Effect of the FIFA 11+ injury prevention program in collegiate female football players over three consecutive seasons.

Magoshi H, Hoshiba T, Tohyama M, Hirose N, Fukubayashi T. Scand J Med Sci Sports. 2023 May 21. doi: 10.1111/sms.14379. Epub ahead of print.


Take-Home Message

Over 3 seasons, injury prevention programs effectively decrease lower extremity injuries, particularly those considered non-contact or moderate-severe.


Injury prevention programs reduce the risk of lower extremity injuries. However, most studies have only examined the effectiveness of these programs during a single season. It would be helpful to verify if these benefits persist if a team continues to perform an injury prevention program for multiple seasons. 

Study Goal

The authors conducted a nonrandomized controlled trial to investigate the effectiveness of an injury prevention program (FIFA 11+) to reduce the risk of injuries for up to 3 seasons among soccer teams in the Kanto University Women Football Association Division 1 (similar level to NCAA Division 1).


Four teams consented to perform the FIFA 11+ program for 20 minutes before practice 2-3 times per week. Three teams refused to consent to the program and represented the control group. Each team’s athletic trainer or physiotherapist recorded sport-related injuries, participation in practices/matches, and how often a team completed the FIFA 11+. The authors defined a sports-related injury as an injury that caused a player to miss at least one day of training or a match.


Compliance with the FIFA 11+ program was high (~88%). Compared to the other teams, the teams performing the FIFA 11+ program decreased the rate of new injuries in a season by 36 to 61% – especially for noncontact, moderate-severe, or lower extremity injuries. Teams performing the FIFA 11+ may experience better results each subsequent season (e.g., decreased rate of new injuries in season 2 vs. season 1), but this may be primarily because of the athletes that were on each team all three years.


This study adds to the many previous randomized clinical trials demonstrating that injury prevention programs reduce the risk of lower extremity injuries during a single season. This study does a nice job of identifying that injury prevention programs can be effective over 3 seasons, especially for the athletes who complete the program all three years. It would be interesting to see the incidence of injuries in male footballers and other sports associated with lower extremity injury. Furthermore, it would be helpful to confirm these results with a cluster randomized clinical trial with a larger sample size to verify that athletes who continuously perform the FIFA 11+ over several seasons experience more protective benefits each year. Based on this study, it is unclear if the benefits are because of the very high compliance rates (~88%), which likely is because teams actively decided to start the FIFA 11+ program rather than be randomized to perform the program. This highlights a major benefit of getting a team to buy into performing these programs.

Clinical Implications

Clinicians should recommend teams adopt injury prevention programs into weekly team activities.

Questions for Discussion

  1. Commonly, we hear about a lack of time or coach support for these programs as a barrier. What are some strategies we can implement to combat this issue?
  2. Would incidence remain low with a once-per-week approach if maintained in the off seasons?

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Written by Shelly Fetchen DiCesaro
Reviewed by Jeffrey Driban