How Effective are F-MARC Injury Prevention Programs for Soccer Players? A Systematic Review and Meta-Analysis

Abstract

Background

The FIFA Medical and Research Centre (F-MARC) has designed a comprehensive warm-up program targeting muscular strength, body kinaesthetic awareness, and neuromuscular control during static and dynamic movements to decrease injury risk for soccer players. Prior studies have investigated the effectiveness of the F-MARC programs, but have not consistently reported a statistically significant reduction in injury and reduction in time loss due to injury from utilizing the program.

Objective

The purpose of this study was to conduct a systematic review and meta-analysis of randomized controlled trials and interventional studies that evaluated the efficacy of the F-MARC injury prevention programs in soccer.

Methods

Two independent researchers searched the relevant article databases. The keyword domains used during the search were ‘F-MARC’, ‘FIFA 11+’, ‘the 11+’, ‘injury prevention programs’, ‘soccer’, and variations of these keywords. The initial search resulted in 4299 articles which were filtered to nine articles that met the inclusion criteria. Main inclusion criteria were randomized controlled trials or interventional studies, use of F-MARC injury prevention programs, and the primary outcome measuring overall and lower extremity injuries. Extracted data were entered and analyzed using Comprehensive Meta-Analysis software, version 2 (CMA.V2).

Results

The pooled results based on total injuries per 1000 h of exposure showed that F-MARC injury prevention programs had a statistically significant reduction in the overall injury risk ratio of 0.771 (95 % CI 0.647–0.918, p = 0.003) and the lower extremity injury risk ratio of 0.762 (95 % CI 0.621–0.935, p = 0.009). Moreover, FIFA ‘11+’ had a statistically significant reduction in the overall injury risk ratio to 0.654 (95 % CI 0.537–0.798, p < 0.001) and the lower extremity injury risk ratio of 0.612 (95 % CI 0.475–0.788, p < 0.001). However, FIFA ‘11’ did not reach significance for the lower extremity and overall injury reduction. It can be suggested that teams involved in the FIFA ‘11+’ warm-up program will reduce injury rates by between 20 and 50 % in the long term compared with the teams that do not engage in F-MARC programs.

Conclusions

This systematic review and meta-analysis indicated that use of F-MARC injury prevention programs, particularly the ‘11+’ program, decreases the risk of injuries among soccer players. These data also support the case for the development and introduction of sport-specific programs.

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References

  1. 1.

    Darrow CJ, Collins CL, Yard EE, et al. Epidemiology of severe injuries among United States high school athletes: 2005–2007. Am J Sports Med. 2009;37(9):1798–805. doi:10.1177/0363546509333015.

    Article  PubMed  Google Scholar 

  2. 2.

    Bizzini M, Junge A, Dvorak J. 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. 2013;47(12):803–6. doi:10.1136/bjsports-2012-092124.

    PubMed Central  Article  PubMed  Google Scholar 

  3. 3.

    Soligard T, Myklebust G, Steffen K, et al. Comprehensive warm-up program to prevent injuries in young female footballers: cluster randomised controlled trial. Br Med J. 2008;337:a2469. doi:10.1136/bmj.a2469.

    Article  Google Scholar 

  4. 4.

    Emery CA, Meeuwisse WH. The effectiveness of a neuromuscular prevention strategy to reduce injuries in youth soccer: a cluster-randomised controlled trial. Br J Sports Med. 2010;44(8):555–62. doi:10.1136/bjsm.2010.074377.

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Kiani A, Hellquist E, Ahlqvist K, et al. Prevention of soccer-related knee injuries in teenaged girls. Arch Intern Med. 2010;170(1):43–9. doi:10.1001/archinternmed.2009.289.

    Article  PubMed  Google Scholar 

  6. 6.

    Mandelbaum BR, Silvers HJ, Watanabe DS, et al. 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. 2005;33(7):1003–10. doi:10.1177/0363546504272261.

    Article  PubMed  Google Scholar 

  7. 7.

    Walden M, Atroshi I, Magnusson H, et al. Prevention of acute knee injuries in adolescent female football players: cluster randomised controlled trial. Br Med J. 2012;344:e3042. doi:10.1136/bmj.e3042.

    Article  Google Scholar 

  8. 8.

    LaBella CR, Huxford MR, Grissom J, et al. Effect of neuromuscular warm-up on injuries in female soccer and basketball athletes in urban public high schools: cluster randomized controlled trial. Arch Pediatr Adolesc Med. 2011;165(11):1033–40. doi:10.1001/archpediatrics.2011.168.

