The FIFA 11+ Shoulder Injury Prevention Program Was Effective in Reducing Upper Extremity Injuries Among Soccer Goalkeepers: A Randomized Controlled Trial

Shoulder injuries in amateur soccer players. An exploratory cross-sectional survey

OBJECTIVES

To investigate the prevalence, incidence of players reporting shoulder injuries in a non-probability sample of Italian amateur soccer players. We also wanted to explore the characteristics of injuries, predictive factors and differences between men's and women's leagues.

DESIGN

Cross-sectional study.

SETTING

Anonymous online survey.

PARTICIPANTS

Adult athletes playing on a first team of the Italian National Amateur Soccer League.

MAIN OUTCOME MEASURES

Period prevalence, incidence, and characteristics of players reporting shoulder injuries over a soccer season.

RESULTS

Fifty-one out of 431 respondents reported shoulder injuries. The pooled period prevalence was 12.0% (95%CI [9, 15]), with an incidence of .46 (95%CI [.35, .60]) injured/1000 h of players exposure. Goalkeepers were more likely to be injured than outfield players (OR 5.15, 95%CI [2.27, 11.25]). The injury type stated was mainly contusion (n = 22, 43.1%). Among those reporting injuries, thirty-four (66.6%) respondents stated 0-7 days as time loss from sport activity, with no significant difference due to role (p=.161) CONCLUSIONS: Shoulder injuries have a relatively low impact on the participation of adult amateur players in soccer activities. Technical and medical staff need to monitor players after an injury to the shoulder in order to provide appropriate training, prevention of complications and educational programs.

The FIFA 11+ injury prevention program reduces the incidence of lower extremity injuries in football players: a systematic review and meta-analysis

INTRODUCTION

The FIFA 11+ preventive program is designed to reduce the incidence of injury in sports. However, to gain a better understanding of its effect a systematic review and meta-analysis is needed. The current review aims to investigate the effect of the FIFA 11+ preventive program on injury incidence among male and female football players.

EVIDENCE ACQUISITION

This study used Scopus, PEDro, SPORTDiscus, and ProQuest as data sources. The initial selection of the studies, thorough assessment of the tile, and abstract. Extraction of the necessary study data was conducted by two independent researchers. Another two independent researchers assessed the quality of each included study against 39 used criteria. These criteria were combined from several popular quality assessment scales. The incidence of injuries measured in the lower extremities in football players after addressing the FIFA11+ was the outcome of interest.

EVIDENCE SYNTHESIS

This review included 12 trials of variable methodological quality from which 10 trials were selected for the meta-analysis. In general, the FIFA11+ program showed a significant reduction (P<0.1) in lower limb injury incidence for male young and adults in comparison to other programs. However, evidence of its effectiveness in females is lacking and more studies are needed.

CONCLUSIONS

The FIFA 11+ program is recommended to be used and implemented as a preventive strategy in males. Although, the result showed a significant reduction in injury incidence in adult males, heterogeneity between studies is high which may reduce the generalizability of the results. More studies are needed to investigate the effect of the FIFA 11+ program on females.

Effectiveness of FIFA 11+ Injury Prevention Programs in Reducing Head and Neck Injuries, Including Concussion, Among Soccer Players: A Systematic Review and Meta-Analysis

The Federation Internationale de Football Association (FIFA) 11+ and 11+ Kids injury prevention programs have shown success in reducing overall injury risk in soccer players, yet their specific impact on head and neck injuries remains inadequately explored.

PURPOSE

To evaluate the effectiveness of FIFA 11+ and 11+ Kids injury prevention programs in reducing the incidence of head and neck injuries among soccer players.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 2 investigators independently conducted searches in databases (Cochrane Library, PubMed, Web of Science, and PEDro) using keywords like "FIFA 11+," "football," "soccer," and "injury prevention." Only randomized controlled trials assessing FIFA 11+ programs in soccer players were included. Data analysis used the random effects model with RevMan Meta-Analysis software (version 5).

RESULTS

Among 397 studies, 4 met inclusion criteria. Pooled results from 7109 players and 532,341 exposure hours indicated a significant 40% reduction in head and neck injuries per 1000 hours of exposure in the intervention group compared to the control group (injury risk ratio 0.60, 95% CI, 0.41-0.88).

