Injury prevention programs that include balance training exercises reduce ankle injury rates among soccer players: A systematic review.

Al Attar WS, Khaledi EH, Bakhsh JM, Faude O, Ghulam H, Sanders RH, J. Physiother. 2022 July; 68(3):165-173.

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Take-Home Message

Soccer players have a lower risk of ankle injury if they perform an injury prevention warm-up program that includes balance compared to a standard warm-up.


Ankle injuries occur at every level of competition and represent 15% of high school and college athletic injuries. While there are many well-researched lower extremity injury prevention programs (e.g., FIFA 11, FIFA 11+), balance is often not a heavily focused portion. It is unclear if specifically targeting balance exercises can reduce the risk of ankle injuries.

Study Goal

The authors conducted a systematic review of randomized controlled trials to determine if injury prevention programs with balance training lower ankle injury rates among soccer players compared to standard warm-up programs.


The authors searched four databases for papers published between 1985 and 2020 that described randomized clinical trials comparing injury prevention programs with balance training exercises to a standard warm-up program among soccer players. They included studies if they provided the number of ankle injuries or rate of injury in addition to the number of hours training/competing.


The authors identified 9 randomized controlled trials with 9,633 soccer players of all ages and competition levels. Overall, injury prevention programs with balance training lowered the risk of ankle injuries by 36%. The authors found consistent results when examining balance-training only warm-up programs (41% reduction) or the FIFA 11 programs (37% reduction).


The authors found that injury prevention warm-up programs that include balance training can reduce the risk of ankle injuries. Five of the 9 trials focused on the FIFA11+ program, which includes strength, plyometrics, and balance exercises. Two trials assessed warm-up programs focused exclusively on balance. These studies showed similar benefits (33% and 40% reductions in injury rates). Most studies focused on male soccer players who benefited from these warm-up programs. However, one large trial found that these programs may not be as effective for adolescent female soccer players. It would be helpful to explore further how these programs influence male and female soccer players and if the benefits of these programs vary by age or competition level

Clinical Implications

Clinicians should encourage soccer teams to incorporate balance exercises into their warm-up programs to reduce the number of ankle injuries. Teams could consider using standardized 10-15 minute injury prevention warm-up programs that include balance training.

Questions for Discussion

Do your typical warm-up’s tend to emphasize balance, or do you lean towards more flexibility, strength, or stability-based programs?

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