    Article  PubMed  Google Scholar 

  9. 9.

    Krist MR, van Beijsterveldt AM, Backx FJ, et al. Preventive exercises reduced injury-related costs among adult male amateur soccer players: a cluster-randomised trial. J Physiother. 2013;59(1):15–23. doi:10.1016/S1836-9553(13)70142-5.

    Article  PubMed  Google Scholar 

  10. 10.

    Holmich P, Larsen K, Krogsgaard K, et al. Exercise program for prevention of groin pain in football players: a cluster-randomized trial. Scand J Med Sci Sports. 2010;20(6):814–21. doi:10.1111/j.1600-0838.2009.00998.x.

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    Steffen K, Myklebust G, Olsen OE, et al. Preventing injuries in female youth football–a cluster-randomized controlled trial. Scand J Med Sci Sports. 2008;18(5):605–14. doi:10.1111/j.1600-0838.2007.00703.x.

    Article  CAS  PubMed  Google Scholar 

  12. 12.

    Steffen K, Bakka HM, Myklebust G, et al. Performance aspects of an injury prevention program: a ten-week intervention in adolescent female football players. Scand J Med Sci Sports. 2008;18(5):596–604. doi:10.1111/j.1600-0838.2007.00708.x.

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    van Beijsterveldt AM, van de Port IG, Krist MR, et al. Effectiveness of an injury prevention program for adult male amateur soccer players: a cluster-randomised controlled trial. Br J Sports Med. 2012;46(16):1114–8. doi:10.1136/bjsports-2012-091277.

    PubMed Central  Article  PubMed  Google Scholar 

  14. 14.

    F-MARC. FIFA 11+ a complete warm-up program Available from : http://f-marc.com. 2014.

  15. 15.

    Steffen K, Emery CA, Romiti M, et al. High adherence to a neuromuscular injury prevention program (FIFA 11+) improves functional balance and reduces injury risk in Canadian youth female football players: a cluster randomised trial. Br J Sports Med. 2013;47(12):794–802. doi:10.1136/bjsports-2012-091886.

    Article  PubMed  Google Scholar 

  16. 16.

    Owoeye OB, Akinbo SR, Tella BA, et al. Efficacy of the FIFA 11+ Warm-Up Program in Male Youth Football: a cluster randomised controlled trial. J Sports Sci Med. 2014;13(2):321–8.

    PubMed Central  PubMed  Google Scholar 

  17. 17.

    Hammes D, Aus der Funten K, Kaiser S, et al. Injury prevention in male veteran football players—a randomised controlled trial using “FIFA 11+”. J Sports Sci. 2015;33(9):873–81. doi:10.1080/02640414.2014.975736.

    Article  PubMed  Google Scholar 

  18. 18.

    Junge A, Rosch D, Peterson L, et al. Prevention of soccer injuries: a prospective intervention study in youth amateur players. Am J Sports Med. 2002;30(5):652–9.

    PubMed  Google Scholar 

  19. 19.

    Gatterer H, Ruedl G, Faulhaber M, et al. Effects of the performance level and the FIFA “11” injury prevention program on the injury rate in Italian male amateur soccer players. J Sports Med Phys Fit. 2012;52(1):80–4.

    CAS  Google Scholar 

  20. 20.

    Grooms DR, Palmer T, Onate JA, et al. Soccer-specific warm-up and lower extremity injury rates in collegiate male soccer players. J Athl Train. 2013;48(6):782–9. doi:10.4085/1062-6050-48.4.08.

    PubMed Central  Article  PubMed  Google Scholar 

  21. 21.

    Handbook C, Higgins J, Green S. Cochrane handbook for systematic reviews of interventions 4.2.6 [updated September 2006]. The Cochrane Library. Chichester: Wiley; 2006. p. 4.

    Google Scholar 

  22. 22.

    Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Br Med J. 2009;339:b2535. doi:10.1136/bmj.b2535.

    Article  Google Scholar 

  23. 23.

    Furlan AD, Pennick V, Bombardier C, et al. 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine (Phila Pa 1976). 2009;34(18):1929–41. doi:10.1097/BRS.0b013e3181b1c99f.

    Article  Google Scholar 

  24. 24.

    Fuller CW, Ekstrand J, Junge A, et al. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Br J Sports Med. 2006;40(3):193–201. doi:10.1136/bjsm.2005.025270.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  25. 25.

