The delivery of injury prevention exercise programmes in professional youth soccer: Comparison to the FIFA 11+

doi:10.1016/j.jsams.2016.05.007

Journal of Science and Medicine in Sport

Volume 20, Issue 1, January 2017, Pages 26-31

https://doi.org/10.1016/j.jsams.2016.05.007 Get rights and content

Abstract

Objectives

Injury prevention exercise programmes for amateur soccer have gained considerable attention, but little is known about their relevance and adaptability to professional soccer settings. The first aim of this study was to evaluate the delivery and content of injury prevention exercise programmes used by professional youth soccer teams, compared to the industry standard injury prevention exercise programme for soccer, the Fédération Internationale de Football Association's FIFA 11+. The second aim was to document specific challenges to implementing injury prevention exercise programmes in this context.

Design

Prospective observational study.

Methods

The participants were soccer coaches, fitness coaches and physiotherapists (n = 18) from four teams in a professional youth soccer academy. Each team's chosen injury prevention exercise programmes were observed weekly across an entire soccer season (160 sessions). The delivery and content of the programmes were documented on a standardised worksheet and compared to the FIFA 11+. Specific implementation challenges were recorded.

Results

Fitness coaches were the primary deliverers of injury prevention exercise programmes, with support from physiotherapists. Multiple delivery formats and locations were employed, along with the extensive use of equipment. Across all injury prevention exercise programme sessions, a median of one FIFA 11+ exercise was performed in its original form and a further four in a modified form. Implementation challenges included poor staff communication, competing training priorities and heavy game schedules.

Conclusions

Although the basic components of the FIFA 11+ hold relevance for professional youth male teams, the delivery and content of injury prevention exercise programmes require considerable tailoring for this context. Recognising this will inform the development of improved, context-specific injury prevention exercise programmes, along with corresponding strategies to enhance their implementation.

Introduction

Soccer is the world's most popular sport,¹ but injuries are both common and associated with considerable costs, participation loss, decreased team performance and long-term negative side effects.2, 3, 4 In recent years, there has been increased research interest in the prevention of soccer injuries, particularly the use of injury prevention exercise programmes (IPEPs). The efficacy of established IPEPs, including the Fédération Internationale de Football Association's FIFA 11+ and a Swedish IPEP called Knäkontroll, has been demonstrated in large-scale randomised controlled trials (RCTs).5, 6 However, it has also been emphasised that establishing an IPEP's efficacy is only one of several steps in successfully preventing real-world injuries.7, 8 Recent research has highlighted the challenges of reaching target IPEP audiences, enhancing adoption and ensuring adequate compliance over time.9, 10, 11 For example, in a trial of the Knäkontroll programme in amateur female Swedish teams, players with high compliance experienced an 88% reduction in the rate of Anterior Cruciate Ligament (ACL) injuries, whereas the rate among players with low compliance did not differ significantly from the control group.¹⁰ In a further example, Norwegian female players with high compliance to the FIFA 11+ programme, demonstrated a 35% lower risk of injuries compared to players with intermediate compliance levels.¹²

To enhance the real-world impact of sports injury prevention interventions, researchers and evaluators have begun to embrace implementation frameworks from the broader field of health promotion, such as the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework.13, 14, 15 This framework outlines a range of factors influencing the successful translation of evidence-based interventions into real-world practice.¹⁵ A recent systematic review of team ball sport IPEP trials, employing RE-AIM, demonstrated the paucity of current knowledge on implementation factors, particularly relating to aspects of adoption and maintenance.¹⁶ Other recent RE-AIM studies in soccer settings have highlighted the challenge of convincing soccer coaches to adopt IPEPs, perform them as intended and maintain them over time.9, 11, 17 In a three-year follow up to the Knäkontroll RCT, approximately three-quarters of coaches had modified the original content of the programme, or had failed to perform it with the prescribed frequency.⁹ In a study of Oregon high school soccer and basketball coaches, 52% were aware of IPEPs, but just 21% reported using one and only 9% reported performing the programme as originally designed.¹⁷

