Effect of the FIFA 11+ on Landing Patterns and Baseline Movement Errors in Elite Male Youth Soccer Players

Little associations exist between the three commonly used functional screening tests in collegiate athletes

Although an abundant number of studies have investigated the predictability of the commonly used functional screening tests and despite their popularity and applicability, the relationships between these tests have rarely been studied and have not been well established. This study aimed to examine the potential association between the Functional Movement Screen (FMS), Y Balance Test (YBT), and Landing Error Scoring System (LESS). Six hundred twenty-seven Iranian collegiate athletes (347 males, age = 22.63 ± 4.07, weight = 75.98 ± 13.79, height = 181.99 ± 10.15, BMI = 22.84 ± 3.16; and 280 females, age = 22.22 ± 3.37, weight = 60.63 ± 9.58, height = 166.55 ± 6.49, BMI = 21.81 ± 2.84) participated in this study. Following a 5-min warm-up, each participant underwent a standardized screening battery including the FMS, YBT, and LESS, and the scores were recorded and live coded for the statistical analysis, except for the LESS. The LESS tests were video recorded and scored by one expert examiner using an open-source 2D video analysis software (Kinovea- version 0.9.5), afterwards. The Spearman correlation was utilized as a measure for the correlation, and the Mann‒Whitney U test with a significance level of 0.05 was used to check the differences between male and female athletes. The statistical analysis was performed with RStudio 2023.03.0 using R 4.3.1. A small correlation (0.364) was observed between the FMS composite score and the YBT in male athletes. All other pairwise correlations were negligible among male and female athletes, ranging from - 0.096 to 0.294. Reducing the FMS to the component scores targeting the lower extremities did not alter the correlation to the other screening scores. The median FMS composite score in female athletes was significantly higher than that in males (p < 0.001). Negligible correlations exist between the FMS, LESS, and YBT; they do not measure the same values and therefore are irreplaceable with one another. A combination of these tests as a standardized screening battery may potentially better identify injury-predisposed athletes than the application of each test as a stand-alone screening test. Females outperformed males in the FMS test significantly, so sex must be considered a key variable in the FMS studies. Males had slightly higher LESS scores (median difference = 0.5) than females, but this difference is not clinically meaningful. Future research should continue to explore the relationships between various functional screening tests and identify the most effective combinations for comprehensive assessment in different populations and sports disciplines.

A 10-week FIFA 11+ program improves the short-sprint and modified agility T-test performance in elite seven-a-side soccer players

Objective: The primary objective of this study was to assess the effects of 10 weeks of FIFA 11+ training on the physical performance of elite seven-a-side soccer players. Methods: Twenty-five seven-a-side soccer players were recruited from two senior national teams. The players completed the following protocols during 10 weeks of training: a) FIFA 11+: The FIFA group (n = 13) underwent the FIFA 11+ program combined with regular soccer training; b) Dynamic conventional warm-up: The control group (n = 12) underwent regular soccer training. Their ability was validated using a pre-test followed by a post-test to measure the sprint performance (5-, 10-, and 20-m sprints), a modified agility T-test (MAT), and a five-jump test (FJT). Results: A comparison of pre- and post-tests for physical performance in each group demonstrated that the FIFA 11+ warm-up significantly improved the 10-m sprinting performance (p = 0.034; F = 5.04; ηp 2 = 0.17) and reduced the time spent to perform the MAT (p = 0.000; F = 23.16; ηp 2 = 0.52) in the FIFA group compared with the control group; however, no significant changes were observed in the 5- and 20-m sprints and FJT. Conclusion: The main findings of this research showed that the 10-week FIFA 11+ program led to significant improvements in the 10-m sprint and MAT compared to regular training among elite seven-a-side soccer players. Given these positive outcomes, further studies on the practical implementation and optimization of the FIFA 11+ program are warranted to provide valuable guidance for coaches and athletes, seeking to maximize its benefits in real-world settings.

Two-Dimensional and Three-Dimensional Biomechanical Factors During 90° Change of Direction are Associated to Non-Contact ACL injury in Female Soccer Players

Background

The two-dimensional (2D) video-analysis of the change of direction (COD) technique has never been used to attempt to predict the risk of ACL injury in female football players.

