A multinational cluster randomized controlled trial to assess the efficacy of ‘11+ Kids’: A warm-up programme to prevent injuries in children’s football
Rossler R, Junge A, Bizzini M, Verhagen E, Chomiak J, aus der Funten K, Meyer T, Dvorak J, Lichtenstein E, Beaudouin F, Faude O. Sports Med (2017).
Take Home Message: The ‘11+ Kids’, an injury prevention warm-up program tailored for younger athletes, is effective in reducing injuries in youth soccer by nearly 50%; but, compliance is a key factor for optimal success.
Injury prevention for youth soccer is challenging because injury mechanisms and athlete biomechanics and characteristics are different in those under 14 years of age compared with adults. The development of ‘11+ Kids’ – a modification of the FIFA 11+ used for adult soccer players – was designed to be an injury prevention warm-up program for young athletes. However, there is a lack of research on this new injury prevention program. Hence, the researchers conducted a randomized trial to evaluate the efficacy of ‘11+ Kids’ by comparing incidence of injuries among clubs that represented 3 different age groups ([Under 9, Under 11, Under 13] mean age=10.8) from four different European countries. The authors randomized clubs into either a control or 11+ Kids group. The control group performed their own regular warm-up program. The 11+ Kids group used the 15 to 20 minutes ‘11+ Kids’ program. The authors defined an “injury” as any physical complaint during practices or games that resulted in any combination of the following: lost playing time, prevented the athlete from finishing the practice or game, or required the attention of the medical staff. Club coaches were responsible for accurately reporting injury rates during the year-long study of nearly 4000 players over almost 295,000 hours of exposure. The study staff followed-up on each injury with the parents to verify the injury and gain additional information. The 11+ Kids group sustained 48% fewer overall injuries than the control group, had a lower drop-out rate (7.6% versus 13.9%), and had nearly half as many days lost to injuries (2026 days versus 4201 days). For severe injuries, the researchers found that the protective benefit of ‘11+ Kids’ translated into a 74% decrease when compared to the control group. The risk of injury among highly compliant 11+ Kids teams (1-3 sessions/week) was half that of the low compliance teams (< 1 session/week).
Healthy children become healthy adults. The long-term benefits of sport participation are well documented and keeping athletes of all ages injury-free contributes to an overall healthy lifestyle that lasts long into adulthood. Focusing on injury prevention, rather than injury recovery, in young athletes protects them from long-term consequences of injury that may affect their activity levels long after recovery. In the short term, clinicians and coaches working with young athletes should recognize that a good injury prevention warm-up program can mean the difference between having a full line-up of healthy athletes, a bench filled with injured athletes, or large numbers of drop-outs due to injury. For young athletes, being healthy means more playing time. The ‘11+ Kids’ program offers a progressive-difficulty program that addresses common areas where young athletes need intervention the most, such as whole-body stability, dynamic stability of the lower extremity, and motor control. Athletic trainers and coaches can use ‘11+ Kids’ to demonstrate the importance of high compliance when using this program before practice to reduce incidence of injuries, as well as reducing the risk of long-term consequences of injury. While representative of the percentage of girls who participate in soccer, a weakness the authors noted was the low numbers of girls and their injuries in this study. Hence, it’s unclear if the benefits of this program can be transferred equally between boys and girls. Overall, the ‘11+ Kids’ warm-up program is efficacious in youth soccer for reducing injury rates. This is yet another example showing that injury prevention programs can have a profound effect on the number of injuries our teams experience.
Questions for Discussion: Since boys mature differently than girls, should ‘11+ Kids’ be further tailored to the needs of each gender separately?