Recent sports injury prevention implementation research has emphasised that a key first step to enhancing an intervention's success is developing an understanding of the specific context in which it is to be delivered.8, 18 The design and delivery of IPEPs require tailoring to the specific target setting, with consideration of factors such as player age,19, 20 knowledge and beliefs,²¹ competitive level²² and climate.18, 23 Recent studies have evaluated the perceptions of players and staff members towards injury prevention programmes within the specific setting of professional male soccer²⁴ and professional youth male soccer.²⁵ The respondents in these teams expressed strong support for the use of IPEPs, and also identified multiple factors influencing the successful implementation of these programmes in their context. These factors related to both the content and nature of the IPEP itself (e.g. exercise variation/progression), and the delivery and support of IPEPs (e.g. staff communication and coach acceptance). In professional male teams, only 30% of respondents believed that the FIFA 11+ contained adequate progression and variation for their context.²⁴ In professional youth male teams, the majority of respondents were aware of the FIFA 11+, but fewer than a third actually used it and mostly in a modified form.²⁵

Taken together, the results of the above studies suggest that established IPEPs require considerable tailoring for use in professional soccer teams. However, there is currently a lack of published information on the content and delivery of IPEPs in these settings.²⁴ Hence, the aims of the current study were:

(1)
To directly observe the delivery and content of IPEPs in a professional youth soccer academy at weekly intervals across an entire season.
(2)
To document the specific IPEP implementation challenges experienced by staff.

Section snippets

Methods

The study design was a prospective weekly observation of four teams across one entire soccer season. The targeted participants were all soccer coaches, fitness coaches and physiotherapists from four professional youth male soccer teams during the 2014/2015 season. The four teams were all based in a professional European soccer academy and were selected based on existing connections to the researchers. Three teams (Under-15, Under-16 and Under-18 age groups) were competing in the premier

Results

Eighteen (90%) of the 20 eligible staff members, including nine soccer coaches, four fitness coaches and five physiotherapists, agreed to participate. The remaining 2 (10%) cited lack of time as the reason for not participating.

During the initial team meetings, all four teams reported planning to use IPEPs in the coming season and had a defined strategy for the content and delivery of these programmes. None of the teams intended to use the FIFA 11+ in its original form, but their IPEPs were

Discussion

This is the first study to directly observe the implementation of IPEPs in any form of soccer on a weekly basis. This provided a detailed insight into IPEP delivery, content and implementation challenges in a real-world, professional soccer setting. The vast majority of observed sessions were delivered by fitness coaches, using a range of different locations, training formats and training equipment. Taken as a median across the season, over a third of the FIFA 11+ exercises were included in the

Conclusion

The delivery and content of injury prevention exercise programmes used by professional youth soccer teams differ significantly to the recommendations in the industry-standard programme for amateur football, the FIFA 11+. Fitness coaches are the key IPEP deliverers and employ a range of different delivery formats, locations and training equipment. The successful implementation of IPEPs is influenced by a wide range of facilitators and barriers, relating either to the content and nature of the

Practical implications

•
Fitness coaches play a key role in the delivery of injury prevention exercise programmes (IPEPs) in professional youth soccer.
•
The delivery and content of IPEPs for professional soccer need to be tailored to fit different training formats, training locations, player ability levels and athletic goals.
•
A wide range of factors, across multiple levels of professional sport, influence the successful delivery of IPEPs.

Acknowledgements

JO’B led this work as part of his PhD studies. He designed the study, led its conduct, had the major role in paper writing and is responsible for the overall content. CFF and WY contributed to the design of the study, interpretation of the data and the writing of the paper. JO’B is supported by a Federation University Australia Postgraduate Scholarship. CFF is supported by an NHMRC Principal Research Fellowship (ID: 1058737). The Australian Collaboration for Research into Injury in Sport and

