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Higher compliance to a neuromuscular injury prevention program improves overall injury rate in male football players

  • Sports Medicine
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The 11+ injury prevention program has been shown to decrease injury rate. However, few studies have investigated compliance and if it is correlated to time loss. The purpose of this study was to (1) analyze how differences in compliance may impact injury rate and (2) if compliance may impact time loss due to injury.

Methods

This study was a Level 1 prospective cluster randomized controlled trial conducted in NCAA men’s football (soccer) teams that examined the efficacy of the 11+ injury prevention program. The two outcome variables examined were number of injuries and number of days missed from competition. Twenty-seven teams (n = 675 players) used the 11+ program. Compliance, injuries and time loss were recorded. There were three compliance categories, low (LC, 1–19 doses/season), moderate (MC, 20–39 doses/season), and high (HC, > 40 doses/season).

Results

There was a significant difference among the groups for injuries, p = 0.04, pη2 = 0.23. The LC group [mean (M) = 13.25, 95% confidence interval (CI) 9.82–16.68, injury rate (IR) = 10.35 ± 2.21] had a significantly higher injury rate than the HC group (M = 8.33, 95%CI 6.05–10.62, IR = 10.35 ± 2.21), p = 0.02. The MC group (M = 11.21, 95%CI 9.38–13.05, IR = 8.55 ± 2.46) was not significantly different than the LC group, p = 0.29, but was significantly greater than the HC group, p = 0.05. When examined as a continuous variable, compliance was significantly negatively related to injury rate (p = 0.004). It was also significantly negatively related to number of days missed (p = 0.012).

Conclusions

When compliance was high, there was a significant reduction in injury and time loss. This evidence reinforces the importance of consistent injury prevention program utilization. Clinically, these findings have important implications when discussing the importance of consistent utilization of an injury prevention protocol in sport.

Level of evidence

Level 1—Randomized controlled trial (RCT).

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References

  1. Arnason A, Engebretsen L, Bahr R (2005) No effect of a video-based awareness program on the rate of soccer injuries. Am J Sports Med 33:77–84

    Article  PubMed  Google Scholar 

  2. Bahr R, Thorborg K, Ekstrand J (2015) Evidence-based hamstring injury prevention is not adopted by the majority of Champions League or Norwegian Premier League football teams: the Nordic Hamstring survey. Br J Sports Med 49:1466–1471

    Article  PubMed  Google Scholar 

  3. Barengo NC, Meneses-Echavez JF, Ramirez-Velez R, Cohen DD, Tovar G, Bautista JE (2014) The impact of the FIFA 11+ training program on injury prevention in football players: a systematic review. Int J Environ Res Public Health 11:11986–12000

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bizzini M, Junge A, Dvorak J (2013) Implementation of the FIFA 11+ football warm up program: how to approach and convince the Football associations to invest in prevention. Br J Sports Med 47:803–806

    Article  PubMed  PubMed Central  Google Scholar 

  5. Blakely C, Mayer J, Gottschalk R, Schmitt N, Davidson W, Riotman D et al (1987) The fidelity-adaptation debate: implications for the implementation of public sector social programs. Am J Com Psychol 15(3):253–268. https://doi.org/10.1007/BF00922697

    Article  Google Scholar 

  6. Caraffa A, Cerulli G, Projetti M, Aisa G, Rizzo A (1996) Prevention of anterior cruciate ligament injuries in soccer. A prospective controlled study of proprioceptive training. Knee Surg Sports Traumatol Arthrosc 4(1):19–21

    Article  PubMed  CAS  Google Scholar 

  7. Carroll C, Patterson M, Wood S, Booth A, Rick J, Balain S (2007) A conceptual framework for implementation fidelity. Implement Sci 2:40

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ekstrand J, Gillquist J, Lysholm J, Moller M, Oberg B (1983) Considerably decreased amount of soccer injuries after introduction of a preventive program. Lakartidningen 80:1803–1804 (1809)

