Objective To investigate the effect of FIFA injury prevention programmes in football (FIFA 11 and FIFA 11+ Results 6 cluster-randomised controlled trials had assessed the effect of FIFA injury prevention programmes compared with controls on the overall football injury incidence in recreational/subelite football. These studies included 2 specific exercise-based injury prevention programmes: FIFA 11 (2 studies) and FIFA 11+ (4 studies). The primary analysis showed a reduction in the overall injury risk ratio of 0.75 (95% CI 0.57 to 0.98), p=0.04, in favour of the FIFA injury prevention programmes. Secondary analyses revealed that when pooling the 4 studies applying the FIFA 11+ prevention programme, a reduction in the overall injury risk ratio (incidence rate ratio (IRR) 0.61; 95% CI 0.48 to 0.77, p<0.001) was present in favour of the FIFA 11+ prevention programme. No reduction was present when pooling the 2 studies including the FIFA 11 prevention programme (IRR 0.99; 95% CI 0.80 to 1.23, p=0.940). Conclusions An injury-preventing effect of the FIFA injury prevention programmes compared with controls was shown in football. This effect was induced by the FIFA 11+ prevention programme which has a substantial injurypreventing effect by reducing football injuries by 39%, whereas a preventive effect of the FIFA 11 prevention programme could not be documented. Trial registration number PROSPERO CRD42015024120.

This statement summarises and appraises the evidence on diagnosis, prevention and treatment of the most common lower extremity muscle injuries in sport. We systematically searched electronic databases, and included studies based on the highest available evidence. Subsequently, we evaluated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework, grading the quality of evidence from high to very low. Most clinical tests showed very low to low diagnostic effectiveness. For hamstring injury prevention, programmes that included the Nordic hamstring exercise resulted in a hamstring injury risk reduction when compared with usual care (medium to large effect size; moderate to high quality of evidence). For prevention of groin injuries, both the FIFA 11+programme and the Copenhagen adductor strengthening programme resulted in a groin injury risk reduction compared with usual care (medium effect size; low to moderate quality of evidence). For the treatment of hamstring injuries, lengthening hamstring exercises showed the fastest return to play with a lower reinjury rate compared with conventional hamstring exercises (large effect size; very low to low quality of evidence). Platelet-rich plasma had no effect on time to return-to-play and reinjury risk (trivial effect size; moderate quality of evidence) after a hamstring injury compared with placebo or rehabilitation. At this point, most outcomes for diagnosis, prevention and treatment were graded as very low to moderate quality of evidence, indicating that further high-quality research is likely to have an important impact on the confidence in the effect estimates.

Background: Patellofemoral pain (PFP) and Osgood Schlatter (OSD) are common in adolescents, but we lack knowledge on these conditions and their impact in young adolescents (<15 years).Objectives: Compare pain, physical activity, quality of life, strength and knee function between adolescents with PFP or OSD, compared to pain-free controls. Methods: Self-report questionnaires were used to describe pain, physical activity, knee function, and quality of life in participants with PFP (N=151), OSD (N=51), and pain-free controls (N=50) aged between 10 and 14 years. Hip and knee strength were measured by handheld dynamometry.Physical activity levels were measured using wearable accelerometers.Results: More than 98% with PFP or OSD participated in sports prior to knee pain, and 60% reported reduced sports participation due to pain. Despite this, the adolescents were highly active (accumulating >120min vigorous physical activity per day), with no differences between OSD, PFP, or controls.Adolescents with knee pain (PFP and OSD) scored 23-57 points lower than controls (P<0.001) in the Knee Osteoarthritis Outcome Score. Adolescents with OSD had lower knee extension strength compared to controls (P<0.05, effect size (ES) 1.25). In the PFP group, only females displayed lower hip abduction strength compared to female controls (P<0.05, ES 0.49). Both girls and boys with PFP had lower hip extension strength compared to controls (P<0.05, ES 0.73). Conclusion:Adolescents with PFP or OSD are characterized by high physical activity levels, despite impaired sports participation and knee function relative to pain-free controls.

ObjectiveThe preseason Nordic Hamstring Protocol (NHP) reduces hamstring strain injuries in football players. Despite persisting injury rates, elite clubs are reluctant to apply the NHP often over concerns of negative impacts on performance. This pilot study investigated if sprint or jump-performance outcomes tended to increase or decrease following implementation of the NHP in elite male soccer-players.ResultsNineteen male soccer players from the Danish 1st division were randomised to perform NHP (27 sessions) during pre-season, or to control group (CG). Sprint performance (30 m with 5 and 10 m split times) and countermovement jump (CMJ height) was measured before the mid-seasonal break and again after 10 weeks of performing the NHP at the end of pre-season. Dropouts were due to transfers and injuries unrelated to performing NHP (NHP = 0, CG = 5). Sprint performance on the short split distances improved for most players in the NHP (6 out of 9 improved, median changes for 5 m split: − 0.068 s; 10 m split: − 0.078 s), but not CG (2 out of 5 improved, median changes for 5 m split: + 0.1 s; 10 m split: CG: + 0.11 s), but both groups had small declines at 30 m sprint (NHP: 7 out of 9 declined, median changes: + 0.116 s; CG: 4 out of 5 declined, median changes: + 0.159 s). CMJ height mostly improved in both groups (NHP: 6 out of 9 improved, median changes: + 2.1 cm; CG: 4 out of 8 improved, median changes: + 0.55 cm). Performing the NHP in elite soccer players did therefore not seem to negatively affect sprint and vertical jump performance outcomes in the present study, while in fact showing some promise for the more explosive characteristics such as the short 5 and 10 m split-times and maximal CMJ height, which all are highly relevant performance parameters in elite football.