File
Assuman N1,2, Jelsma J2, Dunleavy K3, Burgess T2
1University of Rwanda, Physiotherapy College of Medicine and Health Sciences, Kigali, Rwanda, 2University of Cape Town, Physiotherapy, Cape Town, South Africa, 3University of Florida, Physical Therapy, Gainesville, United States
Background: The nature of soccer predisposes players to lower extremity injuries. In Africa, due to limited medical support, many players are unable to proceed to elite levels of play due to injury. The Medical Assessment and Research Centre of the Federation of International Football Association developed the FIFA 11+ injury prevention warm up programme with the goal of reducing the incidence of injuries in soccer players. Only a few randomised controlled trials have been conducted to study effectiveness of the warm up, with limited evaluation in African countries.
Purpose: The purpose of the study was to assess the impact of the FIFA +11 warm up intervention on injury incidence and severity in second division soccer players in Rwanda.
Methods: A cluster randomized controlled trial with teams as the unit of randomization was conducted in 24 second division soccer teams in Rwanda for a period of seven months. Teams were randomly assigned: intervention, 12 teams (309 players); control: 12 teams (317 players). Intervention group coaches received training in the FIFA 11+ soccer specific warm up, and were instructed to perform the FIFA 11+ at least three times a week during training and matches. Control group coaches received training in first aid and continued their usual warm up. Medical personnel recorded training and match time-loss injuries following the FIFA guidelines. Coaches recorded exposure and compliance data. Cluster-adjusted exposure, injury, and compliance data were used in the analysis. Odds Ratios of the control/ intervention group players sustaining injuries was computed using the Epi-Info complex tables function. All ethical issues were considered.
Results: The teams carried out the programme an average 3.6 times per week at 77% of all training sessions and matches. In the control group, 63% of players sustained 252 injuries corresponding to 4.01 injuries/ 1000 hours. In the intervention group, 40% of players sustained 168 injuries, with a significantly lower incidence rate of 2.63 injuries/ 1000 hours (p=0.016). Additionally, training and match injuries were significantly lower in the intervention group (p 0.001). The control group exhibited a significantly higher risk difference (10.65, 95%CI: 1.29-20.1), risk ratio (1.29, 95%CI: 1.04-1.60) and odds ratio (1.55, 95%CI: 1.06-2.28) for overall injuries. The incidence of lower limb (p 0.001), thigh and groin (p=0.002), knee (p=0.049) and ankle (p=0.005) injury was significantly lower in the intervention group. There was a 20% risk reduction for moderate and severe injuries in the intervention group (95%CI: 1.56-3.40). The layoff time was significantly higher for the control group (mean=15; 95% CI : 12.0-17.4 days) than for the intervention group (mean=9; 95%CI: 7.0-10.7 days) (p 0.001).
Conclusion(s): The FIFA 11+ programme significantly decreased the incidence of overall and lower limb injuries. The findings of this study strongly support the need for coach-led injury prevention programmes to reduce injury incidence in soccer.
Implications: It is possible to reduce the rate and minimize risk of moderate and severe lower extremity injuries through the FIFA11+ warm-up programme. This information will be valuable for physiotherapists working with soccer coaches in low-income counties to improve safety.
Keywords: Athletic injury, Injury prevention, Rwanda
Funding acknowledgements: The study was funded by the Government of Rwanda though a PhD scholarship by the Rwanda Education Board.
Purpose: The purpose of the study was to assess the impact of the FIFA +11 warm up intervention on injury incidence and severity in second division soccer players in Rwanda.
Methods: A cluster randomized controlled trial with teams as the unit of randomization was conducted in 24 second division soccer teams in Rwanda for a period of seven months. Teams were randomly assigned: intervention, 12 teams (309 players); control: 12 teams (317 players). Intervention group coaches received training in the FIFA 11+ soccer specific warm up, and were instructed to perform the FIFA 11+ at least three times a week during training and matches. Control group coaches received training in first aid and continued their usual warm up. Medical personnel recorded training and match time-loss injuries following the FIFA guidelines. Coaches recorded exposure and compliance data. Cluster-adjusted exposure, injury, and compliance data were used in the analysis. Odds Ratios of the control/ intervention group players sustaining injuries was computed using the Epi-Info complex tables function. All ethical issues were considered.
Results: The teams carried out the programme an average 3.6 times per week at 77% of all training sessions and matches. In the control group, 63% of players sustained 252 injuries corresponding to 4.01 injuries/ 1000 hours. In the intervention group, 40% of players sustained 168 injuries, with a significantly lower incidence rate of 2.63 injuries/ 1000 hours (p=0.016). Additionally, training and match injuries were significantly lower in the intervention group (p 0.001). The control group exhibited a significantly higher risk difference (10.65, 95%CI: 1.29-20.1), risk ratio (1.29, 95%CI: 1.04-1.60) and odds ratio (1.55, 95%CI: 1.06-2.28) for overall injuries. The incidence of lower limb (p 0.001), thigh and groin (p=0.002), knee (p=0.049) and ankle (p=0.005) injury was significantly lower in the intervention group. There was a 20% risk reduction for moderate and severe injuries in the intervention group (95%CI: 1.56-3.40). The layoff time was significantly higher for the control group (mean=15; 95% CI : 12.0-17.4 days) than for the intervention group (mean=9; 95%CI: 7.0-10.7 days) (p 0.001).
Conclusion(s): The FIFA 11+ programme significantly decreased the incidence of overall and lower limb injuries. The findings of this study strongly support the need for coach-led injury prevention programmes to reduce injury incidence in soccer.
Implications: It is possible to reduce the rate and minimize risk of moderate and severe lower extremity injuries through the FIFA11+ warm-up programme. This information will be valuable for physiotherapists working with soccer coaches in low-income counties to improve safety.
Keywords: Athletic injury, Injury prevention, Rwanda
Funding acknowledgements: The study was funded by the Government of Rwanda though a PhD scholarship by the Rwanda Education Board.
Topic: Sport & sports injuries; Musculoskeletal: lower limb; Orthopaedics
Ethics approval required: Yes
Institution: University of Cape Town
Ethics committee: Faculty of Health Sciences Human Research Ethics Committee
Ethics number: HREC/REF: 683/2014
All authors, affiliations and abstracts have been published as submitted.
