Title: FIFA 11 exercises and injury prevention in pediatric population.

Presenter: Dr. Fahim Merali

Date: Tuesday October 11

Time: 18:00

Location: Goldring Centre room 221

FIFA 11+

20 minute warm-up program to prevent injury in amateur soccer players

First studied in young females, now applied to males, pros, referees

Based on improving balance and neuromuscular control [Symbol] performance benefits

Implementation campaigns ongoing worldwide

FIFA11+ website lists 2 key studies to back full scale implementation:


  1. Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial, Soligard et al. (PHD thesis), BMJ 2008;337:a2469

Objective: to examine the effect of a comprehensive warmup programme designed to reduce the risk of injuries in female youth football.

Population: female players aged 13-17

Primary outcome: Injuries to the lower extremity (foot, ankle, lower leg, knee, thigh, groin, and hip).

Design: Convenience sample (91/183 clubs in Norwegian soccer league), RCT; Coaches reported extent of use and injury stats weekly, followed up by research team; intention to treat analysis; reported incidence

Results: Lower body injuries rate ratio 0.71 (0.49 – 1.03, p=0.072), Statistically significant reductions in overuse, severe and overall injuries (Secondary and subgroup analyses)


  • Methodology + internal validity: Selection bias? (50% of clubs not analysed), did not follow ITT

External Validity: heavy compliance efforts, only Norwegian teen females

  • Type 1 error: inadequate sample size based on own estimates

Type 2 error: Not powered due to inadequate sample size

Conclusion: Low confidence in results due to higher than acceptable chance of both false neg and pos, need meta-analysis

  1. Countrywide Campaign to Prevent Soccer Injuries in Swiss Amateur Players, Junge et al, The American Journal of Sports Medicine 2010DOI: 10.1177/0363546510377424

Objective: assess the implementation and effects of a countrywide campaign to reduce the incidence of soccer injuries in Swiss amateur players

Population: coaches of soccer clubs from Schweizerischer Fussballverband (Swiss soccer association)

Design: Interventional (FIFA11+ built in to mandatory basic education and q2years refresher course for coaches) + Prospective Cohort Study, Representative sample (n=1574), telephone interview pre- and post-intervention survey (2004) (coaches)

Results: 79.8 % of coaches knew the FIFA 11+ program, 57% of coaches implemented at least part of the program (average 3.7 exercises/15), 33% performed program 2/week as prescribed, 57% performed program >6months

Showed statistically significant reduction in training injuries (-18.9% compared to pre-intervention), showed increase in female injuies


Effectiveness in question: Cohort design – can’t claim causation

Methodological concerns: Doesn’t take into account the efficacy of the teaching methods, relied on coaches to recall injuries, pre-intervention coaches are not the same as the post

Uncertainty in results: Apparent increase in injuries in female group, contradicts study #1

Conclusion: Effectiveness of program in question; relevance of implementation data at this point seems irrelevant as program is already being implemented world-wide and at various levels

Articles for review:

Junge A, Lamprecht M, Stamm H, Hasler H, Bizzini M, Tschopp M, Reuter H, Wyss H, Chilvers C, Dvorak J. Countrywide campaign to prevent soccer injuries in Swiss amateur players. Am J Sports Med. 2011 Jan;39(1):57-63. doi: 10.1177/0363546510377424. Epub 2010 Oct 17.

Soligard T, Myklebust G, Steffen K, Holme I, Silvers H, Bizzini M, Junge A, Dvorak J, Bahr R, Andersen T. Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ. 2008 Dec 9;337:a2469. doi: 10.1136/bmj.a2469.