The Use and Modification of Injury Prevention Exercises by Professional Youth Soccer Teams

Abstract

BackgroundThe efficacy of injury prevention exercise programs (IPEPs) for amateur youth soccer has been established, but little is known about their adaptability to other soccer populations.ObjectiveThis study aimed to assess the use of individual injury prevention exercises by professional youth soccer teams, against the industry-standard, FIFA 11+ program.DesignProspective observational study.SettingA European professional youth soccer academy.ParticipantsSoccer coaches, fitness coaches and physiotherapists (n=18) from four teams.Data collectionThe teams' chosen IPEPs (total 160 sessions) were observed across one season and documented on a standardized form. The use of each FIFA 11+ exercise was coded as “performed” (in its original form), “performed modified” or “not performed”.Main Outcome MeasurementsThe primary outcome measure was the proportion of the 160 observed sessions containing each individual exercise in original or modified forms. The secondary outcome measure was the staff members' reasons for using and modifying FIFA 11+ exercises.ResultsOn average, individual FIFA 11+ exercises were conducted in original form in 12% of the sessions (range 0–33%), and in modified form in 28% of sessions (range 2–62%). The five most frequently observed exercises, in either original or modified form, were “bench” (72%), “squats” (69%),“running straight” (68%), “single-leg stance” (66%), and “sideways bench” (64%). Staff modified exercises to add variation, progression, and individualization, and to align with specific training formats and goals.ConclusionsProfessional youth soccer teams often use injury prevention exercises similar to those in the FIFA 11+, but tailor them considerably to fit their implementation context. These findings will inform the design and delivery of future, context-specific IPEPs.

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

“…Despite the success of the 11+ program in reducing injury incidence in football, a number of barriers exist which limit implementation of the program . This study shows that the simple act of rescheduling Part 2 of the 11+ program to the end of training significantly improves 11+ compliance while maintaining the overall effectiveness of the 11+ program.…”

“…Performing the exercises contained in Part 2 of the 11+ before training is the source of most concern for practitioners and is the most modified component of the 11+ . As such, investigating methods to improve compliance and effectiveness of exercises in Part 2 of the 11+ program such as the Nordic Hamstring Exercise (NHE), which is known to reduce the risk of hamstring injuries, is important for improving adoption .…”

“…Previous research has shown that injury rates can be reduced by ≥ 40% when players complete the 11+ program at least twice per week, with higher program compliance and dose exposure associated with increased program effectiveness . However, despite the proven effectiveness of the 11+ program, only 10% of FIFA’s member associations have endorsed the program and several studies highlight low 11+ program compliance …”

“…Poor adoption and compliance rates of the 11+ program have been explained by (a) the time required to complete and boredom associated with the program, (b) fatigue and soreness caused by exercises contained in Part 2, and (c) a lack of awareness and knowledge of how to perform the program . Furthermore, given the importance of strengthening exercises in reducing injury risk, it is concerning that research has shown that the strengthening exercises performed in Part 2 of the 11+ program are often modified or not performed . Potential fatigue caused by the exercises in Part 2 may contribute to why compliance to the full 11+ program is poor, with fatigue considered by practitioners to be a primary injury risk factor in football .…”

“…Furthermore, given the importance of strengthening exercises in reducing injury risk, it is concerning that research has shown that the strengthening exercises performed in Part 2 of the 11+ program are often modified or not performed . Potential fatigue caused by the exercises in Part 2 may contribute to why compliance to the full 11+ program is poor, with fatigue considered by practitioners to be a primary injury risk factor in football . Interestingly, it has been found that performing an exercise in Part 2, the Nordic Hamstring Exercise (NHE), prior to football activity exacerbates eccentric hamstring fatigue, although administering these exercises after training did not affect the exercise stimulus.…”