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FIFA 11+
Reducing injury rates
in soccer in Ontario
Rhona McGlasson PT, MBA
Stella Makris RKin
Chelsea Norris CSEP-CPT
Matt Greenwood
April 29, 2015
Agenda
• Review of the research
• What is injury prevention
• Injuries in soccer
• FIFA 11+ program
• Ontario project
2
• Reduction of injuries in soccer
• Promotion of soccer as a safe
and health enhancing leisure
activity
3
FIFA- MARC
Medical Assessment and Research
Centre
Research on knee and ankle
injuries
• Higher in game than training
• Increased rates with skill level
• Most caused by contact with another player
• Most injuries are minor• Most injuries affect the lower extremity
– Ankle sprain– Knee sprain– ACL– Fractures
• Aligns with program for head injuries
4
Injuries - Anterior cruciate
ligament rupture
• Males versus females: 1 / 5
• 70% non-contact injuries
• Multiple factors
• Recovery 6-9 months
• Return to sport up to 1 year of competitive play
• Early development of OA
• Reduced ability to be active long term
5
Ligaments in the knee
• Medial collateral
ligament (MCL)
• Lateral collateral
ligament (LCL)
• Posterior
cruciate
ligament (PCL)
• Anterior cruciate
ligament (ACL)6
What happens in an ACL
injury?
Injuries - Ankle Sprain
FIFA 11+ Injury Prevention
What is injury prevention?
Positioning and landing
FIFA 11+ Website
http://f-marc.com/11plus/exercises/
FIFA 11+ Exercises
• 15 exercises
• 3 Parts
– Running (8 mins)
• 6 exercises
– Strength, plyometrics and balance (10 mins)
• 6 exercises, 3 levels of difficulty
– Running (2 mins)
• 3 exercises
12
Part 1: Running
• Running
• Hip in
• Hip out
• Circling partner
• Jumping with shoulder
contact
• Quick forward and
backward sprints
13
Part 2: Strength,
plyometrics and balance
• 3 levels of difficulty
• Core strength
– Planks
• Forward
• side
• Hamstring
– Eccentric (muscle
working as it gets longer)
Part 2: Strength,
plyometrics and balance
• Plyometrics
• Jumping and Landing
• Bend knees
• Knee over toe
• Girls do not do this well
• Improves with training
• Balance
– Dynamic
– Working together
15
Part 3: Running
• Putting it all together
• Agility
– Cutting
– Knee over toe
16
Summary of exercises
• Running
• Cutting/planting
• Strength
– Core strength
– Hamstring strength
• Positioning (plyometrics)
– Knee over toes
– Landing
17
Implementation considerations
• U 13 – U 18
• Reduces injury rate by 29 – 46%
• 2x a week
• Warm up routine
– Practice – Parts 1 – 3
– Game – not Part 2
• Completed by kids independently
• Part of the rehabilitation program for any
injured player
18
Canadian Recommendations
May 2014
19
Ontario Project: 2014 - 2016
• 750 clubs
• 150 youth clubs
• Qualified Coaches:
15,000
• Referees: 11,000
• District Associations: 21
• 4 Levels of Competition
• 2 years of funding through Ontario Trillium
Foundation for an awareness and adoption program
Ontario Project: Stakeholders
Soccer
• Culture shift
– Organization professionalism
– Injury prevention
• Increased programming around
medical management
• Measurement of injury rates
• Improving standards for
readiness to return to sports
• Compensating for decreased
physical fitness in youth
Heath care
• Multiple professionals
– Physicians, PTs, ATs, Kins
• Sports specialists versus generalists
• Increased interaction directly with
clubs
• Messaging to parents and players
• Professional credits for working with
clubs to develop programs
• Culture shift to supporting
community programs
Ontario project: Coaches survey
• March 2014
• Questions: Prior to this survey had you ever heard
of FIFA 11+?
45%
55%
0%
10%
20%
30%
40%
50%
60%
1
Yes No
Ontario project: Activities 2014 - 2016
• Club training by project staff
– Coaches introductory training sessions 1 – 2 hours• Presentation on the program 30 - 60 mins
• 60 mins to do the training with a team and answer coaches
questions
– Team training sessions • 45 mins to go through exercises and assess technique
Ontario project: Activities 2014 - 2016
• Provincial and local providers
• Training health care professionals in the community to provide ongoing training
– Club conditioning or trainers
– Link clubs to health care professionals
to assist with implementation/
training/standards for return to sports
• Developing a network of “champions”
– Learn from each other and problem
solve
• Clubs arranging the services that work
best in their club
• Seasons
– Winter: Sept/Oct – April
– Summer: May – Sept/Oct
Awareness Materials
All materials
used need to
have been
developed by
FIFA
Tear off padPackages of cards that
can be given to players
and/or parents
PosterPoster that has pictures
of all the exercises
Other factors that affect injury
• Cleats: Blade cleats
• Turf: Different types and quality of turf
• Stretching
26
Other activities to consider in
the club
• Build into the club culture
• Go to “expert”
• Policies and procedures
• Tracking system for injury
• Coaches contracts
• Insurance
• Management of injured athletes
27
References• Campbell C et al, Canadian Academy of Sport and Exercise Medicine statement:
Neuromuscular training programs can decrease anterior cruciate ligament
injuries in youth soccer Clin J Sport Med 2014; 24; 263 - 267
• Soligard T, Nilstad A, Steffen K, et al. Compliance with a comprehensive warm-up
programme to prevent injuries in youth football. Br J Sports Med 2010;44:787-
793.
• Steffen K, Meeuwisse WH, Romiti M, Kang J, Bizzini M, Dvorak J, Finch CF, Emery
CA. High adherence to a neuromuscular injury prevention programme (FIFA 11+)
improves functional balance and reduces injury risk in Canadian youth female
football players: a cluster randomized trial. Br J Sports Med. 2013 Aug; 47(12):
794-802
• Steffen K, Romiti R, C Finch, G Myklebust, R Bahr, J Dvorak, M Bizzini, Meeuwisse
WH, Emery CA. The effect of different delivery methods of the 11+ programme
on performance in Canadian female youth football players Br J Sport Med
2013:47(12);794-802.
28
Acknowledgements
• Dr. Cathy Campbell, FIFA representative Canada
• Dr. Julia Alleyne, Medical Lead Pan Am Games
FIFA team
Matt Greenwood
Rhona McGlasson
Stella Makris
Chelsea Norris
Thank You
For Reducing Injuries in
youth!