    PubMed  CAS  Google Scholar 

  9. Fortington LV, Donaldson A, Lathlean T, Young WB, Gabbe BJ, Lloyd D et al (2015) When ‘just doing it’ is not enough: assessing the fidelity of player performance of an injury prevention exercise program. J Sci Med Sport 18:272–277

    Article  PubMed  Google Scholar 

  10. Fuller C, Ekstrand J, Junge A et al (2006) Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Br J Sports Med 40:193–201

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Gilchrist J, Mandelbaum BR, Melancon H, Ryan GW, Silvers HJ, Griffin LY et al (2008) A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players. Am J Sports Med 36:1476–1483

    Article  PubMed  Google Scholar 

  12. Grooms DR, Palmer T, Onate JA, Myer GD, Grindstaff T (2013) Soccer-specific warm-up and lower extremity injury rates in collegiate male soccer players. J Athl Train 48:782–789

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hagglund M, Atroshi I, Wagner P, Walden M (2013) 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 47:974–979

    Article  PubMed  Google Scholar 

  14. Hagglund M, Walden M, Atroshi I (2009) Preventing knee injuries in adolescent female football players—design of a cluster randomized controlled trial [NCT00894595]. BMC Musculoskelet Disord 10:75

    Article  PubMed  PubMed Central  Google Scholar 

  15. Heidt RS Jr, Carlonas RL, Traub JA, Tekulve FX (2000) Avoidance of soccer injuries with preseason conditioning. Am J Sports Med 28:659–662

    Article  PubMed  Google Scholar 

  16. Hewett TELT., Riccobene JV, Noyes FR (1999) The effect of neuromuscular training on the incidence of knee injury in female athletes. A prospective study. Am J Sports Med 27:699–706

    Article  PubMed  CAS  Google Scholar 

  17. Mandelbaum BR, Silvers HJ, Watanabe DS, Knarr JF, Thomas SD, Griffin LY et al (2005) Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up. Am J Sports Med 33:1003–1010

    Article  PubMed  Google Scholar 

  18. McKay CD, Verhagen E (2016) ‘Compliance’ versus ‘adherence’ in sport injury prevention: why definition matters. Br J Sports Med 50:382–383

    Article  PubMed  Google Scholar 

  19. Myklebust G, Engebretsen L, Braekken IH, Skjolberg A, Olsen OE, Bahr R (2007) Prevention of noncontact anterior cruciate ligament injuries in elite and adolescent female team handball athletes. Instr Course Lect 56:407–418

    PubMed  Google Scholar 

  20. Nilsen P (2004) What makes community based injury prevention work? In search of evidence of effectiveness. Injury Prev 10:268–274

    Article  CAS  Google Scholar 

  21. O’Brien J, Finch CF (2017) Injury prevention exercise programs for professional soccer: understanding the perceptions of the end-users. Clin J Sport Med 27:1–9

    Article  PubMed  Google Scholar 

  22. Owoeye OB, Akinbo SR, Tella BA, Olawale OA (2014) Efficacy of the FIFA 11+ warm-up programme in male youth football: a cluster randomised controlled trial. J Sports Sci Med 13:321–328

    PubMed  PubMed Central  Google Scholar 

  23. Pfeiffer RP, Shea KG, Roberts D, Grandstrand S, Bond L (2006) Lack of effect of a knee ligament injury prevention program on the incidence of noncontact anterior cruciate ligament injury. J Bone Joint Surg Am 88:1769–1774

    Article  PubMed  Google Scholar 

  24. Silvers-Granelli H, Mandelbaum B, Adeniji O, Insler S, Bizzini M, Pohlig R et al. (2015) Efficacy of the FIFA 11+ Injury Prevention Program in the Collegiate Male Soccer Player. Am J Sports Med. https://doi.org/10.1177/0363546515602009

    Article  PubMed  PubMed Central  Google Scholar 

  25. Soligard T, Myklebust G, Steffen K, Holme I, Silvers H, Bizzini M et al (2008) Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ 337:a2469