CONCLUSION

Implementing FIFA 11+ injury prevention programs significantly reduces the risk of head and neck injuries in soccer players, offering a compelling alternative to traditional warm-ups. This study contributes valuable evidence for optimizing injury prevention strategies in soccer training regimens.

Systematic video analysis of shoulder dislocations in professional male football (soccer): Injury mechanisms, situational and kinematic patterns

Purpose

Shoulder dislocations in professional football are severe injuries with an increasing incidence and considerable layoff times. Unlike other football injuries, the mechanisms leading to shoulder dislocations are not well understood, which limits the development of targeted preventive measures. Thus, the aims of this study were: (1) to analyse injury mechanisms of shoulder dislocations in professional football, (2) to evaluate situational and (3) to assess kinematic patterns by performing a systematic video analysis.

Methods

The study included all shoulder dislocations occurring in official matches within Germany's top two professional male football (soccer) leagues (1. and 2. Bundesliga) from the 2012/2013 to the 2022/2023 seasons. A systematic video analysis was performed using the official Bundesliga video database. Two independent reviewers assessed injury-related, situational and kinematic parameters.

Results

A total of 37 shoulder dislocations in 36 players (mean age 25 years) were analysed. Two primary injury mechanisms were identified: Type 1 mechanisms, caused by direct contact to the upper extremity (n = 14), and Type 2 mechanisms, caused by catching a fall (n = 22). Only one case did not fit these categories. Median layoff times were 94 days for Type 1 and 56 days for Type 2, but this difference was not statistically significant. Statistically significant differences between the two types were found in player action (p < 0.001) and type of contact (p = 0.005), while factors like player's speed, movement direction, football-specific actions, ball possession and pitch location showed no statistically significant differences. On-field treatment methods varied, but there were no statistically significant differences in repositioning attempts or reduction techniques (n.s.). Trunk position, shoulder joint version, shoulder elevation, and rotation, as well as elbow and wrist joint positions at the moment of dislocation, were similar between the two types (n.s.).

Conclusion

Shoulder dislocations in professional football typically occur through direct contact or catching a fall, indicating a potential role for specific preventive measures.

Level of Evidence

Level III.

Guide to Muscular Injuries and Common Ligamentous Injuries Among Soccer Players

With over 250 million players worldwide, soccer is the most popular sport in the world. The overall number of players at professional, amateur, and recreational levels has increased along with an increase in player diversity, including age and sex. These increases in player numbers, as well as a variety of demographics, have resulted in an increase in soccer-related injuries. Injury in the professional setting can lead to time off the field and an effect on team results and earnings. Injury at the amateur and recreational levels can lead to time off work, away from other activities, and change in activities of daily living. We provide an extensive list of common injuries sustained by soccer players, their pathophysiology, diagnosis, treatment, and general guidelines on return to play.

Effect of supervision and athlete age and sex on exercise-based injury prevention programme effectiveness in sport: A meta-analysis of 44 studies

We aimed to evaluate the influence of supervision, athlete age and sex and programme duration and adherence on exercise-based injury prevention programme effectiveness in sport. Databases were searched for randomized controlled trials evaluating exercise-based injury prevention programme effectiveness compared to "train-as-normal". A random effects meta-analysis for overall effect and pooled effects by sex and supervision and meta-regression for age, intervention duration and adherence were performed. Programmes were effective overall (risk ratio (RR) 0.71) and equally beneficial for female-only (0.73) and male-only (0.65) cohorts. Supervised programmes were effective (0.67), unlike unsupervised programmes (1.04). No significant association was identified between programme effectiveness and age or intervention duration. The inverse association between injury rate and adherence was significant (β=-0.014, p = 0.004). Supervised programmes reduce injury by 33%, but there is no evidence for the effectiveness of non-supervised programmes. Females and males benefit equally, and age (to early middle age) does not affect programme effectiveness.

'We may need some help; we are just parents who have chosen to engage in football': a qualitative study on amateur coaches' experiences of use of and support for injury prevention training in Sweden

INTRODUCTION

Achieving sufficient adherence with injury prevention exercise programmes is a challenge. The aim was to explore how amateur football coaches experience the use of and support for injury prevention training using the Knee Control programmes as examples.

