Does the FIFA 11+ Injury Prevention Program Reduce the Incidence of ACL Injury in Male Soccer Players?

Silvers-Granelli, Holly; Bizzini, Mario; Arundale, Amelia; Mandelbaum, Bert R.; Snyder‐Mackler, Lynn

doi:10.1007/s11999-017-5342-5

Cited by 141 publications

(134 citation statements)

References 48 publications

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“…Furthermore, it is noteworthy that 6 of the 8 ACLR in the Standard‐11+ group were non‐contact injuries, while all ACLR in the P2 post group involved contact with another player. Previous 11+ research found a similar dose‐related effect to ACLR incidence, and our findings present encouraging data that may help reduce non‐contact ACLR in sub‐elite football.…”

Section: Discussionsupporting

confidence: 85%

Rescheduling Part 2 of the 11+ reduces injury burden and increases compliance in semi‐professional football

Whalan

Lovell

Steele

et al. 2019

Scandinavian Med Sci Sports

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Although the 11+ program has been shown to reduce injuries in sub‐elite football, program compliance is typically poor, suggesting that strategies to optimize delivery are necessary. This study investigated the effect of rescheduling Part 2 of the three‐part 11+ program on program effectiveness. Twenty‐five semi‐professional football clubs were randomly allocated to either a Standard‐11+ (n = 398 players) or P2post group (n = 408 players). Both groups performed the 11+ program at least twice a week throughout the 2017 football season. The Standard‐11+ group performed the entire 11+ program before training activities commenced, whereas the P2post group performed Parts 1 and 3 of the 11+ program before and Part 2 after training. Injuries, exposure, and individual player 11+ dose were monitored throughout the season. No significant between group difference in injury incidence rate (P2post vs Standard‐11+ = 11.8 vs 12.3 injuries/1000 h) was observed. Severe time loss injuries > 28 days (33 vs 58 injuries; P < .002) and total days lost to injury (4303 vs 5815 days; P < .001) were lower in the P2post group. A higher 11+ program dose was observed in the P2post (29.1 doses; 95% CI 27.9‐30.1) versus Standard‐11+ group (18.9 doses; 95% CI 17.6−20.2; P < .001). In semi‐professional football, rescheduling Part 2 of the 11+ program to the end of training maintained the effectiveness of the original 11+ program to reduce injury incidence. Importantly, rescheduling Part 2 improved player compliance and reduced the number of severe injuries and total injury burden, thereby enhancing effectiveness of the 11+ program.

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Section: Discussionsupporting

confidence: 85%

Rescheduling Part 2 of the 11+ reduces injury burden and increases compliance in semi‐professional football

Whalan

Lovell

Steele

et al. 2019

Scandinavian Med Sci Sports

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“…The program is effective in reducing lower extremity injuries in collegiate age men and high school age women. 1,2,5 The 11+ program focuses on proper lower extremity alignment and landing technique with emphasis on avoiding valgus movement patterns (knee abduction, hip adduction, and hip internal rotation). This study found both the 11+ and Control groups had bilateral increases in peak knee abduction angle, coupled with unilateral increases in hip abduction and external rotation on the non-dominant side for the 11+ group and dominant for the Control group.…”

Section: Discussionmentioning

confidence: 99%

“…5 High school age women soccer players also seemed to benefit from the program demonstrating a 32% reduction in lower extremity injury risk, and although not statistically significant a 38% reduction in knee injury risk. 2 The efficacy of the 11+ has not been tested in collegiate women soccer players, however they are at a known high risk for ACL injuries.…”

Section: Introductionmentioning

confidence: 92%

Changes in biomechanical knee injury risk factors across two collegiate soccer seasons using the 11+ prevention program

Arundale

Silvers-Granelli

Marmon

et al. 2018

Scandinavian Med Sci Sports

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The 11+ injury prevention program effectively reduces injuries in high school-aged female soccer player, but the mechanism of the 11+ is unknown, particularly whether it impacts biomechanical risk factors associated with knee injuries. The purpose of this study was to report the changes in hip and knee biomechanics with use of the 11+ over two soccer seasons. Two collegiate women's soccer teams performed the 11+ for two soccer seasons. A control team was followed for one season. Athletes performed motion analysis of a drop vertical jump during preseason and postseason. Both groups had meaningful increases in peak knee abduction angle over the first season, and there were no meaningful changes in peak knee abduction moment over either season. The control group had bilateral decreases in knee flexion angle. The program did not seem to systematically impact biomechanical risk factors associated with knee injuries, with increases in peak knee abduction angle and no bilateral changes in frontal or transverse hip motion. The 11+ may have mitigated clinically meaningful decreases in knee flexion; however, as ACL injuries do not occur purely in the sagittal plane, it is unclear the impact of these changes. The results of this study indicate that the 11+ may require some modifications to impact landing biomechanics and potentially risky movement patterns, particularly when used in collegiate women over multiple seasons.

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“…Another more recent study has been conducted in male athletes. 43 In this study, a large number of soccer players (675 intervention, 850 control) participated in an ACL injury prevention training program and a 77% reduction in the risk of ACL injury was found. This is an encouraging finding and indicates that the effectiveness of ACL injury prevention training programs in males should be further investigated to confirm the above results, which are based on limited data.…”

mentioning

confidence: 87%

Meta‐analysis of meta‐analyses of anterior cruciate ligament injury reduction training programs

Webster

Hewett

2018

Journal Orthopaedic Research

184

132

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Several meta-analyses have been published on the effectiveness of anterior cruciate ligament (ACL) injury prevention training programs to reduce ACL injury risk, with various degrees of risk reduction reported. The purpose of this research was to perform a systematic review and meta-analysis of overlapping meta-analyses evaluating the effectiveness of ACL injury prevention training programs so as to summarize the amount of reduction in risk for all ACL and non-contact ACL injuries into a single source, and determine if there were sex differences in the relative efficacy of ACL injury prevention training programs. Five databases (Medline, PubMed, Embase, CINAHL, and Cochrane) were searched to identify meta-analyses that evaluated the effectiveness of ACL injury prevention training programs on ACL injury risk. ACL injury data were extracted and the results from each meta-analysis were combined using a summary meta-analysis based on odds ratios (OR). Eight meta-analyses met eligibility criteria. Six of the eight only included data for female athletes. Summary meta-analysis showed an overall 50% reduction (OR = 0.5 [0.41-0.59]; I = 15%) in the risk of all ACL injuries in all athletes and a 67% reduction (OR = 0.33 [0.27-0.41]; I = 15%) for non-contact ACL injuries in females. This paper combines all previous meta-analyses into a single source and shows conclusive evidence that ACL injury prevention programs reduce the risk of all ACL injuries by half in all athletes and non-contact ACL injuries by two-thirds in female athletes. There is insufficient data to make conclusions as to the effectiveness of ACL injury prevention programs in male athletes. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2696-2708, 2018.

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Does the FIFA 11+ Injury Prevention Program Reduce the Incidence of ACL Injury in Male Soccer Players?

Abstract: Level I, therapeutic study.

Cited by 141 publications

References 48 publications

Rescheduling Part 2 of the 11+ reduces injury burden and increases compliance in semi‐professional football

Rescheduling Part 2 of the 11+ reduces injury burden and increases compliance in semi‐professional football

Changes in biomechanical knee injury risk factors across two collegiate soccer seasons using the 11+ prevention program

Meta‐analysis of meta‐analyses of anterior cruciate ligament injury reduction training programs

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