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An overarching theme “Coaches of youth athletes value injury prevention but have limited knowledge and support” was identified and five main categories were formed. Coaches perceived themselves to play an important role in injury prevention, yet they described limited time for knowledge acquisition and highlighted the close collaboration with other professions as a key in injury prevention.
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Injury rates have remained high in ladies Gaelic football over the last decade and treatment costs continue to increase significantly. Injury prevention programmes are a proposed solution and their efficacy has been demonstrated in Gaelic games, however, anecdotally their adoption is low. The aim of this study was to determine the barriers and facilitators to uptake, implementation, and long-term adoption of an injury prevention strategy for adult Ladies Gaelic football players and coaches.
Semi-structured interviews were conducted with 23 participants (13 coaches, 10 players). Four coaches were at intercounty level and nine were at club level, while two players competed at intercounty and club level and eight played solely at club level. The interviews were audio-recorded, transcribed verbatim and thematically analysed.
Stakeholder attitudes, accessibility, education, communication, and injury prevention programme characteristics were perceived as key barriers to an injury prevention strategy succeeding. Injury prevention promotion, injury prevention programme characteristics, leadership, and communication, were identified as the main factors that would facilitate the success of a strategy.
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One study has reported increased efficacy of and improved adherence to the 11+ after re-ordering its components.28 However, modifying the actual content of an IPP could reduce its efficacy, especially if modifications are not guided by existing evidence on ACL injury prevention.19,27 Asking coaches to identify who should be responsible for completion of an IPP was a unique feature of this survey.
Knee injury prevention programs (IPPs) reduce knee and anterior cruciate ligament (ACL) injury rates in female athletes, however, implementation of IPPs is low. The purpose of this study was to identify barriers to implementation of IPPs among collegiate women’s soccer coaches.
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Ten respondents reported that they did not use an IPP (Non-users), and nineteen respondents reported that they did use an IPP (Users). “Cost” was the most highly ranked barrier (median rank: 2) to implementing an IPP among Non-users. For the statement, “Who should be responsible for completing an IPP,” Users said “Coaches” (47%) and “Other” (21%), while Non-users said “Strength and conditioning” (50%) and “Athletic trainers” (30%). Respondents who marked “Other”, elaborated that it was the responsibility of coaches, athletes, and additional staff members.
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These activities may enhance individual and team performance, leading to greater buy-in from coaches and players.26 Furthermore, given the specificity to sport and setting, implementation and adherence could be increased.27 Re-engagement with program implementers and end-users will be necessary to ensure the relevance of the football-specific group as development pathways improve, and females start playing AF consistently from a young age.
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Concept Mapping.
The Concept Systems Global MAX™ web platform was used to collect and analyse data from 27 context and content experts (22 physiotherapists, 5 athletes). Participants brainstormed statements representing the critical elements that should be included in an ACL injury risk reduction program for women playing elite Australian Football (AF).
Twenty-two participants brainstormed 56 statements that were synthesised and edited to 62 statements. Statements were sorted into clusters by twenty-three participants and rated on importance and feasibility using six-point scales. Multidimensional scaling and cluster analysis identified a 5-cluster solution as follows: Football-specific preparation (15 statements); Movement skills (17 statements); Strength and conditioning (15 statements); Individual preparation (7 statements); and Education (8 statements). Calculation of mean ratings for each cluster and statement identified the Movement skills cluster as most important (mean = 3.61 out of 5) and the Football-specific preparation cluster as most feasible (3.75 out of 5). By contrast, the Individual preparation cluster was rated the least important (mean = 2.9 out of 5), and the least feasible (3.12 out of 5), to include in the program.
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View full text

Original researchThe delivery of injury prevention exercise programmes in professional youth soccer: Comparison to the FIFA 11+

Abstract

Objectives

Design

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Conclusion

Practical implications

Acknowledgements

J Sci Med Sport

Clin Sports Med

J Sci Med Sport

J Sci Med Sport

Big count

Injuries affect team performance negatively in professional football: an 11-year follow-up of the UEFA Champions League injury study

Br J Sports Med

Countrywide campaign to prevent soccer injuries in Swiss amateur players

Am J Sports Med

Prevention of acute knee injuries in adolescent female football players: cluster randomised controlled trial

Br Med J

Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial

Br Med J

It will take more than an existing exercise programme to prevent injury

Br J Sports Med

Implementation of a neuromuscular training programme in female adolescent football: 3-year follow-up study after a randomised controlled trial

Br J Sports Med

Superior compliance with a neuromuscular training programme is associated with fewer ACL injuries and fewer acute knee injuries in female adolescent football players: secondary analysis of an RCT

Br J Sports Med

Compliance with a comprehensive warm-up programme to prevent injuries in youth football

Br J Sports Med

A sports setting matrix for understanding the implementation context for community sport

Br J Sports Med

Applying implementation science to sports injury prevention

Br J Sports Med

Original research
The delivery of injury prevention exercise programmes in professional youth soccer: Comparison to the FIFA 11+