This feature aims to take a comprehensive look at the current literature supporting the use of FIFA’s injury prevention base warm up programme ‘The 11+'; making some recommendations for its implementation and possible additional/alternate exercises based on previous experience.
So lets kick-off by taking a look at what the 11+ is all about. Back in 2003 the FIFA Medical and Research Centre (F-MARC) developed an injury prevention programme aptly named ‘The 11’ consisting of 11 exercises based around core stability, balance, dynamic stabilisation, and eccentric hamstring strength exercises aimed at reducing the rate of common injuries experienced in football. Due to low compliance rates witnessed during the study period, no effect on injury rate was recorded; resulting in the development of a new improved programme ‘The 11+’.The revised programme incorporated a range of additional exercises designed to improve both the preventive effect of the programme as well as to provide variety in order to improve compliance rates. The new 11+ also included a set of structured running exercises that enable the programme to be used as a comprehensive warm-up programme both before training and matches.
The “11+” has three parts with a total of 15 exercises, which should be performed in the specified sequence. The programme takes around 20 minutes to complete and is recommended to be performed as a standard warm-up, at the start of each training session at least twice a week and prior to matches (only the running exercises parts 1 and 3).
Part 1: running exercises at a slow speed combined with active stretching and controlled partner contacts;
Part 2: six sets of exercises, focusing on core and leg strength, balance, and plyometrics/ agility, each with three levels of increasing difficulty;
Part 3: running exercises at moderate/high speed combined with planting/cutting movements.
Great importance should also be placed on correct technique with attention paid to correct posture and good body control, including straight leg alignment, knee-over-toe position and soft landings.
Click picture below to view exercises or view entire 11+ manual at http://f-marc.com/11plus/manual/
So what does the research say?
F-MARC will be quick to tell you that ‘teams that performed the 11+ at least twice a week had 30 – 50% less injured players'; however it is important to note that all studies to date have been conducted amongst foreign, amateur, female and youth populations only and no current data supporting its use amongst a professional or UK base population is available. Caution should also be taken when implementing the 11+ into other athletic populations as the programme was designed specifically with the prevention of football injuries in mind. Although this will have some transfer over to other sports and common injuries, specific injury data , need analysis and movement patterns for each sport should be analysed before adopting/adapting the 11+ protocol. With this aside, current studies incorporating the 11+ prevention programme have demonstrated positive effects on injury rates amongst each respective population.
The first study by Soligard et al (2008) examined the effect of the 11+ to reduce the risk of injury amongst 1892 female football players (aged 13-17) across 125 Norwegian clubs. The results of this study did not reach significance in the reduction of lower limb injuries however; a reduction in severe, overuse and overall injuries was recorded.
A later article by Soligard et al (2010) documented the compliance rates over the study period, reporting that teams completed the injury prevention programme in 77% (mean 1.3 sessions per week) of all training and match sessions, and players in 79% (mean 0.8 sessions per week) of the sessions they attended. Those players with a high compliance rate demonstrated a 35% lower risk of all injuries.
In a study by Junge et al (2010) aiming to assess the implementation and effects of a countrywide application in amateur football across Switzerland also reported a correlation between high compliance rates and a lower risk of injury, reporting that the 57% of subjects who completed the programme saw a 11.5% and 25.3 % lower incidence of match and training injuries respectively; with a particular decrease in noncontact mechanisms being noted.
Conversely; the results of a more recent study comparing the effect of the ’11’ programme on injury rates in male adult players across different levels of amateur Italian football are less favorable of the programme; suggesting that injury rate in amateur players depends rather on the skill level than the prevention program (Gatterer et al, 2012).
The results of the most recent study to assess the effects of the 11+ programme; and perhaps the most convincing so far, surprisingly come from the only study to date to document the effects of the 11+ amongst a ‘non football’ population. The study published last month by Longo et al (2012), assessed the effect of the 11+ on injury rates in 121 elite male Italian basketball players across 11 teams within the same club. The results of the study demonstrated statistically significant lower injury rates in the intervention group for overall injuries, training injuries, lower extremity injuries, acute injuries and severe injuries than were recorded in the control group; suggesting the possibility of the 11+ to be used as a multisport prevention programme.
Although the current research on the F-MARC 11+ prevention program appears in the most part to be positive, care should be taken when interpreting results or looking to implement within different populations/sports and several specific factors also need to be taken into account as previously mentioned.
Hopefully you’ve now gained a good incite into the structure, purpose and research regarding the 11+ protocol. The next installment of this feature will aim to focus on the specific exercises of the programme and give considerations for implementation and recommended additional/alternative exercises based on previous experience working within youth football.
In the meantime here’s some additional reading and resources:
11+ exercise videos at http://f-marc.com/11plus/exercises/
11+ FAQ at http://f-marc.com/11plus/faq/
Gatter H, Ruedl G, Faulhaber M, Regele M & Burtscher M (2012) Effects of the performance level and the FIFA “11” injury prevention program on the injury rate in Italian male amateur soccer players. Journal of Sports Medicine and Physical Fitness. 52(1):80-4.
Junge A, Lamprecht M, Stamm H, Hasler H, Bizzini M, Tschopp M, Reuter H, Wyss H, Chilvers C & Dvorak J (2010) Countrywide Campaign to Prevent Soccer Injuries in Swiss Amateur Players American Journal of Sports Medicine. doi:10.1177/0363546510377424
Longo UG, Loppini M, Berton A, Marinozzi A, Maffulli N & Denaro V (2012) The FIFA 11+ program is effective in preventing injuries in elite male basketball players: a cluster randomized controlled trial. American Journal of Sports Medicine. 40(5):996-1005.
Soligard T, Myklebust G, Steffen K, Holme I, Silvers H, Bizzini M, Junge A, Dvorak J, Bahr R & Andersen TE (2008) Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial Britsh Medical Journal;337:a2469.
Soligard T, Myklebust G, Steffen K, Holme I, Silvers H, Bizzini M, Junge A, Dvorak J, Bahr R & Andersen TE (2010) Compliance with a comprehensive warm-up programme to prevent injuries in youth footballBritish Journal of Sports. 44:787–793.
Steffen K,Myklebust G, OlsenOE, Holme I, Bahr R. (2008) Preventing injuries in female youth football—a cluster-randomized controlled trial.Scand J Med Sci Sports.