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Objective: The Fédération International de Football Association (FIFA) 11+ Referees Injury Prevention Program (FIFA 11+ Referees Program) is a structured warm‐up program specially designed to prevent injuries in soccer referees. However, its effectiveness has yet to be fully documented in the literature. Therefore, the purpose of this study was to investigate the effectiveness of the FIFA 11+ Referees Program in reducing injury rates among soccer referees. Methods: A randomized controlled trial was conducted. Two hundred male amateur soccer referees (mean ± SD age, 31.6 ± 4.1 years) participated in this study. Participants were randomly allocated to the experimental and control groups. The experimental group performed the FIFA 11+ Referees Program as a warm‐up during training sessions at least twice a week, and the control group performed their usual warm‐ups. The participants were followed up for one season. The outcome measures were the incidence of overall injury, initial injury, recurrent injury, injury mechanism, and injury severity (primary), and the rate of adherence to the intervention program (secondary). Results: A total of 24 injuries were reported among 100 referees in the control group in 16 606 h of exposure (1.45 injuries/1000 exposure h), and a total of nine injuries were reported across 100 referees within the experimental group in 17 834 exposure h (0.50 injuries/1000 exposure h). The Injury Risk Ratio (IRR) was 0.35 (95% CI 0.26–0.45). Conclusion: The results indicated that the FIFA 11+ Referees Program effectively reduced injuries in the experimental group by 65% compared to the control group. [ABSTRACT FROM AUTHOR]

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). [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: The FIFA 11+ injury prevention program has been shown to decrease the risk of soccer injuries in men and women. The program has also been shown to decrease time loss resulting from injury. However, previous studies have not specifically investigated how the program might impact the rate of anterior cruciate ligament (ACL) injury in male soccer players.Questions/purposes: The purpose of this study was to examine if the FIFA 11+ injury prevention program can (1) reduce the overall number of ACL injuries in men who play competitive college soccer and whether any potential reduction in rate of ACL injuries differed based on (2) game versus practice setting; (3) player position; (4) level of play (Division I or II); or (5) field type.Methods: This study was a prospective cluster randomized controlled trial, which was conducted in 61 Division I and Division II National Collegiate Athletic Association men's soccer teams over the course of one competitive soccer season. The FIFA 11+ is a 15- to 20-minute on-the-field dynamic warm-up program used before training and games and was utilized as the intervention throughout the entire competitive season. Sixty-five teams were randomized: 34 to the control group (850 players) and 31 to the intervention group (675 players). Four intervention teams did not complete the study and did not submit their data, noting insufficient time to complete the program, reducing the number for per-protocol analysis to 61. Compliance to the FIFA 11+ program, athletic exposures, specific injuries, ACL injuries, and time loss resulting from injury were collected and recorded using a secure Internet-based system. At the end of the season, the data in the injury surveillance system were crosshatched with each individual institution's internal database. At that time, the certified athletic trainer signed off on the injury collection data to confirm their accuracy and completeness.Results: A lower proportion of athletes in the intervention group experienced knee injuries (25% [34 of 136]) compared with the control group (75% [102 of 136]; relative risk [RR], 0.42; 95% confidence interval [CI], 0.29-0.61; p < 0.001). When the data were stratified for ACL injury, fewer ACL injuries were reported in the intervention group (16% [three of 19]) compared with the control group (84% [16 of 19]), accounting for a 4.25-fold reduction in the likelihood of incurring ACL injury (RR, 0.236; 95% CI, 0.193-0.93; number needed to treat = 70; p < 0.001). With the numbers available, there was no difference between the ACL injury rate within the FIFA 11+ group and the control group with respect to game and practice sessions (games-intervention: 1.055% [three of 15] versus control: 1.80% [12 of 15]; RR, 0.31; 95% CI, 0.09-1.11; p = 0.073 and practices-intervention: 0% [zero of four] versus control: 0.60% [four of four]; RR, 0.14; 95% CI, 0.01-2.59; p = 0.186). With the data that were available, there were no differences in incidence rate (IR) or injury by player position for forwards (IR control = 0.339 versus IR intervention = 0), midfielders (IR control = 0.54 versus IR intervention = 0.227), defenders (IR control = 0.339 versus IR intervention = 0.085), and goalkeepers (IR control = 0.0 versus IR intervention = 0.0) (p = 0.327). There were no differences in the number of ACL injuries for the Division I intervention group (0.70% [two of nine]) compared with the control group (1.05% [seven of nine]; RR, 0.30; CI, 0.06-1.45; p = 0.136). However, there were fewer ACL injuries incurred in the Division II intervention group (0.35% [one of 10]) compared with the control group (1.35% [nine of 10]; RR, 0.12; CI, 0.02-0.93; p = 0.042). There was no difference between the number of ACL injuries in the control group versus in the intervention group that occurred on grass versus turf (Wald chi square [1] = 0.473, b = 0.147, SE = 0.21, p = 0.492). However, there were more ACL injuries that occurred on artificial turf identified in the control group (1.35% [nine of 10]) versus the intervention group (0.35% [one of 10]; RR, 0.14; 95% CI, 0.02-1.10; p = 0.049).Conclusions: This program, if implemented correctly, has the potential to decrease the rate of ACL injury in competitive soccer players. In addition, this may also enhance the development and dissemination of injury prevention protocols and may mitigate risk to athletes who utilize the program consistently. Further studies are necessary to analyze the cost-effectiveness of the program implementation and to analyze the efficacy of the FIFA 11+ in the female collegiate soccer cohort.Level Of Evidence: Level I, therapeutic study. [ABSTRACT FROM AUTHOR]

The Functional Movement Screen™ (FMS™) is aimed at assessing fundamental movements and is often used to identify players’ injury risk. The purpose of this study was to determine whether the FMS™ can be used to predict injuries in veteran footballers (aged > 32 years). Eighteen veteran football teams (n = 238) were recruited and prospectively followed for 9 months. The players (44 ± 7 years; 178 ± 7 cm, 84 ± 11 kg) performed the FMS™ at the start of the study period. Players’ exposure hours and injuries were recorded. The difference of FMS™ overall score between injured and uninjured players was not significant (11.7 ± 2.9 vs 12.2 ± 2.8 points; Mann-Whitney U-testP = 0.17). Players scoring <10 (score < 1 standard deviation [SD]) below the mean) had a significantly higher injury incidence (z-statisticsP < 0.05) compared to an intermediate reference group (mean ± 1 SD; scores of 10–14). No lower injury incidence for players with scores of >14 (score > 1 SD above the mean) was found. Further analyses of potential risk factors suggest higher age, lower body mass and a longer football career to be risk factors for injuries. The findings of this study suggest that the suitability of the FMS™ for injury prediction in veteran footballers is limited. [ABSTRACT FROM PUBLISHER]

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). [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]