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

Abstract

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.

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

“…Based on this, the Nordic hamstring exercise protocol showed a large and significant risk reduction (RR: 0.35, 95% CI 0.22 to 0.54; I 2 =0.0%) compared with usual care on hamstring injuries in football (n=1521) (high quality of evidence) 56 57. Data from individual studies62–65 are presented in table 2.…”

“…In total 2468 studies were identified in the literature search. Three systematic reviews52–54 and 12 RCT’s was included 21 55–65. A systematic review and meta-analysis performed by van Dyk et al (2019) showed a medium and significant risk reduction (RR: 0.55, 95% CI 0.34 to 0.89; I 2 =67.0%) of hamstring injuries in football players in interventions including the Nordic hamstring exercise versus usual care (n=5362) (moderate quality of evidence) 53.…”

“…In total 1566 studies were identified in the literature search. Two systematic reviews54 72 and 13 RCTs were included 21 58 60 62 64 65 73–79. None of the studies specifically reported on acute adductor injuries.…”

“…In total 3002 studies were identified in the literature search. No systematic reviews and five RCTs were included 21 60 62 64 65. As part of this statement data from Soligard et al 60 and Silvers-Granelli et al 21 was pooled post hoc, as this analysis was not available in the existing literature.…”

“…Based on this, the FIFA 11+ programme showed a small and not significant effect versus usual care (RR: 0.73, 95% CI 0.48 to 1.12; I 2 =0.0%) in reducing anterior thigh injuries in football (n=3417) (low quality of evidence) 21 60. Data from individual studies62 64 65 are presented in table 7.…”