A multinational cluster
randomized controlled trial to assess the efficacy of ‘11+ Kids’: A warm-up
programme to prevent injuries in children’s football
Rossler
R, Junge A, Bizzini M, Verhagen E, Chomiak J, aus der Funten K, Meyer T, Dvorak
J, Lichtenstein E, Beaudouin F, Faude O. Sports Med (2017).
Take Home
Message
: The ‘11+ Kids’, an injury
prevention warm-up program tailored for younger athletes, is effective in
reducing injuries in youth soccer by nearly 50%; but, compliance is a key
factor for optimal success.
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Injury
prevention for youth soccer is challenging because injury mechanisms and
athlete biomechanics and characteristics are different in those under 14 years
of age compared with adults. The development of ‘11+ Kids’
– a
modification of the FIFA 11+ used for adult soccer players – was designed to be
an injury prevention warm-up program for young athletes.  However, there is a lack of research on this
new injury prevention program. Hence, the researchers conducted a randomized
trial to evaluate the efficacy of ‘11+ Kids’ by comparing incidence of injuries
among clubs that represented 3 different age groups ([Under 9, Under 11, Under 13]
mean age=10.8) from four different European countries. The authors randomized
clubs into either a control or 11+ Kids group. The control group performed
their own regular warm-up program. The 11+ Kids group used the 15 to 20 minutes
‘11+ Kids’ program. The authors defined an “injury” as any physical complaint
during practices or games that resulted in any combination of the following: lost
playing time, prevented the athlete from finishing the practice or game, or
required the attention of the medical staff. Club coaches were responsible for
accurately reporting injury rates during the year-long study of nearly 4000
players over almost 295,000 hours of exposure. The study staff followed-up on
each injury with the parents to verify the injury and gain additional
information. The 11+ Kids group sustained 48% fewer overall injuries than the
control group, had a lower drop-out rate (7.6% versus 13.9%), and had nearly
half as many days lost to injuries (2026 days versus 4201 days). For severe
injuries, the researchers found that the protective benefit of ‘11+ Kids’ translated
into a 74% decrease when compared to the control group. The risk of injury
among highly compliant 11+ Kids teams (1-3 sessions/week) was half that of the
low compliance teams (< 1 session/week).
Healthy
children become healthy adults. The long-term benefits of sport participation
are well documented and keeping athletes of all ages injury-free contributes to
an overall healthy lifestyle that lasts long into adulthood. Focusing on injury
prevention, rather than injury recovery, in young athletes protects them from
long-term consequences of injury that may affect their activity levels long
after recovery. In the short term, clinicians and coaches working with young
athletes should recognize that a good injury prevention warm-up program can
mean the difference between having a full line-up of healthy athletes, a bench
filled with injured athletes, or large numbers of drop-outs due to injury.  For young athletes, being healthy means more
playing time. The ‘11+ Kids’ program offers a progressive-difficulty program
that addresses common areas where young athletes need intervention the most,
such as whole-body stability, dynamic stability of the lower extremity, and
motor control. Athletic trainers and coaches can use ‘11+ Kids’ to demonstrate
the importance of high compliance when using this program before practice to
reduce incidence of injuries, as well as reducing the risk of long-term consequences
of injury. While representative of the percentage of girls who participate in
soccer, a weakness the authors noted was the low numbers of girls and their
injuries in this study. Hence, it’s unclear if the benefits of this program can
be transferred equally between boys and girls. Overall, the ‘11+ Kids’ warm-up
program is efficacious in youth soccer for reducing injury rates. This is yet
another example showing that injury prevention programs can have a profound
effect on the number of injuries our teams experience.
Questions
for Discussion
: Since boys mature
differently than girls, should ‘11+ Kids’ be further tailored to the needs of
each gender separately?
Written
by: Catherine E. Lewis
Reviewed
by: Jeffrey Driban
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