title: 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.
abstract: BACKGROUND
  A protective effect on injury risk in youth sports through neuromuscular warm-up training routines has consistently been demonstrated. However, there is a paucity of information regarding the quantity and quality of coach-led injury prevention programmes and its impact on the physical performance of players.
  
  
  OBJECTIVE
  The aim of this cluster-randomised controlled trial was to assess whether different delivery methods of an injury prevention programme (FIFA 11+) to coaches could improve player performance, and to examine the effect of player adherence on performance and injury risk.
  
  
  METHODS
  During the 2011 football season (May-August), coaches of 31 tiers 1-3 level teams were introduced to the 11+ through either an unsupervised website or a coach-focused workshop with and without additional on-field supervisions. Playing exposure, adherence to the 11+, and injuries were recorded for female 13-year-old to 18-year-old players. Performance testing included the Star Excursion Balance Test (SEBT), single-leg balance, triple hop and jumping-over-a-bar tests.
  
  
  RESULTS
  Complete preseason and postseason performance tests were available for 226 players (66.5%). Compared to the unsupervised group, single-leg balance (OR=2.8; 95% CI 1.1 to 4.6) and the anterior direction of the SEBT improved significantly in the onfield supervised group of players (OR=4.7; 95% CI 2.2 to 7.1), while 2-leg jumping performance decreased (OR=-5.1; 95% CI -9.9 to -0.2). However, significant improvements in 5 of 6 reach distances in the SEBT were found, favouring players who highly adhered to the 11+. Also, injury risk was lower for those players (injury rate ratio, IRR=0.28, 95% CI 0.10 to 0.79).
  
  
  CONCLUSIONS
  Different delivery methods of the FIFA 11+ to coaches influenced players' physical performance minimally. However, high player adherence to the 11+ resulted in significant improvements in functional balance and reduced injury risk.
authors.affiliation: Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, Canada. kathrin.steffen@nih.no
authors.forename: Kathrin
authors.initials: K
authors.lastname: Steffen
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Emery
authors.forename: Maria
authors.initials: M
authors.lastname: Romiti
authors.forename: Jian
authors.initials: J
authors.lastname: Kang
authors.forename: Mario
authors.initials: M
authors.lastname: Bizzini
authors.forename: Jiri
authors.initials: J
authors.lastname: Dvorak
authors.forename: Caroline F
authors.initials: CF
authors.lastname: Finch
authors.forename: Willem H
authors.initials: WH
authors.lastname: Meeuwisse
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000503:physiopathology / Q000517:prevention & control; D054874:Athletic Performance / Q000502:physiology; D002170:Canada; D016000:Cluster Analysis; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000293:injuries*; D010349:Patient Compliance; D004856:Postural Balance / Q000502:physiology*; D012307:Risk Factors; D012916:Soccer / Q000293:injuries*; D020196:Trauma, Nervous System / Q000517:prevention & control*; D063996:Warm-Up Exercise / Q000502:physiology*
keywords: Adolescents; Implementation; Injury Prevention; Soccer; Training