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Objectives: To investigate if the 11+ injury prevention programme decreases the risk of hamstring injury and improves recovery time and determine whether compliance with the 11+ affects hamstring injury risk., Methods: This study is a secondary analysis from a prospective cluster randomised controlled trial that included 65 National Collegiate Athletic Association (NCAA) division I and II men's soccer teams over the fall 2012 season. Thirty-one teams were randomised to the intervention group that were using the 11+ as their warm-up and 35 teams to the control group that continued to use their traditional warm-up. Each certified athletic trainer (ATC) collected data on demographics, hamstring injury (HSI), mechanism of injury, position, playing surface, time lost due to injury and compliance to the 11+ programme., Results: The 11+ decreased the risk of HSI by 63% compared with the control group (RR=0.37, 95% CI 0.21 to 0.63). Difference in return to play after HSI between the control (9.4±11.2 days) and intervention groups (10.2±11.3 days) was not significant (p=0.8). High compliance (>2 or more doses on average per week) reduced the risk of HSI by 78% (RR=0.22, 95% CI 0.06 to 0.87) compared with low compliance (<1 dose on average per week), and moderate compliance (1 to <2 doses on average per week) decreased the risk of HSI by 67% (RR=0.33, 95% CI 0.11 to 0.97) compared with low compliance. There was no significant difference between high and moderate compliance., Conclusion: The 11+ decreased the risk of HSI by 63% but did not improve recovery time. High to moderate compliance is essential and makes the programme more effective at reducing HSI., Competing Interests: Competing interests: The authors have not indicated any direct competing interests in conjunction with this manuscript. HS-G is a research consultant for Major League Soccer (MLS), National Football League (NFL) and the Aspetar Scientific Board. KT and MB both have editorial board positions with the British Journal of Sports Medicine., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The Fédération Internationale de Football Association (FIFA) 11+ Kids is an exercise-based injury prevention program developed by an international group of experts to prevent injuries among child soccer players., Hypothesis: It was hypothesized that the FIFA 11+ Kids program would be more effective than performing a typical warm-up regimen in reducing overall injuries among soccer players aged 7 to 13 years., Study Design: A clustered randomized controlled trial., Level of Evidence: Level 1., Methods: A total of 94 boys' soccer teams, including 780 players, were randomly allocated into an experimental or control group. Complete datasets were collected from 45 teams (377 players) and 43 teams (363 players) in the experimental and control groups, respectively. The experimental group underwent the FIFA 11+ Kids program as a warm-up during training sessions and matches at least twice a week, and the control group continued performing their usual warm-ups. Participants were prospectively followed during 1 season (6 months). The primary outcomes included the incidence of overall and recurrent injuries and their mechanism and severity. The secondary outcome was the rate of compliance with the intervention program., Results: A total of 43 injuries were reported in the experimental group in 50,120 hours of exposure (0.85 injuries/1000 exposure hours). A total of 86 injuries were reported in the control group in 42,616 hours of exposure (2.01 injuries/1000 exposure hours). The injury risk ratio was 0.43 (0.29-0.61), suggesting that the experimental group experienced 57% fewer injuries than those in the control group., Conclusion: The FIFA 11+ Kids program reduced overall injury rates in children playing soccer more than the usual warm-ups., Clinical Relevance: The results of this study provide evidence for children's coaches to consider including the FIFA 11+ Kids program in their warm-up regimen. Such a program may prevent injury risk and decrease absenteeism and injury-related financial burdens.

