming up for physical activity. One of the keys to having a successful career as a player or coach is to maintain a healthy team; having a injury prevention program that has proven positive results only provides an avenue in accomplishing that.

Kyle said...

Becca and Brandon,

Thanks for the excellent comments! I agree with you both. Training coaches in injury prevention programs has been shown in the literature to be effective in injury prevention. With that in mind it is easy to wonder why there is not more of a outward push for this. For a second though, let me play devil's advocate. What if the coach is trained in a specific injury prevention program but has no other training is sports medicine/kinesiology? Could this have a negative impact on the athletes? What if the coach is question is not making the correct adjustments to technique? Brandon, I believe it was your point that this may be especially effective for utilization in a younger population. I know when I was younger my father coached my sisters soccer team. While he was a dedicated coach, he was not a soccer player himself but took on the responsibility when not many others were willing. Would he be able to effectively implement, monitor and maintain an injury prevention program? I think my overarching question is with many different scenarios regarding coach's experience/expertise, access to a trained clinician, and varying levels of competition, should the push be for all levels to implement these programs or should clinicians be more selective in whom they target to implement them? I'd love to hear what your thoughts are. Thanks again for the great comments!

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