of specific exercise-based football injury prevention programmes on the overall
injury rate in football: a systematic review and meta-analysis of the FIFA 11
and 11+ programmes

Thorborg K, Krommes KK,
Esteve E, Clausen MB, Bartels EM, Rathleff MS. Br J Sports Med. 2017
Apr;51(7):562-571. doi: 10.1136/bjsports-2016-097066. Epub 2017 Jan 13.

Home Message: The FIFA 11+ program reduces injury rates in recreational and
sub-elite soccer players.

There are a variety of
training programs to prevent injury in athletics, particularly in soccer. Many
of these programs target anterior cruciate ligament (ACL) injury prevention but
these programs are also able to reduce the risk of injury in general. The FIFA
Medical Assessment and Research Centre (F-MARC) created the FIFA 11 and 11+
programs to reduce injury and allow for continued participation in soccer.
While various investigators have implemented these programs, their effects on
injury have been conflicting. Therefore, the authors conducted a meta-analysis
to pool data from individual studies to increase our ability to precisely
estimate the possible effects of these programs. Initially, the authors
identified 4,842 results and screened them for eligibility. Six studies met the
inclusion criteria of being randomized control trials or cluster randomized
control trials that compared FIFA injury prevention programs with a control (no
intervention or sham intervention). Two of the studies used the FIFA 11 program
and four studies used the revised FIFA11+ program, which is expanded and more detailed regarding exercise
inclusion and progression. The pooled results of all six studies showed that
the programs offered a 25% reduction in injury. The authors also looked at the
studies with the FIFA 11 and 11+ separately.  Trials with the FIFA 11+ program resulted in a
39% decrease in injury compared with the FIFA 11 program that resulted in no
decrease in injury.  Specifically, the
FIFA 11+ program reduced the number of injuries at the hamstrings by ~60%,
hip/groin by ~41%, knee by ~48%, and ankle by 32%. These positive effects on
injury reduction were achieved even though < 15% of teams completed the
recommended frequency of at least two sessions per week.

The FIFA 11+ program is a
more complete program from several perspectives than the original FIFA 11. The 11+
program offers greater detail with a variety of strength, plyometric, running
and agility drills, as well as exercise progression. While it is not surprising
that the more complete FIFA 11+ is more effective it is interesting that the
magnitude of change between the FIFA 11 and FIFA 11+ programs was so large. While
these authors show that implementing the FIFA 11+ program can be beneficial in
reducing soccer-related injuries the study did not examine effects on specific
types of injury. This limitation is important as ACL injury prevention is often
thought of when looking at injury prevention programming due to the large
expenses and time lost from these injuries as well as modifiable risk factors
of non-contact injuries. Regardless, the authors definitively show positive
effects on injury and the benefits of FIFA 11+. The program is beneficial even
though only a few teams met the recommended frequency of twice per week for the
program. Hence, we may be underestimating the amount of injury reduction that
we could achieve with improved compliance. Ultimately the results of the
meta-analysis provide strong evidence that FIFA 11+ programming should be
widely adopted. The vast numbers of youth and adolescents participating in
soccer provides a great opportunity for implementation of this program and the
ability to successfully impact injury and prolong participation.

for Discussion: What effect does the program instructor have on compliance,
exercise performance, and effectiveness; i.e. does implementation by sport
coach/parents have the same effect as direction from professionals (AT, PT,
Strength Coach)? Can future studies with improved compliance show an even larger reduction in

Written by: Adam Lake
Reviewed by: Jeffrey

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Thorborg, K., Krommes, K., Esteve, E., Clausen, M., Bartels, E., & Rathleff, M. (2017). Effect of specific exercise-based football injury prevention programmes on the overall injury rate in football: a systematic review and meta-analysis of the FIFA 11 and 11+ programmes British Journal of Sports Medicine, 51 (7), 562-571 DOI: 10.1136/bjsports-2016-097066