Objective: To provide consensus on how to plan, organize and implement exercise-based injury prevention program (IPP) in sports., Design: Delphi., Setting: LimeSurvey platform., Participants: Experienced sports physical therapists from the International Federation of Sports Physical Therapy member countries., Main Outcome Measures: Factors related to sports IPP planning, organization and implementation., Results: We included 305 participants from 32 countries. IPP planning should be based on an athlete's injury history, on pre-season screening results, and on injury rates (respectively, 98%, 92%, 89% agreement). In total 97% participants agreed that IPP organization should depend on the athlete's age, 93% on the competition level, and 93% on the availability of low-cost materials. It was agreed that IPP should mainly be implemented in warm-up sessions delivered by the head or strength/conditioning coach, with physical training sessions and individual physical therapy sessions (respectively, 94%, 92%, 90% agreement)., Conclusion: Strong consensus was reached on (1) IPP based on the athlete's injury history, pre-season screening and evidence-based sports-specific injury rates; (2) IPP organization based on the athlete's age, competition level, and the availability of low-cost materials and (3) IPP implementation focussing on warm-up sessions implemented by the strength/conditioning coach, and/or individual prevention sessions by the physical therapist., Competing Interests: Declaration of competing interest LDM, CR, CN, UB are on the IFSPT executive board. The other co-authors have none declared., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Synopsis: There is an absence of high-quality evidence to support rehabilitation and return-to-sport decisions following shoulder injuries in athletes. The Athlete Shoulder Consensus Group was convened to lead a consensus process that aimed to produce best-practice guidance for clinicians, athletes, and coaches for managing shoulder injuries in sport. We developed the consensus via a 2-round Delphi process (involving more than 40 content and methods experts) and an in-person meeting. This consensus statement provides guidance with respect to load and risk management, supporting athlete shoulder rehabilitation, and decision making during the return-to-sport process. This statement is designed to offer clinicians the flexibility to apply principle-based approaches to managing the return-to-sport process within a variety of sporting backgrounds. The principles and consensus of experts working across multiple sports may provide a template for developing additional sport-specific guidance in the future. J Orthop Sports Phys Ther 2022;52(1):11-28. doi:10.2519/jospt.2022.10952 .

Background: Soccer is one of the most popular sports worldwide. Goalkeepers are more likely to injure their upper limbs, particularly their shoulders, than outfield players. To reduce upper extremity injuries, the FIFA 11+ Shoulder Injury Prevention Program (FIFA 11+S) was developed., Purpose: The purpose of this study was to assess the effectiveness of the FIFA 11+S program in reducing the incidence of upper extremity injuries among amateur soccer goalkeepers., Study Design: Randomized controlled trial; Level of evidence, 1., Methods: A total of 726 goalkeepers, who were blinded to study intent, were randomly assigned to the experimental group (n = 360) or control group (n = 366). The experimental group was instructed to perform the FIFA 11+S program before all training sessions for 1 season (6 months). The control group was instructed to continue performing their usual routine warm-up program before training sessions for 1 season. Primary outcomes included the incidence of upper extremity injury and incidence of mechanism, type, and severity of injury measured using injury risk ratios (IRR); compliance with the experimental and control interventions was also recorded., Results: A total of 50 injuries (0.62 injuries per 1000 exposure-hours) were reported in the experimental group, and 122 injuries (1.94 injuries/1000 hours) were reported in the control group. The FIFA 11+S program reduced the total number of upper extremity injuries by 68% (IRR = 0.32 [95% CI, 0.27-0.34]) compared with the usual warm-up. The FIFA 11+S program reduced the incidence of contact injury (IRR = 0.30 [95% CI, 0.25-0.31]), noncontact injury (IRR = 0.40 [95% CI, 0.35-0.43]), initial injury (IRR = 0.34 [95% CI, 0.29-0.36]), recurrent injury (IRR = 0.20 [95% CI, 0.17-0.21]), and overuse injury (IRR = 0.40 [95% CI, 0.35-0.43]). Participants in the experimental group demonstrated a significant decrease in injuries of minor (IRR = 0.32 [95% CI, 0.27-0.34]) and moderate severity (IRR = 0.33 [95% CI, 0.29-0.35]) compared with the control group. We noted no difference in compliance between the experimental and control groups (80% vs 73%, respectively; P = .92)., Conclusion: The FIFA 11+S program resulted in 50% fewer upper extremity injuries among soccer goalkeepers, compared with a regular warm-up., Registration: ACTRN12618001080213 (Australian New Zealand Clinical Trials Registry).

