Wednesday, October 20, 2010

Effectiveness of a Nationwide Injury Prevention Program

As has been discussed on the Science of Soccer Online, the incidence of soccer-related injuries is troubling. Females especially are very susceptible to knee and ankle sprains and ligament tears. In Switzerland, it is estimated that as many as 1 in 14 players will suffer a soccer-related injury. Some of these injuries are mild in nature but many have high personal and financial costs. The SSO has also used published research to promote various injury prevention programs, such as FIFA’s “The 11”, as a way to lower injury risk. Controlled studies clearly show that these programs are effective in reducing injuries as well as improving performance. A new study reports the effectiveness of a nationwide education campaign to lower injuries in young players. Amateur coaches were instructed on using “The 11” as a part of the Swiss amateur licensing program. Researchers find that by instructing coaches on how to include “The 11” as part of training, the incidence of injuries can be reduced.

This study was a joint effort by the FIFA F-MARC, SUVA insurance company and the SFV (Schweizerischer Fussballverband) and began in 2004. All licensed, amateur coaches in the SFV are required to complete a basic coaching education program as well as periodic refresher courses. Using this program, all coaches were educated on implementing FIFA’s “The 11” injury prevention program (for details, click here). They were given instructions on how to correctly perform the exercises and provided with materials including a DVD, instructional booklet and a poster (all of these are available through FIFA using the link above). Coaches were then encouraged to use the program with their teams.

A total of 5549 coaches too part in 145 courses where "The 11" was introduced.  After completion of the course, 80% of the coaches felt confident in using “The 11”.

The intervention period lasted four years (from May 2004 to May 2008). During this time, 57% of the coaches used all or part of “The 11” program with their teams. On average, coaches used 40% of the 11 exercises, once per week. This is less than recommended (11 exercises, twice per week). However, some coaches stated that they also used exercises that were similar but not a specific part of “The 11”. Those coaches who did not use “The 11” at all stated that they “didn’t have enough time” or “had other priorities”. Interestingly, the majority of the coaches who did not use the program did not have a coaching license.

Was the program effective? After four years of using “The 11”, the incidence of non-contact, match injuries was reduced by 28%. Knee injuries were lowered by 17%. Training injuries were also significantly reduced by 25%. Those teams not using the program reported no major changes in the incidence of injury over the four-year period.

The reduction in injury rate found in this study was not as great as shown in other studies (click here). Those studies strictly controlled and supervised implementation of the “The 11”, generally to a small group of teams. Thus, they had a higher compliance rate. The present study instructed coaches on how to use the program and simply asked them to do so.  No supervision of training was provided.  This is a much broader and more practical approach to large-scale implementation.  Despite the lack of supervision and lower compliance rate, this Swiss study still reported significant reductions in the incidence of injuries.

What is most interesting is that the researchers used Swiss accident insurance data to estimate the health care cost savings. During the four-year implementation period, the cost of treating soccer injuries rose by 1.7%. However, the number of participants in amateur soccer increased by 10%. This large rise in participation with a minimal change in injury costs suggests that FIFA’s “The 11” may also be an effective cost saving strategy.

This study is the first of its kind. It used a nation-wide approach to educating coaches in injury prevention and saw a reduction in the incidence of injuries. It was a broad-based approach used to implement “The 11” injury prevention program that involved more than 5500 coaches.  The conclusion is that educating coaches on injury prevention strategies can lead to them to incorporating these programs into their training sessions and can lead to reductions in the rate of injuries ad the associated medical costs.


Junge A, Lamprecht M, Stamm H, Hasler H, Bizzini M, Tschopp M, Reuter H, Wyss H, Chilvers C, Dvorak J (2010) Contrywide campaign to prevent soccer injuries in amateur players. American Journal of Sports Medicine, DOI: 10.1177/0363546510377424.