Preventing injuries and keeping athletes on the field are key priorities for all athletes and sports medicine specialists.

Lower extremity injuries are common in high school sports — and are costly. Some of these injuries result in long-term problems, such as early onset arthritis. Others have poor outcomes. Injury prevention is important to keep athletes safe and performing at their highest level.

FIFA 11 + Injury Prevention Program

The injury prevention program FIFA 11 + is a pre-practice warm-up program that takes about 15 minutes to perform. It consists of exercises that utilize running, strength training, jumping, landing and dynamic stretching and requires a coach to observe and teach the athlete correct form.

The program has had great success in decreasing injuries in elite, NCAA and club soccer teams who typically practice year-round. Some studies report that FIFA 11+ decreases injuries by approximately 70 percent. Teams with greater compliance report better results.

A FIFA 11+ Trial in Vermont

Little information exists regarding high school-wide injury prevention programs high schools. We wanted to know if we could apply FIFA 11+ to multiple sports, so we initiated a trial in Vermont.

We divided 14 high schools into two groups. Seven used the FIFA 11+ warm-up and seven continued to warm up as they always had.

We investigated football and boys’ and girls’ soccer, basketball, and lacrosse. More than 44 experts — physical therapists, strength-and-conditioning coaches, residents, UVM students, UVM medical students — taught and observed athletes and coaches over two years.  This was incredible community outreach and a great example of Vermont’s high schools working together to find a way to keep athletes safer.

What We Discovered

We identified 196 lower extremity injuries among 1,825 athletes in the FIFA 11+ group, and 172 injuries among 1,786 athletes in the control group. No injuries were reported during the FIFA 11+ warm-up program. The severity of injuries defined as lost days of sport participation differed between the 2 groups, with minimal injuries (1-3 lost days) representing a larger proportion of the injuries in the FIFA 11+ group (40.3%) than the control group (14.5%)

In both groups, more than half of the injuries occurred during games. The injuries did not differ by sex, sport, or level of play. Although the data did not meet the level of statistical significance, some observations included:

  • The FIFA 11+ group saw larger proportions of thigh and foot injuries, while the control group had higher proportions of knee and ankle injuries.
  • The rates of mild, moderate, and severe injuries were somewhat lower in the FIFA 11+ group and
  • The rate of minimal injuries in the FIFA 11+ group was higher than that of the control group.

Unfortunately, only 32% performed of the FIFA 11+ teams reported that they performed the FIFA 11+program at least twice a week.

What We Can Conclude

Simply identifying that most injuries occur in game situations in Vermont helps us look at rule changes and numbers of games (and possible live scrimmages) that our athletes participate in over seasons.

The low compliance by the teams in using FIFA 11+ likely related to the delivery of the FIFA 11+ program. The high turnover of coaches, teams and athletes after season, short seasons, poor weather limiting practice time and limited access to playing surfaces and gyms all contributed to low compliance. 

The Future of FIFA 11+

The FIFA 11 + program works in year-round sports, elite team’s and NCAA athletes. We just need to figure out how to better deliver an injury prevention program to high school athletes.

One approach? Targeting at-risk athletes or providing dedicated time outside practice for athletes to perform the injury prevention program with a dedicated coach. This hopefully would  provide results more like the soccer and NCAA studies. 

What we know for sure is that the excitement and motivation to decrease injury by the surrounding health care community, high school coaches, and athletic departments and UVM Medical Center Sports Medicine is high. The next step is to secure more funding to take injury prevention in our high schools to the next level.

James Slauterbeck, MD, is an orthopedic surgeon at the University of Vermont Medical Center and associate professor at the Larner College of Medicine at UVM. He is also the team physician for UVM Athletics.

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