Context: Injury prevention programs for the lower extremities are effective in team-sport athletes., Objective: To identify barriers and facilitators among professional ice hockey players and staff members for adhering to an injury prevention program., Design: Cross-sectional survey., Setting and Participants: A questionnaire about barriers and facilitators related to knowledge/perceptions, beliefs, adoption, and habits about injury prevention was filled out by Swiss professional male ice hockey players and staff members., Main Outcome Measures: Frequencies of ratings were calculated and binary logistic regression analysis was applied to predict a relationship between a high/low perceived benefit of an injury prevention program and player characteristics., Results: Knowledge, perceived benefit, and relevance of injury prevention as well as awareness of high risk of injuries in ice hockey were identified as important facilitators. Players' habit of exercise performance was identified as a barrier. Program understanding of staff members was identified as a facilitator and barrier. No significant relationships were observed between a high/low perceived benefit of an injury prevention program and age (P = .85), nationality (P = .53), level of education (P = .63), National League experience (P = .50), or occurrence of lower-extremity injuries in the previous season (P = .10)., Conclusions: Players and staff members clearly rated perceived benefits of an injury prevention program, which can be considered an important facilitator of the uptake and adoption of such a program in ice hockey teams. Players should be educated about well-performed injury prevention exercises. Staff members should be educated about the aim of a regular injury prevention program. An injury prevention program might be implemented in players of all ages, levels of education, and experience in the National League, irrespective of previous injuries. Identified barriers and facilitators should be addressed when implementing an injury prevention program in a setting of professional ice hockey teams in the future.

Epidemiological studies of injury in elite and recreational golfers have lacked consistency in methods and definitions employed and this limits comparison of results across studies. In their sports-generic statement, the Consensus Group recruited by the IOC (2020) called for sport-specific consensus statements. On invitation by International Golf Federation, a group of international experts in sport and exercise medicine, golf research and sports injury/illness epidemiology was selected to prepare a golf-specific consensus statement. Methodological stages included literature review and initial drafting, online feedback from the consensus group, revision and second draft, virtual consensus meetings and completion of final version. This consensus statement provides golf-specific recommendations for data collection and research reporting including: (i) injury and illness definitions, and characteristics with golf-specific examples, (ii) definitions of golf-specific exposure measurements and recommendations for the calculation of prevalence and incidence, (iii) injury, illness and exposure report forms for medical staff and for golfers, and (iv) a baseline questionnaire. Implementation of the consensus methodology will enable comparison among golf studies and with other sports. It facilitates analysis of causative factors for injuries and illness in golf, and can also be used to evaluate the effects of prevention programmes to support the health of golfers., Competing Interests: Competing interests: Author affiliations are provided in Appendix 1. Francois Gazzano is Chief Executive Officer (CEO) and founder of FITSTATS. Robert Neal is the CEO and founder of Golf BioDynamics., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: None declared.