METHODS

Semistructured interviews with 20 amateur football coaches around experiences of injury prevention training, facilitators and barriers, and perceived support, analysed with qualitative content analysis. Participants coached male and female, junior and senior teams. Experience of having used the Knee Control programmes was an inclusion criteria.

RESULTS

Four main categories were developed: Why are we really doing this?, How do we make it work?, What are our drivers and challenges? and What could be improved? Coaches were motivated for injury prevention training but faced challenges such as limited access to football grounds and low player motivation. To make the prevention programme work for them, they integrated it and used exercises in the pauses during football-specific drills, or used as a warm-up. Many conducted prevention routines from an early player age. Coaches believed preventive training use could be further enhanced by education and practical support, and by football associations and clubs working together to reduce injuries.

CONCLUSION

Coaches were motivated and creatively worked with the prevention programme to make it fit their team. Even coaches with long-term experience of using prevention programmes wanted support, indicating that present implementation strategies targeting those about to start using prevention programmes should be complemented by continuous support for maintained use. These strategies should preferably target both coaches and players.

MRI findings of closed hand injuries in adolescent goalkeepers: a case-based review

Soccer-related injuries in youth goalkeepers are underrepresented in epidemiological studies, despite goalkeepers experiencing distinct types of upper limb injuries and training loads compared to outfield players. Digit injuries are particularly prevalent, with up to five times more upper extremity injuries reported in this position. Such injuries can lead to interphalangeal joint instability and an increased risk of reinjury. Mechanisms of injury include falls, axial loading of digits, and rotational force due to grasping activities. The proximal interphalangeal joint is the most frequently injured in sports, followed by the metacarpophalangeal joint of the thumb. Achieving precise diagnosis can be challenging due to the complex soft-tissue anatomy of the hand. Radiologists play a crucial role in accurate diagnosis through imaging studies, enabling timely treatment. This article focuses on closed traumatic finger and thumb injuries in adolescent goalkeepers, describing injury mechanisms and outlining relevant MRI features to facilitate proper clinical approaches for diagnosis based on imaging findings.

Shoulder injuries in Brazilian professional football players: epidemiological analysis of 3828 games

OBJECTIVES

Football is a globally played sport that poses potential risks for musculoskeletal injuries. Upper-limb injuries have a lower incidence rate than lower-limb injuries but can still cause absenteeism and performance impairment in football players. This descriptive epidemiological study aimed to evaluate and compare the epidemiological data on shoulder injuries among professional football players in two major Brazilian football championships.

METHODS

Data were collected throughout the championships, and club physicians medically evaluated each player during official games using two online forms. The collected information included the player's age and position, injury diagnosis, laterality, location on the field where the injury occurred, playing time, imaging examinations performed, need for surgical treatment, time to return to play (TRP), and recurrence of the injury. The incidence of injuries was evaluated using the Federation Internationale de Football Association (FIFA) incidence formula.

RESULTS

A total of 107 shoulder injuries were recorded (4.3% of all injuries), with a FIFA incidence of 0.847. Glenohumeral dislocations (GHDs) and acromioclavicular dislocations (ACDs) accounted for 37.38% and 35.51% of all shoulder injuries, respectively. Goalkeepers and defenders presented, respectively, a 2.15 and 1.57 times increased risk of suffering shoulder injuries, while attackers presented a 0.63 times decreased risk. Injury recurrence was observed in 14.95% of cases, with GHDs and ACDs showing recurrence rates of 35.00% and 5.26%, respectively. Surgery was performed in 9.35% of cases, with GHDs representing 50% of all surgeries. The average TRP was 22.37 days, with severe and major injuries accounting for 11.21% and 10.28% of all injuries, respectively. Goalkeepers had the highest average TRP of 36.15 days. Recurring injuries had a higher average TRP of 33.44 days compared to nonrecurring injuries, which had an average TRP of 20.43 days. Surgically treated injuries had the highest average TRP of 112.5 days.

