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