Background: To assess the effects of the injury prevention programme '11+ Kids' on reducing severe injuries in 7 to 13 year old football (soccer) players., Methods: Football clubs (under-9, under-11 and under-13 age groups) from the Czech Republic, Germany, the Netherlands and Switzerland were cluster-randomised (clubs) into an intervention (INT) and a control group (CON). INT replaced their usual warm-up by '11+ Kids' two times a week. CON followed their regular training regime. Match and training exposure and injury characteristics were recorded and injury incidence rates (IRs) and 95% CIs calculated. For the present analysis, only severe injuries (absence from training/match ≥28 days) were considered. Hazard ratios (HR) were calculated using extended Cox models., Results: The overall IR of severe injuries per 1000 football hours was 0.33 (95% CI 0.25 to 0.43) in CON and 0.15 (95% CI 0.10 to 0.23) in INT. There was a reduction of severe overall (HR 0.42, 95% CI 0.24 to 0.72), match (0.41, 0.17 to 0.95) and training injuries (0.42, 0.21 to 0.86) in INT. The injury types that were prevented the most were: other bone injuries 66%, fractures 49% and sprains and ligament injuries 37%. Severe injuries located at the knee (82%), hip/groin (81%), the foot/toe (80%) and the ankle (65%) were reduced tremendously., Conclusions: '11+ Kids' has a large preventive effect on severe injuries by investing only 15 to 20 min per training session. The present results should motivate coaches to implement effective injury prevention programmes such as the '11+ Kids' in children's football., Trial Registration Number: NCT02222025., Competing Interests: Competing interests: RR, KadF, MB, JC, EV, AJ and OF were responsible for the conception of ‘11+ Kids’. MB, AJ and JD were involved in the conception of ‘The 11’ and ‘The 11+’., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Aim: Understanding the barriers to programme use is important to facilitate implementation of injury prevention programmes in real-word settings. This study investigated the barriers to coaches of adolescent female soccer teams, in Victoria, Australia, implementing the evidence-based FIFA 11+ injury prevention programme., Methods: Concept mapping with data collected from 19 soccer coaches and administrators., Results: Brainstorming generated 65 statements as barriers to 11+ implementation. After the statements were synthesised and edited, participants sorted 59 statements into groups (mean, 6.2 groups; range, 3-10 groups). Multidimensional scaling and hierarchical cluster analysis identified a six-cluster solution: Lack of 11+ knowledge among coaches (15 statements), Lack of player enjoyment and engagement (14), Lack of link to football-related goals (11), Lack of facilities and resources (8), Lack of leadership (6) and Lack of time at training (5). Statements in the 'Lack of 11+ knowledge among coaches' cluster received the highest mean importance (3.67 out of 5) and feasibility for the Football Federation to address (3.20) rating. Statements in the 'Lack of facilities and resources' cluster received the lowest mean importance rating (2.23), while statements in the 'Lack of time at training' cluster received the lowest mean feasibility rating (2.19)., Conclusions: A multistrategy, ecological approach to implementing the 11+-with specific attention paid to improving coach knowledge about the 11+ and how to implement it, linking the 11+ to the primary goal of soccer training, and organisational leadership-is required to improve the uptake of the 11+ among the targeted coaches., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objective: To identify which exercise combinations are most effective as part of a lower extremity injury prevention programme for team-sport athletes., Design: Umbrella review., Data Sources: A comprehensive literature search was performed in PubMed, Scopus, Cochrane Library and PEDro databases. Studies published between January 2000 and March 2017 were included in this umbrella review., Study Eligibility Criteria: Moderate to high-quality systematic reviews that investigated the effectiveness of a combination of two or more exercise components, that is, strength, agility, plyometrics, balance, stretching, technique, warm-up and functional activity, regarding injury incidence/rate of lower extremity injuries in team-sport athletes. The methodological quality of the included systematic reviews was independently assessed by two reviewers using the Assessing the Methodological Quality of Systematic Reviews measurement tool and the Grading of Recommendations Assessment, Development and Evaluation guidelines were used to assess the overall quality of evidence for particular outcomes., Results: Twenty-four systematic reviews met the inclusion criteria. Multicomponent exercise interventions were effective in reducing the injury incidence/rate of lower extremity, knee, ACL and ankle injuries, but not groin injuries. Strength and balance exercise components were included in 10 of 11 effective injury prevention programmes for the lower extremity, knee, ACL and ankle injuries., Summary/conclusion: Lower extremity injury prevention programmes in team sports are effective in preventing lower extremity, knee, ACL and ankle injuries. Lower extremity muscle strength and balance exercises should be prioritised in lower extremity injury prevention programmes for team-sport athletes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: None declared.

The Academy of Orthopaedic Physical Therapy and the American Academy of Sports Physical Therapy have an ongoing effort to create evidence-based clinical practice guidelines (CPGs) for orthopaedic and sports physical therapy management and prevention of musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability and Health (ICF). This particular guideline focuses on the exercise-based prevention of knee injuries. J Orthop Sports Phys Ther. 2018;48(9):A1-A42. doi:10.2519/jospt.2018.0303.