CONCLUSION

Shoulder injuries in the professional football scenario are of great concern due to the high recurrence rate and need for surgical treatment, which will lead to a long TRP. These findings emphasize the need to implement prevention protocols and effective treatments to reduce the consequences of such injuries, which are usually underestimated in this sport.

LEVEL OF EVIDENCE

III.

Does Headgear Prevent Sport-Related Concussion? A Systematic Review and Meta-Analysis of Randomized Controlled Trials Including 6311 Players and 173,383 Exposure Hours

CONTEXT

A sport-related concussion (SRC) is a traumatic brain injury that is caused by biomechanical stresses and results in a complex pathophysiological process in the brain. Some in the sporting community believe that headgear (HG) can prevent SRC, and several professional Australian sports organizations, including rugby, football, and soccer clubs, recommend its use.

OBJECTIVE

The purpose of this study is to determine whether HG is effective in lowering the prevalence of SRC in sports.

DATA SOURCES

A systematic search for related studies published between 1985 and 2023 was conducted using the following databases: Cochrane Library, AMED, PubMed, Web of Science, and Physiotherapy Evidence Database (PEDro).

STUDY SELECTION

Only randomized controlled trials (RCTs) that investigated the effectiveness of HG in reducing SRC rate were included.

STUDY DESIGN

Systematic review and meta-analysis of RCTs.

LEVEL OF EVIDENCE

Level 1a.

DATA EXTRACTION

Two researchers independently completed the title and abstract search and performed full-text reviews. A third reviewer was consulted to reach a consensus if any discrepancies were noted. The PEDro scale was used to evaluate the quality of the included RCTs. Data recorded from each study included authors, year of publication, type and number of players, study design, duration of the study, injury rate, compliance (%), sports/level, and exposure hours.

RESULTS

The pooled results of 6311 players and 173,383 exposure hours showed 0% SRC reduction per 1000 hours of exposure in the experimental group compared with the control group, with an injury risk ratio of 1.03 (95% CI, 0.82-1.30; P = 0.79).

CONCLUSION

This systematic review and meta-analysis demonstrates that HG does not prevent SRC among soccer and rugby players, and therefore the findings from this meta-analysis do not currently support the use of HG to prevent SRC in soccer or rugby.

A 10-week FIFA 11+ program improves the short-sprint and modified agility T-test performance in elite seven-a-side soccer players

Objective: The primary objective of this study was to assess the effects of 10 weeks of FIFA 11+ training on the physical performance of elite seven-a-side soccer players. Methods: Twenty-five seven-a-side soccer players were recruited from two senior national teams. The players completed the following protocols during 10 weeks of training: a) FIFA 11+: The FIFA group (n = 13) underwent the FIFA 11+ program combined with regular soccer training; b) Dynamic conventional warm-up: The control group (n = 12) underwent regular soccer training. Their ability was validated using a pre-test followed by a post-test to measure the sprint performance (5-, 10-, and 20-m sprints), a modified agility T-test (MAT), and a five-jump test (FJT). Results: A comparison of pre- and post-tests for physical performance in each group demonstrated that the FIFA 11+ warm-up significantly improved the 10-m sprinting performance (p = 0.034; F = 5.04; ηp 2 = 0.17) and reduced the time spent to perform the MAT (p = 0.000; F = 23.16; ηp 2 = 0.52) in the FIFA group compared with the control group; however, no significant changes were observed in the 5- and 20-m sprints and FJT. Conclusion: The main findings of this research showed that the 10-week FIFA 11+ program led to significant improvements in the 10-m sprint and MAT compared to regular training among elite seven-a-side soccer players. Given these positive outcomes, further studies on the practical implementation and optimization of the FIFA 11+ program are warranted to provide valuable guidance for coaches and athletes, seeking to maximize its benefits in real-world settings.