    Article  PubMed  PubMed Central  Google Scholar 

  26. Soligard T, Nilstad A, Steffen K, Myklebust G, Holme I, Dvorak J et al (2010) Compliance with a comprehensive warm-up programme to prevent injuries in youth football. Br J Sports Med 44:787–793

    Article  PubMed  Google Scholar 

  27. Steffen K, Emery CA, Romiti M, Kang J, Bizzini M, Dvorak J et al (2013) 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 randomised trial. Br J Sports Med 47:794–802

    Article  PubMed  Google Scholar 

  28. Steffen K, Myklebust G, Olsen OE, Holme I, Bahr R (2008) Preventing injuries in female youth football—a cluster-randomized controlled trial. Scand J Med Sci Sports 18:605–614

    Article  PubMed  CAS  Google Scholar 

  29. Thorborg K, Krommes KK, Esteve E, Clausen MB, Bartels EM, Rathleff MS (2017) Effect of specific exercise-based football injury prevention programmes on the overall injury rate in football: a systematic review and meta-analysis of the FIFA 11 and 11+ programmes. Br J Sports Med 51:562–571

    Article  PubMed  Google Scholar 

  30. Tilson HH (2004) Adherence or Compliance? Changes in Terminology. Ann Pharmacother 38:161–162

    Article  PubMed  Google Scholar 

  31. Walden M, Atroshi I, Magnusson H, Wagner P, Hagglund M (2012) Prevention of acute knee injuries in adolescent female football players: cluster randomised controlled trial. BMJ 344:e3042

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This study was funded by The Fédération Internationale de Football Association (FIFA).

Author information

Authors and Affiliations

  1. Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA

    Holly J. Silvers-Granelli & Amelia Arundale

  2. Velocity Physical Therapy, 11611 San Vicente Boulevard, GF-1, Los Angeles, CA, 90049, USA

    Holly J. Silvers-Granelli

  3. Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland

    Mario Bizzini

  4. Santa Monica Orthopaedic Group, 1919 Santa Monica Boulevard, 4th Floor, Santa Monica, CA, 90404, USA

    Bert R. Mandelbaum

  5. Department of Physical Therapy and Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA

    Lynn Snyder-Mackler

  6. Department of Biomechanical and Movement Sciences, University of Delaware, Newark, DE, USA

    Lynn Snyder-Mackler

Authors
  1. Holly J. Silvers-Granelli
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  2. Mario Bizzini
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  3. Amelia Arundale
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  4. Bert R. Mandelbaum
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  5. Lynn Snyder-Mackler
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Corresponding author

Correspondence to Holly J. Silvers-Granelli.

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Conflict of interest

One of the authors (HJS-G) received a PhD Research Grant from Simbex, Inc (less than 10,000 USD); and is a research consultant to Major League Soccer’s M-MARC program (less than 10,000 USD) unrelated to this work. One of the authors (AA) received a Grant from the National Institutes of Arthritis and Musculoskeletal and Skin Diseases (R01-AR048212) (less than 10,000 USD) and the Foundation for Physical Therapy–Promotion of Doctoral Studies I Scholarship (less than 10,000 USD). One of the authors (BRM) received funding from FIFA to support the completion of this study (see below); and is a consultant to Athrex, RTI, Exactech, and DePuy Mitek. The institution (Santa Monica Orthopaedic Group) of one or more of the authors (HJS-G, BRM) has received funding from FIFA’s (Fédération Internationale de Football Association) F-MARC Program (2012) for the initial publication (10,000–100,000 USD).

Ethical approval

This study received Internal Review Board (IRB) and Human Ethics approval.

Informed consent

Informed consent was obtained through Quorum Internal Review Board (IRB # 26182/1) (Seattle, WA, USA).

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Silvers-Granelli, H.J., Bizzini, M., Arundale, A. et al. Higher compliance to a neuromuscular injury prevention program improves overall injury rate in male football players. Knee Surg Sports Traumatol Arthrosc 26, 1975–1983 (2018). https://doi.org/10.1007/s00167-018-4895-5

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  • DOI: https://doi.org/10.1007/s00167-018-4895-5

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