Purpose: The 11+ injury prevention program has been shown to decrease injury rate. However, few studies have investigated compliance and if it is correlated to time loss. The purpose of this study was to (1) analyze how differences in compliance may impact injury rate and (2) if compliance may impact time loss due to injury., Methods: This study was a Level 1 prospective cluster randomized controlled trial conducted in NCAA men's football (soccer) teams that examined the efficacy of the 11+ injury prevention program. The two outcome variables examined were number of injuries and number of days missed from competition. Twenty-seven teams (n = 675 players) used the 11+ program. Compliance, injuries and time loss were recorded. There were three compliance categories, low (LC, 1-19 doses/season), moderate (MC, 20-39 doses/season), and high (HC, > 40 doses/season)., Results: There was a significant difference among the groups for injuries, p = 0.04, p η 2  = 0.23. The LC group [mean (M) = 13.25, 95% confidence interval (CI) 9.82-16.68, injury rate (IR) = 10.35 ± 2.21] had a significantly higher injury rate than the HC group (M = 8.33, 95%CI 6.05-10.62, IR = 10.35 ± 2.21), p = 0.02. The MC group (M = 11.21, 95%CI 9.38-13.05, IR = 8.55 ± 2.46) was not significantly different than the LC group, p = 0.29, but was significantly greater than the HC group, p = 0.05. When examined as a continuous variable, compliance was significantly negatively related to injury rate (p = 0.004). It was also significantly negatively related to number of days missed (p = 0.012)., Conclusions: When compliance was high, there was a significant reduction in injury and time loss. This evidence reinforces the importance of consistent injury prevention program utilization. Clinically, these findings have important implications when discussing the importance of consistent utilization of an injury prevention protocol in sport., Level of Evidence: Level 1-Randomized controlled trial (RCT).

Objective: The objective of this study was to assess the efficacy of a newly developed warm-up programme ('11+ Kids') regarding its potential to reduce injuries in children's football., Methods: Children's football teams (under 9 years, under 11 years, and under 13 years age groups) from Switzerland, Germany, the Czech Republic and the Netherlands were invited. Clubs were randomised to an intervention group and a control group, and followed for one season. The intervention group replaced their usual warm-up by '11+ Kids', while the control group warmed up as usual. The primary outcome was the overall risk of football-related injuries. Secondary outcomes were the risks of severe and lower extremity injuries. We calculated hazard ratios using extended Cox models, and performed a compliance analysis., Results: In total, 292,749 h of football exposure of 3895 players were recorded. The mean age of players was 10.8 (standard deviation 1.4) years. During the study period, 374 (intervention group = 139; control group = 235) injuries occurred. The overall injury rate in the intervention group was reduced by 48% compared with the control group (hazard ratio 0.52; 95% confidence interval 0.32-0.86). Severe (74% reduction, hazard ratio 0.26; 95% confidence interval 0.10-0.64) and lower extremity injuries (55% reduction, hazard ratio 0.45; 95% confidence interval 0.24-0.84) were also reduced. Injury incidence decreased with increasing compliance., Conclusion: '11+ Kids' is efficacious in reducing injuries in children's football. We observed considerable effects for overall, severe and lower extremity injuries. The programme should be performed at least once per week to profit from an injury preventive effect. However, two sessions per week can be recommended to further increase the protective benefit., Trial Registration: ClinicalTrials.gov identifier: NCT02222025.

