Due to the various risk factors for injury to footballers, from intrinsic to extrinsic, opinions in the literature are divided regarding the harmful causes, however the prevention of injuries in football is an area of interest and cannot be ruled out in any team, whether amateur or professional.

Given this demand and resulting from a cooperation protocol between 2 research centres, FIFA – Medical and Research Center (F-MARC) and its medical specialists applied their experience related to Sports Medicine to create a set of exercises, evidenced in the light of the current literature, aimed at preventing injuries in sportsmen and women of both sexes over the age of 14 years. This program, called FIFA 11, was created in 2003, and in 2006 it was revised and improved for the FIFA 11+ version, which has been in effect until now.

FIFA 11+ has a predefined sequence, although it is subdivided into three distinct parts. Part 1 consists of running exercises at reduced speed, active stretching and controlled contacts with teammates. Part 2 includes 6 sets of exercises, which have three levels of increasing difficulty, with a focus on strengthening the lower limbs and abdominal region, balance and plyometric training. Finally, part 3 includes running exercises at moderate / high speed, combined with changes in direction. Some strategies transversal to all parts of this program are the correct maintenance of posture during the performance of exercises through good body control, with well-oriented segments and controlled ground receipts (FIFA, 2014).

According to Al Attar et al. (2017), the main objective of these exercises includes the improvement of neuromuscular control, the strengthening of the central region known as CORE and the lower limbs, as well as the development of coordination, balance and agility.

FIFA 11+ has been subject of worldwide research mainly to gauge its effectiveness in different types of populations linked to Sports. The first study to prove its effectiveness was carried out by Steffen et al. (2013) in young female soccer players, between 13 and 18 years old, finding a 50% reduction in injury predisposition, when applied at least twice a week. Going against this evidence, Soligard et al. (2008), also found percentages of reduced risk of injury similar to the aforementioned study. Owoeye et al., (2014, as mentioned in Bizzini et al., 2015) observed a decrease of approximately 40% in the incidence of injury in young Nigerian soccer players aged 14 to 19 years. Like the aforementioned author, Silvers et al. (2015, as mentioned in Bizzini et al., 2015) also showed a 40% reduction in the risk of injury when FIFA 11+ was implemented two to three times a week, although in their study the population consisted of senior semi-professional footballers.

In addition to reducing the risk of injury, FIFA 11+ develops according to the needs of each context, each club, each coach. It is in this perspective that recent studies reveal pioneering discoveries about the effectiveness of FIFA 11+, such as Dunsky et al. (2017) that supported the improvement in the level of balance in static and dynamic situations in young footballers after the implementation of this injury prevention program. Impellizzeri et al. (2013) identified a significant improvement in neuromuscular control, more precisely in the time needed to contract stabilizers in the central region (CORE) and lower limbs, after the implementation of FIFA 11+ for 9 weeks (applied 3 times a week). However, the study by Steffen et al. (2013) proved that the volume of work administered for the preventive aspect of the training cycle, is inversely associated with the risk of injury. This information indicates that the more frequent it is implemented in the training process, the lower the risk of injury associated with the participants (Soligard et al., 2008; Steffen et al. 2013).

Looking at the current scientific literature, this injury prevention program is the one that has the most consensus in literature, which shows its effectiveness in the generalized reduction of sports injuries. However, no program should be rigid and closed, allowing the introduction of new features that promote improvements in its operation.

Al Attar et al. (2017) compared the use of FIFA 11+ only as a warm-up versus its use before and after the training session, with 15 and 10 minutes for each part respectively. The results observed indicated a reduction in injury risk in players who trained before and after the training session. According to these results, in every 5 footballers who perform FIFA 11+ before and after the training session, an injury will be prevented compared to the “conventional” use of FIFA 11+, although no difference was observed in terms of its incidence. Despite the scientifically proven effectiveness, the biggest challenge is its implementation on the ground, essentially due to the coaches’ preference in managing the practice of technical-tactical aspects in the training process, leading to all other aspects being overlooked.

Professionals linked to sports training are increasingly focusing their attention on finding efficient responses to the psycho-technical-tactical demands that football players currently face. Just as the evidence related to this theme improves, the need for awareness among coaches for the implementation of injury prevention and performance optimization strategies of the training process is critical, regardless the context in which they are inserted: amateur, semi-professional or high-performance football.

References:

1. Fédération Internationale de Football Association. (2014). FIFA 11+ manual: um programa de aquecimento completo para prevenir lesões no futebol. FIFA Medical Assessment and Research Centre (F-MARC). Regensburg, DC: Mario Bizzini, Astrid Junge, Jiri Dvorak.
2. Al Attar, W., Soomro, N., Pappas, E., Sinclair, P., & Sanders, R. (2017). Adding a post-training FIFA 11+ exercise program to the pre-training FIFA 11+ injury prevention program reduces injury rates among male amateur soccer players: a cluster-randomised trial. Journal of Physiotherapy, 63(4), 235-242.
3. Steffen, K., Emery, C., Romiti, M., Kang, J., Bizzini, M., Dvorak, J., … Meeuwisse, W. (2013). High adherence to a neuromuscular injury prevention programme (FIFA 11+) improves functional balance and reduces injury risk in Canadian youth female football players: a cluster randomised trial. British Journal of Sports Medicine, 47(12), 794-802.
4. Soligard, T., Myklebust, G., Steffen, K., Holme, I., Silvers, H., Bizzini, M., … Andersen, T. E. (2008). Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ, 337(dec09 2), a2469-a2469.
5. Bizzini, M., & Dvorak, J. (2015). FIFA 11+: an effective programme to prevent football injuries in various player groups worldwide—a narrative review. British Journal of Sports Medicine, 49(9), 577-579.
6. Dunsky, A., Barzilay, I., & Fox, O. (2017). Effect of a specialized injury prevention program on static balance, dynamic balance and kicking accuracy of young soccer players. World Journal of Orthopedics, 8(4), 317.
7. Impellizzeri, F., Bizzini, M., Dvorak, J., Bortolan, L., Schena, F., Modena, R., … Junge, A. (2013). Physiological and performance responses to the “FIFA 11+” (part 1): is it an appropriate warm-up? Journal of Sports Sciences, 31(13), 1481-1490.

By: António Alfaro