Training to avoid soccer injuries

A series of 11 low-impact exercises designed specifically to prevent soccer injuries may do just that, new research shows.

A group of researchers working with the Federation Internationale de Football Association (FIFA) found that soccer coaches who implemented the 11 exercises into their warm-ups reported 12% fewer injuries among their players during matches and 25% fewer injuries during training sessions than did coaches who did not include the programme.

"This is the first study ever published on a nationwide preventive programme in soccer," study author Dr Jiri Dvorak, FIFA's chief medical officer, said.

Soccer is one of the world's most popular sports, enjoyed by an estimated 265 million people. It's also the cause of many injuries -in Switzerland alone, more than 42,000 soccer injuries were reported in 2003, costing millions of dollars and lost working days.

“The 11”

The injury prevention program dubbed "The 11" (now updated to "The 11+") consists of a series of exercises designed specifically to prevent soccer injuries, focusing on stability, balance, flexibility, and strength.

Holly J. Silvers, a researcher based at Santa Monica Orthopaedic in California, explained that soccer players tend to rely disproportionately on specific muscles - the quadriceps and inner thigh.

This overuse causes many of the most common and serious injuries in soccer, namely ankle sprains, hamstring and groin strains, and injuries to the knee ligaments.

The 11 and 11+ programs, therefore, aim to protect those overused muscles by attending to the muscles opposite to them, such as the outer hip, hamstrings, and buttocks, Silvers explained.

To investigate how well the training program works, Dvorak, Dr Astrid Junge at the FIFA Medical Assessment and Research Centre, and their colleagues integrated the programme into a course required of all licensed coaches in Switzerland.

Before the intervention, the researchers interviewed a sample of approximately 1,000 coaches about injuries among their players, then asked the same question four years later, and whether or not they were using "The 11."

Small difference

The researchers found that, during the second interview, coaches who were using "The 11" said 12.6% of their players had been injured in the previous four weeks during matches. In contrast, coaches who did not include "The 11" in practice reported match injuries among 14.2% of their players during the same time period.

The difference is small, but significant, Dvorak explained -when millions of people play soccer, reducing the rate of injury by only one percent has a huge impact. "Even this small percentage, nationwide, has importance," he said, adding that the team is now implementing the program in other countries, such as elsewhere in Europe, Japan, and the Americas.

Coaches who chose to include "The 11" in their warm-ups did not report any increase in the roughly 20 minutes spent on warming up overall, the authors report in The American Journal of Sports Medicine.

Of course, coaches decided whether or not to implement "The 11," and it's possible that those who chose to include it were overall more conscious about preventing injuries than other coaches.

Absolute possibility

That's "absolutely" a possibility in this study, said Silvers, who has co-authored another study about the benefits of The 11+ program.

"From a scientific point of view, the ideal study would be a (randomised controlled trial) to eliminate such confounders and prove the effect of the program," Junge said.

"The present study had a different aim: We wanted to show that it is possible to reduce soccer injuries by country-wide implementation of an injury prevention programme."

Part of what makes the programme so effective, Junge added, is the exercises are easy to learn, and require no expensive equipment.

In principle, the same exercises could also benefit professional soccer players, she added, but professionals typically have more injuries with different causes. As a result, professional players would likely benefit more from "a modified and preferably more individualised injury prevention programme," she wrote in an e-mail.

(Reuters Health, Alison McCook, October 2010) 

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