Slauterbeck: Keeping high school athletes safe: The role of FIFA 11+ Injury Prevention Program

Last fall, the sports medicine team at UNC Health Southeastern saw a significant number of knee injuries among athletes, many requiring surgical reconstruction of major knee ligaments. Advances in surgical techniques have transformed these injuries from career-ending to season-ending injuries, enabling athletes to return to their sport the following season, often performing at or near their previous level.

However, the risk of reinjury remains high, with up to 20 percent of athletes experiencing a repeat injury to the same knee or the opposite one. Although surgical expertise has greatly improved outcomes, the reality is that prevention remains the most effective strategy. By focusing on injury prevention, we can help athletes stay healthy, avoid the physical and emotional toll of recovery, and continue to excel on the field.

Preventing injuries and keeping athletes in peak condition are priorities shared by athletes, coaches, parents, and sports medicine specialists. Among high school sports, lower extremity injuries are common and costly, often leading to long-term problems like early-onset arthritis. This makes injury prevention crucial to keeping young athletes safe and performing at their best.

One promising approach is the FIFA 11+ injury prevention program. It is a pre-practice warm-up that takes about 15 – 20 minutes to complete. It incorporates running, strength training, jumping, landing techniques, and dynamic stretching. A key component of the program is the active involvement of coaches to ensure athletes perform the exercises with the correct form.

The program has shown remarkable success in reducing injuries in year-round, elite, NCAA, and club soccer teams, with some studies reporting injury reductions of up to 70 percent. Teams that follow the program consistently report excellent results. However, little research has been done on the effectiveness of such programs when applied across multiple high school sports.

University of Vermont’s Trial of FIFA 11+ in High School Athletes

To explore whether the FIFA 11+ program could benefit high school athletes across various sports, I co-led a research trial involving 14 high schools in Vermont. Seven schools implemented the FIFA 11+ warm-up, while the other seven continued their usual warm-up routines. The trial included football, soccer, basketball, and lacrosse teams, with over 1,800 athletes participating. It was a remarkable community effort, with over 44 physical therapists, strength coaches, medical students, and other professionals working together over two years.

Findings from the Trial

The study identified 196 lower extremity injuries among 1,825 athletes in the FIFA 11+ group, compared to 172 injuries among 1,786 athletes in the control group. Importantly, no injuries occurred during the FIFA 11+ warm-up itself. Most injuries in both groups happened during games rather than practices, highlighting the need to evaluate game rules and schedules.

While the data did not reach statistical significance, there were noteworthy trends:

– The FIFA 11+ group had fewer knee and ankle injuries than the control group but slightly more thigh and foot injuries.

– Rates of severe injuries were somewhat lower in the FIFA 11+ group, while minor injuries were more common.

– Compliance with the program was low, with only 32% of FIFA 11+ teams performing the exercises at least twice a week.

Challenges and Opportunities

The low compliance rate points to challenges in implementing the program consistently in high schools. Factors such as short sports seasons, high turnover of coaches and athletes from season to season, poor weather, and limited practice facilities likely contributed to these difficulties. These obstacles highlight the need for innovative delivery methods, such as dedicated injury prevention sessions outside of regular practice, identifying and implementing a year-round injury prevention program, or targeting at-risk athletes.

Looking Ahead

The FIFA 11+ program has proven effective in elite and year-round sports. The challenge now is adapting FIFA 11 + for high school athletes, who face unique logistical and seasonal constraints. With the enthusiastic support of North Carolina’s healthcare community, coaches, and athletic departments, we can build on these findings.

Injury prevention is more than just a program. It’s a vital investment in the health, safety, and future of young athletes. By refining and expanding initiatives like FIFA 11+, we can ensure that athletes remain on the field, pursuing the sports they love and performing at their highest potential. Building on the proven success of FIFA 11+ in elite athletes, it’s time to prioritize year-round injury prevention strategies tailored to high school, middle school, and club sports teams. With a proactive approach, we can create a culture of safety and longevity in youth sports, helping athletes thrive both on and off the field.