Hypothesis/Purpose

The purpose of the present pilot study was to prospectively investigate the biomechanical predictors of ACL injury during a COD task in female football players using both gold standard 3D motion capture and a qualitative scoring system based on 2D video-analysis.

Study Design

Prospective cohort study.

Methods

Sixteen competitive female football (soccer) players (age 21.4 ± 4.3) performed a series of pre-planned 90° COD tasks. 3D motion data was recorded through 10 stereophotogrammetric cameras and a force platform. 2D frontal and transverse plane joint kinematics were computed through video-analysis from three high-speed cameras. A scoring system based on five criteria was adopted: limb stability, pelvis stability, trunk stability, shock absorption, and movement strategy. The players were prospectively followed for the next two consecutive football seasons and the occurrence of severe knee injuries was registered.

Results

Four players (25%) experienced an ACL injury. In 3D analysis, ACL-injured players showed greater knee valgus, knee internal rotation, and lower knee flexion (p= 0.017 - 0.029). Lower hip flexion coupled with greater external rotation (p= 0.003 - 0.042), ankle eversion, and contralateral pelvic drop (p<0.001) were also noted. In 2D analysis, ACL-injured players showed greater internal foot rotation, contralateral pelvic drop, lower knee flexion, and contralateral trunk tilt (moderate-to-large effect size). Pelvis stability and trunk stability showed the highest predictive value towards ACL injury. Total score was significantly lower in ACL-injured players with a moderate effect size (d=0.45).

Conclusions

Both 3D and 2D methodologies depicted biomechanical risk factors and offered predictive insights towards the ACL injury risk. Awareness should rise in women's football regarding the high risk of ACL injury and the strategies to assess and mitigate it.

Level of Evidence

3©The Author(s).

Effects of Multicomponent Injury Prevention Programs on Children and Adolescents' Fundamental Movement Skills: A Systematic Review With Meta-Analyses

OBJECTIVE

Fundamental movement skills (FMS) are essential to participate in physical activity. Understanding the effects of multicomponent injury prevention programs (MIPP) on FMS may help promote safe physical activity. Our objective was to synthesize the evidence on the effects of MIPP on biomechanical outcomes and neuromuscular performance measured on children and adolescents while performing FMS.

DATA SOURCE

We searched PubMed, SPORTDiscus, Web of Science, and SCOPUS.

STUDY INCLUSION AND EXCLUSION CRITERIA

We included peer-reviewed randomized controlled trials, published in English, that analyzed the effects of MIPP on biomechanics and neuromuscular performance of FMS in participants under 18 years of age.

DATA EXTRACTION

Two reviewers screened the articles, assessed the quality of the evidence using the Physiotherapy Evidence Database (PEDro) scale, and synthesized the data.

DATA SYNTHESIS

We conducted meta-analyses and reported the characteristics, outcomes, and risk of bias of studies.

RESULTS

We included 27 articles that reported data from 1,427 participants. Positive effects on FMS were reported in 23 of the 27 included articles. Vertical Jump, running speed, acceleration, and dynamic balance presented positive-significant pooled effect sizes. Dribbling and horizontal jump presented non-significant pooled effect sizes.

CONCLUSION

MIPP can positively affect FMS in children and adolescents in sports-related settings. Lack of participant compliance and implementation fidelity may affect MIPP effectiveness. Including MIPP in physical literacy interventions, physical education classes, and organized physical activity may lead to functional adaptations that help promote safe physical activity.

Effects of the FIFA 11+ program on performance, biomechanical measures, and physiological responses: A systematic review

BACKGROUND

The side effects of the FIFA 11+ program on performance have not been generally reviewed. The objective of this study was to synthesize the literature on the effects of the 11+ on players' performance.

METHODS

Five online databases (PubMed, Scopus, ScienceDirect, Springer, and Google Scholar) were searched (from April 2006 to March 2022) using predefined keywords and sub-keywords. The potential references were primarily recorded through Endnote and imported to Covidence. Out of the 123 references screened by 2 blinded researchers through the software, 59 full texts were assessed for eligibility, 33 of which were ultimately included. The quality of the studies and the risk of bias were then assessed. Study ID, title, place, aim, design, start/end dates, population description, study criteria, statistical analysis, and outcomes were extracted.

