Effectiveness of an injury prevention
programme for adult male amateur soccer players: a cluster-randomized
controlled trials trial

Beijsterveldt AMC, van de Port IGL, Krist MR, Schmikli SL, Stubbe JH, Frederiks
JE, Backx FJ. Br J Sports Med. 2012, Epub Ahead of Print.

Incidence of
injuries in soccer is among the highest of all team sports. FIFA developed an exercise program, called the 11, that focuses on injury
prevention. This program has been tested among younger soccer players but not
among male adults, which represents a large number of soccer players.
Therefore, van Beijsterveldt and
colleagues completed a cluster-randomized controlled trial to
investigate the effectiveness of The 11 program to reduce the incidence and
severity of injuries among adult male amateur soccer players.
High-level amateur soccer teams from
two regions in the Netherlands were invited to participate in the study. The included
players were male and between 18 and 40 years old. In general, all teams had
2-3 practices and 1 match per week. A total of 487 players (on 23 teams) were
randomized by team (241 players among 11 teams in the intervention (The 11
program) group, 246 players among 12 teams in control group). During the
2009-10 season all of the coaches, whose team was in the intervention group,
were instructed to incorporate The11 into the warm-ups of practices at least
twice a week. Exercises took approximately 10-15 minutes for the teams to
perform and the exercises included core stability exercises, eccentric
exercises for the thigh muscles, proprioceptive training, dynamic
stabilization, and plyometric exercises. Coaches were trained in applying The 11
by the research staff, received various supplemental materials (DVD’s, posters,
etc.), and attended a familiarization session prior to the start of the season.
Throughout the season, researchers visited each team every month to monitor the
implementation of the program. During the 2009-10 season, each individual’s
exposure to soccer was recorded by the coaches and any injuries were recorded
by that team’s medical coverage. Following the intervention season, a total of
31 players (18 intervention, 13 control) were lost to follow-up. The
investigators analyzed the data from the remaining players and reported a total
exposure time of 44,252 hrs and 427 injuries during the season. Overall, the total
injury incidences between the two groups were not significantly different (intervention
group: 9.6 injuries per 1000 hrs, control group: 9.7 injuries per 1000 hrs).
There was also no difference between groups in regards to injury severity. There
was some evidence that the incidence of knee injuries may have been lower in
the intervention than the control group.

Overall, this
study presents an interesting view into injury prevention among soccer players.
 While this study showed that
implementing The 11 program into the warm-ups of high-level amateur male soccer
players did little to affect the injury incidence or severity, it had some
evidence of decreasing the number of knee injuries. Unfortunately, no study has
shown a similar affect among a female population, which is interesting in
itself. Why has this program not had an effect on the female soccer population?
Conceivably, The 11 should show some injury prevention in this population as it
encompasses the type of exercises which are used in female anterior cruciate
ligament (ACL) injury prevention programs (proprioception, plyometrics, etc.). If
this program does not work among females, this would be particularly important
for clinicians to know. Perhaps a study comparing The 11 to an ACL rupture
prevention program would also be clinically helpful. It would also be
interesting to record more detail regarding specific diagnosis of injuries
occurred rather than categorizing by anatomic location or severity by time lost
to injury. Do you have any experience with The11? Have you noticed less knee
injuries after implementing an injury prevention warm-up program like The 11?

Written by:
Kyle Harris
Reviewed by:
Jeffrey Driban

Related Post:

van Beijsterveldt AM, van de Port IG, Krist MR, Schmikli SL, Stubbe JH, Frederiks JE, & Backx FJ (2012). Effectiveness of an injury prevention programme for adult male amateur soccer players: a cluster-randomised controlled trial. British Journal of Sports Medicine PMID: 22878257