Deciding when to return to sport after injury is complex and multifactorial-an exercise in risk management. Return to sport decisions are made every day by clinicians, athletes and coaches, ideally in a collaborative way. The purpose of this consensus statement was to present and synthesise current evidence to make recommendations for return to sport decision-making, clinical practice and future research directions related to returning athletes to sport. A half day meeting was held in Bern, Switzerland, after the First World Congress in Sports Physical Therapy. 17 expert clinicians participated. 4 main sections were initially agreed upon, then participants elected to join 1 of the 4 groups-each group focused on 1 section of the consensus statement. Participants in each group discussed and summarised the key issues for their section before the 17-member group met again for discussion to reach consensus on the content of the 4 sections. Return to sport is not a decision taken in isolation at the end of the recovery and rehabilitation process. Instead, return to sport should be viewed as a continuum, paralleled with recovery and rehabilitation. Biopsychosocial models may help the clinician make sense of individual factors that may influence the athlete's return to sport, and the Strategic Assessment of Risk and Risk Tolerance framework may help decision-makers synthesise information to make an optimal return to sport decision. Research evidence to support return to sport decisions in clinical practice is scarce. Future research should focus on a standardised approach to defining, measuring and reporting return to sport outcomes, and identifying valuable prognostic factors for returning to sport., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Background: The Fédération Internationale de Football Association (FIFA) 11+ program has been shown to be an effective injury prevention program in the female soccer cohort, but there is a paucity of research to demonstrate its efficacy in the male population., Hypothesis: To examine the efficacy of the FIFA 11+ program in men's collegiate United States National Collegiate Athletic Association (NCAA) Division I and Division II soccer., Study Design: Randomized controlled trial; Level of evidence, 1., Methods: Before the commencement of the fall 2012 season, every NCAA Division I and Division II men's collegiate soccer team (N = 396) was solicited to participate in this research study. Human ethics review board approval was obtained through Quorum Review IRB. Sixty-five teams were randomized: 34 to the control group (CG; 850 players) and 31 to the intervention group (IG; 675 players). Four teams in the IG did not complete the study, reducing the number for analysis to 61. The FIFA 11+ injury prevention program served as the intervention and was utilized weekly. Athlete-exposures (AEs), compliance, and injury data were recorded using a secure Internet-based system., Results: In the CG, 665 injuries (mean ± SD, 19.56 ± 11.01) were reported for 34 teams, which corresponded to an incidence rate (IR) of 15.04 injuries per 1000 AEs. In the IG, 285 injuries (mean ± SD, 10.56 ± 3.64) were reported for 27 teams, which corresponded to an IR of 8.09 injuries per 1000 AEs. Total days missed because of injury were significantly higher for the CG (mean ± SD, 13.20 ± 26.6 days) than for the IG (mean ± SD, 10.08 ± 14.68 days) (P = .007). There was no difference for time loss due to injury based on field type (P = .341)., Conclusion: The FIFA 11+ significantly reduced injury rates by 46.1% and decreased time loss to injury by 28.6% in the competitive male collegiate soccer player (rate ratio, 0.54 [95% CI, 0.49-0.59]; P < .0001) (number needed to treat = 2.64)., (© 2015 The Author(s).)

The warm-up programme "FIFA 11+" has been shown to reduce football injuries in different populations, but so far veteran players have not been investigated. Due to differences in age, skill level and gender, a simple transfer of these results to veteran football is not recommended. The purpose of this study was to investigate the preventive effects of the "FIFA 11+" in veteran football players. Twenty veteran football teams were recruited for a prospective 9-month (1 season) cluster-randomised trial. The intervention group (INT, n = 146; 45 ± 8 years) performed the "FIFA 11+" at the beginning of each training session, while the control group (CON, n = 119; 43 ± 6 years) followed its regular training routine. Player exposure hours and injuries were recorded according to an international consensus statement. No significant difference was found between INT and CON in overall injury incidence (incidence rate ratio [IRR]: 0.91 [0.64-1.48]; P = 0.89). Only severe injuries reached statistical significance with higher incidence in CON (IRR: 0.46 [0.21-0.97], P = 0.04). Regular conduction (i.e. once a week) of the "FIFA 11+" did not prevent injuries in veteran footballers under real training and competition circumstances. The lack of preventive effects is likely due to the too low overall frequency of training sessions.