RESULTS

Studies were conducted on male and female players aged 10-32 years old. The quality of the studies was moderate to high, and except for unclear bias for blinding outcome assessment, the risk of bias for all domains was low. Long-term application of the 11+ improved most biomechanical measures and physiological responses except for lower extremity stability, ankle evertors time latency, ankle dorsiflexion, and proprioception. Conversely, the 11+ showed acute negative effects on physical performance compared to dynamic warm-ups and non-significant effects on technical abilities.

CONCLUSION

Mid-to-long-term implementation of the 11+ improved the majority of biomechanical and a couple of physical measures but showed no effects on technical skills. Precaution must be observed for using the 11+ before competitions, as it could acutely decrease physical/technical performance. Given the contradictory nature of the literature, further studies should evaluate the short-to-mid-term effects of the 11+. Further studies are required to address ankle responses to the 11+ intervention.

Ankle dorsiflexion range of motion and landing postures during a soccer-specific task

INTRODUCTION

Ankle dorsiflexion range of motion (DF-ROM) has been shown to be associated with poor landing posture. However, previously used tasks have been controlled, and it is unclear whether clinical measurements of the ankle DF-ROM, are associated with landing positions during sport-specific task. This study sought to determine the relationship between ankle DF-ROM and landing positions.

METHODS

Thirty male soccer players participated in this study. The ankle DF-ROM was measured by the weight bearing lunge test in degrees using a cell phone app (TiltMeter). Landing patterns were assessed during a soccer-specific task using landing error scoring system items using Kinovea software. Simple correlations were used to evaluate the relationships between ankle DF-ROM and landing error scores.

RESULTS

Significant correlations were found between ankle DF-ROM and landing errors (r = -0.450, P = 0.006). A decreased ankle DF-ROM was associated with greater landing errors in a soccer specific situation.

CONCLUSION

These results suggest that ankle DF-ROM may serve a useful clinical measure for identifying poor landing posture in the real-world environment. Therefore, assessment of ankle DF-ROM could be included in the screening process, which could help identify the cause of the faulty motion.

Quo Vadis Nordic Hamstring Exercise-Related Research?-A Scoping Review Revealing the Need for Improved Methodology and Reporting

The objective of this scoping review is to assess Nordic Hamstring Exercise quality (ANHEQ) of assessments and interventions according to the ANHEQ rating scales and to present practical recommendations for the expedient design and reporting of future studies. A total of 71 Nordic Hamstring Exercise (NHE) assessments and 83 NHE interventions were selected from the data sources PubMed, Scopus, and SPORTDiscus. Research studies which were presented in peer-reviewed academic journals and implemented the NHE during laboratory-based assessments or multi-week interventions met the eligibility criteria. NHE assessments analyzed force (51%), muscle activation (41%), knee angle kinematics (38%), and bilateral symmetry (37%). NHE interventions lasted 4-8 weeks (56%) and implied an exercise volume of two sessions per week (66%) with two sets per session (41%) and ≥8 repetitions per set (39%). The total ANHEQ scores of the included NHE assessments and interventions were 5.0 ± 2.0 and 2.0 ± 2.0 (median ± interquartile range), respectively. The largest deficits became apparent for consequences of impaired technique (87% 0-point-scores for assessments) and kneeling height (94% 0-point-scores for interventions). The 0-point-scores were generally higher for interventions compared to assessments for rigid fixation (87% vs. 34%), knee position (83% vs. 48%), kneeling height (94% vs. 63%), and separate familiarization (75% vs. 61%). The single ANHEQ criteria, which received the highest score most frequently, were rigid fixation (66% of assessments) and compliance (33% of interventions). The quality of NHE assessments and interventions was generally 'below average' or rather 'poor'. Both NHE assessments and interventions suffered from imprecise reporting or lacking information regarding NHE execution modalities and subsequent analyses. Based on the findings, this scoping review aggregates practical guidelines how to improve the design and reporting of future NHE-related research.

