by Aminah Emeran

Soccer is arguably the most popular sport globally, with an estimated 200 million players worldwide (1). There are many health benefits of playing soccer, including reducing the risk of type 2 diabetes and hypertension (2). Despite its health benefits, soccer also poses a significant risk of injury (3), particularly to areas such as the knee, ankle and thigh (4). These injuries are largely attributed to insufficient warm-ups, muscle fatigue and imbalance (5). A study conducted on the incidence of soccer injuries, showed that 15-20 injuries occurred per 1000 hours of match play, in players above 15 years old (6).

Because of the high incidence of soccer injuries worldwide, an injury prevention strategy for amateur players was developed in 2006, called the FIFA 11+. The FIFA 11+ comprises of a simple warm-up routine consisting of 15 exercises, that soccer players are to perform for a minimum of 2 times per week. The warmup requires minimal equipment, is available online and can be performed within 10-15 minutes (7).

 The FIFA 11+ prevention programme

Does the warmup reduce injury risk?

This question was answered by conducting trials that implemented the FIFA 11+ intervention into real life practice. These trials were then analysed in systematic reviews. The studies selected for review were implemented in a range of locations including North America, Europe, Asia and Africa, and tested male and female amateur players, with ages ranging from 15-45 years (7–10).

Overall results showed that implementing the FIFA 11+ warm-up for about 2 months, reduced the number of injuries in male and female amateur players between 13 and 25 years, by 30-39%. Studies also showed an improvement in motor and neuromuscular performance such as improved balance, increased quadriceps and muscle strength, speed and agility (7,8,10). The largest reduction in injury risk occurred when players adhered to performing the warm-up correctly. This was achieved with the help of supervision from coaches. Studies where little reduction in injury was seen, could be due to lack of compliance to the intervention and lack of guidance from coaches (7).

These results sound very promising. However, there are some limitations in the studies analysed. These include a risk of outcome bias that could result from the participants knowing that they were receiving the 11+ intervention, and the researcher knowing what group did and did not perform the intervention (9). Some studies also used different injury definitions, with some not even defining the type of injury analysed (8).

Despite these limitations, the warm-up has been successfully utilised in other sporting fields, such as basketball. It has also been endorsed by 20 FIFA Member Associations. Thus, given the high prevalence of soccer injuries sustained by amateur players, the FIFA 11+ intervention is recommended to reduce injury risk (7)(9).

References:

1. FIFA C. FIFA Big Count 2006: 270 million people active in football. FIFA Commun Div Inf Serv. 2007;31:1–12.
2. Krustrup P, Bangsbo J. Recreational football is effective in the treatment of non-communicable diseases. Br J Sports Med. 2015;49(22):1426–7.
3. Rahnama N, Reilly T. Injury risk associated with playing actions during competitive soccer. Br J Sport Med [Internet]. 2002;36:354–9. Available from: http://bjsm.bmj.com/
4. Price RJ, Hawkins RD, Hulse MA, Hodson A. The Football Association medical research programme: An audit of injuries in academy youth football. Br J Sports Med. 2004;38(4):466–71.
5. Ekstrand J, Hägglund M, Waldén M. Injury incidence and injury patterns in professional football: The UEFA injury study. Br J Sports Med. 2011;45(7):553–8.
6. Faude O, Rößler R, Junge A. Football injuries in children and adolescent players: Are there clues for prevention? Sport Med. 2013;43(9):819–37.
7. Barengo NC, Meneses-Echávez F, Ramírez-Vélez R, Cohen DD, Tovar G, Correa Bautista JE, et al. The Impact of the FIFA 11+ Training Program on Injury Prevention in Football Players: A Systematic Review. Int J Environ Res Public Heal [Internet]. 2014;11:11. Available from: http://www.mdpi.com/journal/ijerph
8. Thorborg K, Krommes KK, Esteve E, Clausen MB, Bartels EM, Rathleff MS. Effect of specific exercise-based football injury prevention programmes on the overall injury rate in football: A systematic review and meta-analysis of the FIFA 11 and 11+ programmes. Br J Sports Med. 2017;51(7):562–71.
9. Sadigursky D, Braid JA, De Lira DNL, Machado BAB, Carneiro RJF, Colavolpe PO. The FIFA 11+ injury prevention program for soccer players: A systematic review. BMC Sports Sci Med Rehabil. 2017;9(1):1–8.
10. Bizzini M, Dvorak J. FIFA 11+: An effective programme to prevent football injuries in various player groups worldwide – A narrative review. Br J Sports Med. 2015;49(9):577–9.