Potential Effects of Dynamic Stretching on Injury Incidence of Athletes: A Narrative Review of Risk Factors

The use of dynamic stretching as a replacement for static stretching in the warm-up is widespread based on the reports of static stretching-induced performance impairments. While acute and chronic static stretching has been reported to reduce musculotendinous injuries, especially with explosive and change of direction actions, the influence of dynamic stretching on injury incidence lacks a similar volume of literature for acute and chronic responses. It was the objective of this narrative review to examine the acute and training effects of dynamic stretching on injury incidence and possible moderating variables such as dynamic stretching effects on range of motion, strength, balance, proprioception, muscle morphology, and psycho-physiological responses. One study demonstrated no significant difference regarding injury incidence when comparing a dynamic stretching-only group versus a combined dynamic stretching plus static stretching group. The only other study examined functional dynamic stretching training with injured dancers and reported improved ankle joint stability. However, several studies have shown that dynamic activity with some dynamic stretching exercises within a warm-up consistently demonstrates positive effects on injury incidence. Regarding moderating variables, while there is evidence that an acute bout of dynamic stretching can enhance range of motion, the acute and training effects of dynamic stretching on strength, balance, proprioception, and musculotendinous stiffness/compliance are less clear. The acute effects of dynamic stretching on thixotropic effects and psycho-physiological responses could be beneficial for injury reduction. However, the overall conflicting studies and a lack of substantial literature compared with SS effects points to a need for more extensive studies in this area.

The Changing Landscape in Upper Limb Sports Rehabilitation and Injury Prevention

This editorial aims to feature authors who intend to submit their research to this Special Issue of Sports entitled "Clinical Advances in Upper Limb Sports Rehabilitation and Injury Prevention" in areas that need special consideration [...].

Effects of FIFA 11 + warm-up program on kinematics and proprioception in adolescent soccer players: a parallel‑group randomized control trial

This study aimed to compare the effects of 8 weeks 11 + warm-up injury prevention program on kinematics and proprioception in adolescent male and female soccer players. Forty adolescent soccer players (20 males, 20 females) aged between 14-16 years old were randomly assigned into four groups. The experimental group performed the 11 + program for 8 weeks and the control group did their warm-up program. The kinematic variable in a cutting maneuver was measured using VICON motion analysis and ankle and knees' proprioception by joint position sense (JPS) was measured using a digital inclinometer. For kinematic variables only significant differences in knee valgus among females 11 + compared with female and male control groups were found (P < 0.05). Moreover, there were significant improvements in joint position sense variables in 11 + groups compared to control groups (P < 0.05). In conclusion, the 11 + program was proven to be a useful warm-up protocol in improving knee valgus and JPS among female and male adolescent soccer players. We suggest adding more training elements to the 11 + program that aimed to enhance the proper alignment of lower extremities which may consequently improve joint kinematics.

Diagnosis, prevention and treatment of common shoulder injuries in sport: grading the evidence - a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF)

This statement paper summarises and appraises the evidence on diagnosis, prevention, and treatment of common shoulder injuries in sports. We systematically searched Medline and Embase. The Grading of Recommendations Assessment, Development and Evaluation tool was applied to evaluate the overall quality of evidence.For diagnosis, we included 19 clinical tests from mixed populations. Tests for anterior instability, biceps-labrum complex injuries and full subscapularis rupture had high diagnostic accuracy (low to moderate quality of evidence).For prevention, the Oslo Sports Trauma Research Center, the Shoulder Control, the FIFA 11+ shoulder injury prevention programmes, and a baseball-specific programme (range of motion, stretching, dynamic stability and strengthening exercises) showed moderate to large effect size in reducing the risk of shoulder injury compared with no intervention (very low to moderate quality of evidence).For treatment, a rehabilitation programme including stretching, ice packs, electrotherapy and compression, and strengthening exercises showed a large effect size in reducing pain and disability compared with no intervention in athletes with subacromial impingement syndrome (very low to moderate quality of evidence). For the treatment of supraspinatus tendinopathy, hyperthermia treatment (heating the skin to 38°C-40°C) resulted in large effect size in reducing pain and disability compared with ultrasound or pendular swinging and stretching exercises (moderate quality of evidence). Strengthening exercise alone or in combination with stretching exercises promoted a large effect in reducing shoulder pain (cohort studies, no comparators) (very low quality of evidence). The quality of evidence for most estimates was low to moderate, indicating that future high-quality research may alter our recommendations for clinical practice.

The FIFA 11+ Kids Injury Prevention Program Reduces Injury Rates Among Male Children Soccer Players: A Clustered Randomized Controlled Trial

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.