The aim of this study was to examine the training effects of an injury prevention programme on neuromuscular control, strength and performance in male amateur football players. Eighty-one players were allocated to the "FIFA 11+" (n = 42) or a control group (CON, n = 39). The "FIFA 11+" group performed the programme 3 times a week for 9 weeks; the control group completed the usual warm-up. Primary outcomes were: time-to-stabilisation test and eccentric/concentric flexors strength. Secondary outcomes were: eccentric/concentric extensors strength, star excursion balance test, core-stability test, vertical jump, sprint, and agility. After controlling for covariates, significant between-group differences after the intervention (in favour of the "FIFA 11+" players) were found for time-to-stabilisation (-2.8%, 90% confidence interval [CI] -4.4 to -1.2%) and core-stability (-8.9%, -14.6 to -3.1%). Differences were also found for eccentric (3.8%, 1.4 to 6.2%) and concentric flexors strength (3.2%, 0.6 to 5.9%) at 60° · s(-1) but this difference was only possibly meaningful (62.4%) from a practical point of view. No substantial and/or significant differences were found for the other outcomes. Performing "FIFA 11+" for 9 weeks can improve neuromuscular control. Possible worthwhile differences were found for flexors strength but there were no substantial effects in the other performance measures.

The aim of the study was to examine the post-exercise effects of the "FIFA 11+" on various physical performance and physiological variables, to understand whether this programme is an appropriate warm-up for football players. Results were compared with the literature using a meta-analytical approach. Twenty amateur male football players [mean age 25.5 (s ± 5.1) years, body mass 75(8) kg, height 181(6) cm] participated in the study. They were tested twice before (control period) and once after the "FIFA 11+" for: 20-m sprints, agility, vertical jump, stiffness, isometric maximal voluntary contraction (MVC), rate of force development (RFD), and star excursion balance test. Oxygen uptake, lactate and core temperature were also measured. Pre-post warm-up differences were found for all the performance variables (from 1.0 to 6.2%; 0.015 < P < 0.001) with the exclusion of MVC (-13%; P = 0.426) and RFD (-10%; P = 0.205). After the warm-up there was an increase (0.004

Background: In Switzerland, the national accident insurance company registered a total of 42 262 soccer injuries, resulting in costs of approximately 145 million Swiss francs (~US$130 million) in 2003. Research on injury prevention has shown that exercise-based programs can reduce the incidence of soccer injuries., Purpose: This study was conducted to assess the implementation and effects of a countrywide campaign to reduce the incidence of soccer injuries in Swiss amateur players., Study Design: Cohort study; Level of evidence, 3., Methods: All coaches of the Schweizerischer Fussballverband (SFV) received information material and were instructed to implement the injury prevention program "The 11" in their training of amateur players. After the instruction, the coaches were asked to rate the quality and the feasibility of "The 11." Before the start of the intervention and 4 years later, a representative sample of about 1000 Swiss soccer coaches were interviewed about the frequency and characteristics of injuries in their teams. Teams that did or did not practice "The 11" were compared with respect to the incidence of soccer injuries., Results: A total of 5549 coaches for amateur players were instructed to perform "The 11" in the training with their teams. The ratings of the teaching session and the prevention program were overall very positive. In 2008, 80% of all SFV coaches knew the prevention campaign "The 11" and 57% performed the program or most parts of it. Teams performing "The 11" had an 11.5% lower incidence of match injuries and a 25.3% lower incidence of training injuries than other teams; noncontact injuries in particular were prevented by the program., Conclusion: "The 11" was successfully implemented in a countrywide campaign and proved effective in reducing soccer injuries in amateur players. An effect of the prevention program was also observed in the population-based insurance data and health-care costs.