    Caine D, Maffulli N, Caine C. Epidemiology of injury in child and adolescent sports: injury rates, risk factors, and prevention. Clin Sports Med. 2008;27(1):19–50. doi:10.1016/j.csm.2007.10.008.

    Article  PubMed  Google Scholar 

  26. 26.

    Hewett TE, Ford KR, Myer GD. Anterior cruciate ligament injuries in female athletes: part 2, a meta-analysis of neuromuscular interventions aimed at injury prevention. Am J Sports Med. 2006;34(3):490–8. doi:10.1177/0363546505282619.

    Article  PubMed  Google Scholar 

  27. 27.

    Prodromos CC, Han Y, Rogowski J, et al. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy. 2007;23(12):1320 e6–1325 e6. doi:10.1016/j.arthro.2007.07.003.

    Article  PubMed  Google Scholar 

  28. 28.

    Sugimoto D, Myer GD, Bush HM, et al. Compliance with neuromuscular training and anterior cruciate ligament injury risk reduction in female athletes: a meta-analysis. J Athl Train. 2012;47(6):714–23. doi:10.4085/1062-6050-47.6.10.

    PubMed Central  Article  PubMed  Google Scholar 

  29. 29.

    Witchalls J, Blanch P, Waddington G, et al. Intrinsic functional deficits associated with increased risk of ankle injuries: a systematic review with meta-analysis. Br J Sports Med. 2012;46(7):515–23. doi:10.1136/bjsports-2011-090137.

    Article  PubMed  Google Scholar 

  30. 30.

    Freckleton G, Pizzari T. Risk factors for hamstring muscle strain injury in sport: a systematic review and meta-analysis. Br J Sports Med. 2013;47(6):351–8. doi:10.1136/bjsports-2011-090664.

    Article  PubMed  Google Scholar 

  31. 31.

    Myer GD, Sugimoto D, Thomas S, et al. The influence of age on the effectiveness of neuromuscular training to reduce anterior cruciate ligament injury in female athletes: a meta-analysis. Am J Sports Med. 2013;41(1):203–15. doi:10.1177/0363546512460637.

    PubMed Central  Article  PubMed  Google Scholar 

  32. 32.

    Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2014;48(11):871–7. doi:10.1136/bjsports-2013-092538.

    Article  PubMed  Google Scholar 

  33. 33.

    Leppanen M, Aaltonen S, Parkkari J, et al. Interventions to prevent sports related injuries: a systematic review and meta-analysis of randomised controlled trials. Sports Med. 2014;44(4):473–86. doi:10.1007/s40279-013-0136-8.

    Article  PubMed  Google Scholar 

  34. 34.

    Rossler R, Donath L, Verhagen E, et al. Exercise-based injury prevention in child and adolescent sport: a systematic review and meta-analysis. Sports Med. 2014;44(12):1733–48. doi:10.1007/s40279-014-0234-2.

    Article  PubMed  Google Scholar 

  35. 35.

    Taylor JB, Waxman JP, Richter SJ, et al. Evaluation of the effectiveness of anterior cruciate ligament injury prevention program training components: a systematic review and meta-analysis. Br J Sports Med. 2015;49(2):79–87. doi:10.1136/bjsports-2013-092358.

    Article  PubMed  Google Scholar 

  36. 36.

    Marshall PW, Robbins DA, Wrightson AW, et al. Acute neuromuscular and fatigue responses to the rest-pause method. J Sci Med Sport. 2012;15(2):153–8. doi:10.1016/j.jsams.2011.08.003.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

All authors of this paper have contributed substantially to the conception and design of the review, the analysis and interpretation of the data, the drafting of the article or revising it critically for important intellectual content, and the final approval of the published version.

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Correspondence to Wesam Saleh A. Al Attar.

Ethics declarations

Wesam Saleh A. Al Attar is supported by Umm Al Qura University in Makkah, Saudi Arabia. No sources of funding were used to assist in the preparation of this review.

Conflict of interest

Wesam Saleh A. Al Attar, Najeebullah Soomro, Peter Sinclair, Evangelos Pappas and Ross Sanders declare they have no conflicts of interest with the content of this review.

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Al Attar, W.S.A., Soomro, N., Pappas, E. et al. How Effective are F-MARC Injury Prevention Programs for Soccer Players? A Systematic Review and Meta-Analysis. Sports Med 46, 205–217 (2016). https://doi.org/10.1007/s40279-015-0404-x

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Keywords

  • Soccer Player
  • Injury Rate
  • Injury Risk
  • Lower Extremity Injury
  • Injury Prevention Program