Objective To investigate the effect of FIFA injury prevention programmes in football (FIFA 11 and FIFA 11+ Results 6 cluster-randomised controlled trials had assessed the effect of FIFA injury prevention programmes compared with controls on the overall football injury incidence in recreational/subelite football. These studies included 2 specific exercise-based injury prevention programmes: FIFA 11 (2 studies) and FIFA 11+ (4 studies). The primary analysis showed a reduction in the overall injury risk ratio of 0.75 (95% CI 0.57 to 0.98), p=0.04, in favour of the FIFA injury prevention programmes. Secondary analyses revealed that when pooling the 4 studies applying the FIFA 11+ prevention programme, a reduction in the overall injury risk ratio (incidence rate ratio (IRR) 0.61; 95% CI 0.48 to 0.77, p<0.001) was present in favour of the FIFA 11+ prevention programme. No reduction was present when pooling the 2 studies including the FIFA 11 prevention programme (IRR 0.99; 95% CI 0.80 to 1.23, p=0.940). Conclusions An injury-preventing effect of the FIFA injury prevention programmes compared with controls was shown in football. This effect was induced by the FIFA 11+ prevention programme which has a substantial injurypreventing effect by reducing football injuries by 39%, whereas a preventive effect of the FIFA 11 prevention programme could not be documented. Trial registration number PROSPERO CRD42015024120.

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Background/aimGroin injuries are common in football and ice hockey, and previous groin injury is a strong risk factor for future groin injuries, which calls for primary prevention. The aim of this systematic review was to evaluate the effect of specific groin-injury prevention programmes in sports.MethodsA comprehensive search was performed in May 2014 yielding 1747 potentially relevant references. Two independent assessors evaluated randomised controlled trials for inclusion, extracted data and performed quality assessments using Cochrane's risk of bias tool. Quantitative analyses were performed in Review Manager 5.3.ResultsSeven trials were included: six on football players (four male and two female populations) and one on male handball players. In total there were 4191 participants with a total of 157 injuries. The primary analysis, including all participants, did not show a significant reduction in the number of groin injuries after completing a groin injury prevention programme (relative risk (RR) 0.81; 95% CI 0.60 to 1.09). Subgroup analysis based on type of sports, gender and type of prevention programme showed similar non-significant estimates with RR ranging from 0.48 to 0.81.ConclusionMeta-analysis revealed a potential clinically meaningful groin injury reduction of 19%, even though no statistical significant reduction in sport-related groin injuries could be documented.Trial registrationPROSPERO registration ID CRD42014009614.

The time‐loss definition of injury is commonly adopted in epidemiological groin‐injury studies in football, with a significant risk of underestimating the impact of these injuries. This study investigated the extent of groin problems, beyond the time‐loss approach, over a full Spanish football season. Players from 17 amateur male teams were followed over 39 consecutive weeks. Groin‐injury time loss and self‐reported groin pain, irrespective of time loss, were combined to calculate the average weekly prevalence of all groin problems with or without time loss. A subscale measuring hip‐ and groin‐related sporting function from the Copenhagen Hip and Groin Outcome Score questionnaire (HAGOS, Sport/Rec) was registered every 4 weeks. In total, 407 players participated in the study. The average (range) weekly prevalence of all groin problems was 11.7% (7.2%‐20.8%); 1.3% with time loss (0.0%‐3.2%) and 10.4% without time loss (6.3%‐17.6%). Players with groin problems reported lower scores (mean difference) on the HAGOS, Sport/Rec subscale compared with players without (−19.5 [95% CI: −20.7 to −18.4]), while there was no difference between players reporting groin problems with and without time loss (4.0 [95% CI: −1.1 to 9.1]). The traditional time‐loss measure only captured 10% of all groin problems. Hip‐ and groin‐related sporting function was not different between players reporting groin problems with or without time loss, suggesting the reason for continuing to play is not only related to the severity of symptoms. These findings question the judicious use of the time‐loss approach in overuse conditions, such as groin pain in footballers.

Background:Hip adductor muscle weakness and a history of groin injury both have been identified as strong risk factors for sustaining a new groin injury. Current groin pain and age have been associated with hip adductor strength. These factors could be related, but this has never been investigated.Purpose:To investigate whether soccer athletes with past-season groin pain and with different durations of past-season groin pain had lower preseason hip adductor squeeze strength compared with those without past-season groin pain. We also investigated whether differences in preseason hip adductor squeeze strength in relation to past-season groin pain and duration were influenced by current groin pain and age.Study Design:Cross-sectional study; Level of evidence, 3.Methods:In total, 303 male soccer athletes (mean age, 23 ± 4 years; mean weight, 74.0 ± 7.9 kg; mean height, 178.1 ± 6.3 cm) were included in this study. Self-reported data regarding current groin pain, past-season groin pain, and duration were collected. Hip adductor squeeze strength was obtained using 2 different reliable testing procedures: (1) the short-lever (resistance placed between the knees, feet at the examination bed, and 45° of hip flexion) and (2) the long-lever (resistance placed between the ankles and 0° of hip flexion) squeeze tests.Results:There was no difference between those with (n = 123) and without (n = 180) past-season groin pain for hip adductor squeeze strength when adjusting for current groin pain and age. However, athletes with past-season groin pain lasting longer than 6 weeks (n = 27) showed 11.5% and 15.3% lower values on the short-lever (P = .006) and long-lever (P < .001) hip adductor squeeze strength tests, respectively, compared with those without past-season groin pain.Conclusion:Male soccer athletes with past-season groin pain lasting longer than 6 weeks are likely to begin the next season with a high-risk groin injury profile, including a history of groin pain and hip adduction weakness.