Objective: To analyze the extent and characteristics of injuries and musculoskeletal complaints in elite football referees and to analyze differences between match and assistant referees., Design: Retrospective cohort study., Setting: Training camp organized by the Swiss Referees Association., Participants: All 71 referees of the 2 top divisions of the Swiss Football League (2005-2006 season)., Interventions: The referees (66 males and 5 females) completed a questionnaire on their personal characteristics, referee qualifications, time spent in training and matches, career history of injuries, and musculoskeletal complaints caused by training or refereeing and were subsequently interviewed about the location, type, circumstances, and consequences of reported injuries., Main Outcome Measures: Incidence of injuries, frequency of musculoskeletal complaints, type of injuries, and complaints., Results: A total of 41 injuries during the career were reported by 31 of 71 referees (44%). Injuries were incurred more frequently in training than during matches, and all injuries reported resulted in at least 2 weeks of absence from sport. About a quarter of the referees reported an injury, and almost 90% of the referees reported musculoskeletal complaints caused by refereeing during the preceding 12 months. In male referees, hamstring strains and ankle sprains were the most common injuries, and the hamstrings, knee, Achilles tendon, and calf were the most prevalent locations of musculoskeletal complaints. No significant difference in the incidence of injury or in the frequency of complaints was observed between match and assistant referees., Conclusions: Future studies should be designed prospectively and should include a larger group of female referees. Regarding the incidence of injuries and frequency of musculoskeletal complaints related to refereeing, prevention programs for football referees should be developed, evaluated, and implemented.

Objective: To examine the effect of a comprehensive warm-up programme designed to reduce the risk of injuries in female youth football., Design: Cluster randomised controlled trial with clubs as the unit of randomisation., Setting: 125 football clubs from the south, east, and middle of Norway (65 clusters in the intervention group; 60 in the control group) followed for one league season (eight months)., Participants: 1892 female players aged 13-17 (1055 players in the intervention group; 837 players in the control group)., Intervention: A comprehensive warm-up programme to improve strength, awareness, and neuromuscular control during static and dynamic movements., Main Outcome Measure: Injuries to the lower extremity (foot, ankle, lower leg, knee, thigh, groin, and hip)., Results: During one season, 264 players had relevant injuries: 121 players in the intervention group and 143 in the control group (rate ratio 0.71, 95% confidence interval 0.49 to 1.03). In the intervention group there was a significantly lower risk of injuries overall (0.68, 0.48 to 0.98), overuse injuries (0.47, 0.26 to 0.85), and severe injuries (0.55, 0.36 to 0.83)., Conclusion: Though the primary outcome of reduction in lower extremity injury did not reach significance, the risk of severe injuries, overuse injuries, and injuries overall was reduced. This indicates that a structured warm-up programme can prevent injuries in young female football players., Trial Registration: ISRCTN10306290.

Background: Femoroacetabular impingement of the hip joint has been identified as a major cause for hip pain in athletes. Surgical open decompression of the hip has historically been proposed as the first treatment of choice. Functional outcomes in athletes after this procedure are unknown., Purpose: To describe the functional and sport-related outcome 2 years after open surgical hip decompression in a group of young professional ice hockey players suffering from cam femoroacetabular impingement., Study Design: Case series; Level of evidence, 4., Methods: Five young professional ice hockey players (mean age, 21.4 y at follow-up) who suffered from cam femoroacetabular impingement were treated with open surgical decompression of the hip. The operation was performed by the same surgeon, and all athletes followed the same rehabilitation guidelines. Mean follow-up time was 2.7 years. Outcome measures were recorded as time to regain symmetrical hip rotation, regain preoperative core/hip muscle strength, return to team practice, and play at competitive level., Results: Hip rotation range of motion was regained by a mean 10.3 weeks. Core and hip strength values reached preoperative levels by a mean 7.8 months. Return to unrestricted team practice with the ice hockey team was achieved by a mean 6.7 months, and athletes were able to play their first competitive game after a mean 9.6 months. Three athletes were able to perform again at the highest level and in international competitions. Two athletes had to return to minor league ice hockey., Conclusion: Return to high-level ice hockey after open surgical decompression of the hip was possible in this series of 5 consecutive cases.