Tuesday, January 6, 2009

Cutting Edge Research: A Modified Version of the FIFA 11 Reduces Injury Rate In Young Women.

The FIFA 11 training program focuses on core stability, balance, and neuromuscular control as part of a warm-up routine. The goal is to lower the risk of knee and ankle injury in female players. A previous post on the Science of Soccer Online reviewed two studies suggesting that the “FIFA 11” injury prevention program may not be as effective as advertised. The authors of these studies felt that the program’s effectiveness may be limited by the lack of progression (increasing intensity as players improved fitness). A new study used a modified version of the program that was more intense and includes different levels of progression. The researchers found that total injuries, overuse injuries and severe injuries were all reduced in teams using the program. The researcher also found that a key component of the effectiveness was compliance. Those teams with higher compliance, experienced lower injury rates. These findings are very encouraging – including a 20 minute training routine as part of the daily warm-up may markedly reduce the risk of injury in young, female athletes.

The study enrolled clubs in the 15-16 year old division of the Norwegian Football Association. These clubs trained 2-5 times per week and played 15-30 matches over the course of the eight month season. 52 clubs (1055 players) were placed in the intervention group where they utilized a modified version of the FIFA 11 training program. These clubs were asked to use the program at least twice per week as a part of their normal warm-up routine. 41 clubs (837 players) were placed in the control group where they followed their regular training routine.

A description of the program is shown in the figure (taken directly from the research report). An excellent description of the program along with instructional videos can be found using the links below. The focus is on development of strength, balance, core stability and technique. In particular, the athletes were instructed to emphasize hip control and knee alignment and to avoid excessive knee valgus when landing (a knock-kneed position). Once the players were familiar with the program, it took ~20 minutes to complete. The primary difference between this program and the original FIFA 11 is that it allows for progression of intensity. As the players developed strength and balance, they progressed through three different levels.

During the course of the season, all injuries were recorded. Medical personnel noted the site and type of injury as well as the severity.

Over the course of the eight month season, the researchers found that there were lower risks of overall injuries, overuse injuries and severe injuries (those requiring >25 days or recover) in the intervention group. The rate of acute injury to the lower extremity was reduced by 52% in this group. In particular the incidence on knee injuries was reduced by 46%. Interestingly, the incidence of chronic injuries such as tendon pain and low back pain were reduced by more than 60%.

Based on these results, the authors concluded that the “risk of injury can be reduced by about one-third and the risk of severe injury by as much a half” using the modified version of the FIFA 11 as a part of a comprehensive warm-up program.

The authors found that compliance was a key to the programs effectiveness. Those clubs that adhered to the program and utilized it as prescribed (at least twice per week), experienced the lowest injury risk. The reduction in injury incidence was somewhat lower in clubs with lower compliance.

Research shows that neuromuscular training that focuses on core stability, balance and neuromuscular control and emphasizes hip control and knee alignment (avoiding the valgus position) can reduce the risk of knee and ankle injury in female soccer players. This study shows that a relatively short program (~20 minutes) used a part of the regular warm-up routine can also lower injury risk. As for application by coaches, most teams spend 15-20 minutes warming up for the day’s training session. Thus, the program would not cut into the practice time devoted to technical and tactical training. Simply using a more focused approach to the warm-up and including strength, balance and plyometric training, teams may be able to lower the risk of injuries. Given the increased risk of knee injury in female players, any program that can be conveniently employed AND may cut the injury risk by 1/3-1/2 should be strongly considered.


Soligard T, Myklebust G, Steffen K, Silvers H, Bizzini M, Junge A, Dvorak J, Bahr R, Andersen TE (2008) Compehensive warm-up programme to prevent injuries in young female footballers: cluster randomized controlled trial. British Medical Journal, 337:a2469 (doi:10.1136/bmj.a2469).

Additional Links:

Oslo Sports Trauma Research Center (program description and materials).

Instructional Videos (in Norwegian)


A word of thanks to Iain Milligan for bring this article to my attention.