Don't Peak Too Early: Evidence for an ACL Injury Prevention Mechanism of the 11+ Program

Background

The 11+ program prevents anterior cruciate ligament (ACL) injuries in athletes through unknown mechanisms.

Purpose

The aim of the current study was to evaluate the effects of The 11+ intervention program, performed by female soccer players during a single season, on the frequency of Early Peaks during athletic tasks.

Methods

Three teams (69 players) of collegiate female soccer athletes (Divisions I and II) were recruited. Two teams (49 players) volunteered to perform The 11+ three times per week for one season (~22 weeks plus three weeks pre-season), and one team (20 players) served as controls. The athletes performed three repetitions of a cutting maneuver, side shuffle direction change, and forwards to backwards running direction change before and after the competitive season and were recorded using marker-based 3D motion capture. Knee valgus moment time series were calculated for each repetition with inverse kinematics and classified as either "Very Early Peak", "Early Peak" or "other" using cluster analysis. The classification was based timing of the peak relative to the timing of ACL injuries. The effect of the intervention on the frequency of Very Early Peaks and Early Peaks was evaluated with a mixed Poisson regression controlling for the movement task and pre-season frequency.

Results

The 11+ intervention reduced the frequency of Early Peak knee valgus moment in one intervention team (coefficient = -1.16, p = 0.004), but not the other (coefficient = -0.01, p = 0.977). No effect was observed on the frequency of Very Early Peak knee valgus moment.

Conclusions

Reduced frequency of knee valgus moment Early Peak during athletic tasks may explain the mechanism by which The 11+ program decreases risk of ACL injury. Prospective studies with a much larger sample size are required to establish a link between Early Peak knee valgus moments and risk of ACL injury.

Level of evidence

2b.

Do healthy athletes exhibit at-risk biomechanics for anterior cruciate ligament injury during pivoting movements?

A consistent injury mechanism involving multiple joints has been highlighted in athletes experiencing anterior cruciate ligament (ACL) rupture. However, if and to what extent healthy athletes incur an unsafe biomechanical profile during high-dynamics movements is unknown. The present study aimed to investigate the occurrence of the ACL risk profile in a competitive pivoting sports population.Thirty-four athletes (22.8 ± 4.1 y) performed a frontal deceleration and a change of direction at 90°. Full-body kinematics was collected through 15 wearable inertial sensors (Awinda, Xsens). Nine ACL risk factors were defined based on four categories: limited lower limb flexion, valgus collapse, foot rotation and trunk rotation. A movement trial was considered 'at-risk' in the presence of at least 5 simultaneous risk factors. The rate of athletes with at-risk movements was assessed and multivariate regression for associated outcomes was conducted.The overall rate of injury profile occurrence was 9-12%. The injury profile was identified at least in one trial in 24 athletes (71%) and three trials in 5 athletes (15%). Significant associations were found for higher approaching speed (OR = 4.3) and female sex (OR = 4.8). A large occurrence of the typical ACL injury biomechanical profile was noticed. Large screenings are advisable to identify at-risk athletes and promote preventative strategies.

What are gender differences in lower limb muscle activity during jump-landing tasks? A systematic review and meta-analysis

Background

Gender differences in muscle activity during landing have been proposed as a possible contributing factor to the greater incidence of anterior cruciate ligament injuries in women. Conflicting results among a few studies in this regard makes it impossible to reach correct conclusions.

Objectives

The aim of this study was systematic review and the meta-analysis of previous studies which have compared the electromyographic activity of lower limb muscles in gluteus muscles (maximus and medius), quadriceps (rectus femoris, vastus medialis and lateralis), hamstrings (biceps femoris and semimembranosus), and gastrocnemius in men and women in jump–landing task.

Methods

A systematic search of the PubMed, SCOPUS, Science Direct databases was performed for eligible articles in October 2020. Cross-sectional studies that compared the muscle activity of male and female athletes without a history of previous injury in the jump–landing task were included. Unisex and non-athlete's studies were extracted from the included studies. The data were synthesized using a fixed and random effects model.

Results

Eight studies involving 145 participants were included. All participants were people who participated in regular exercises. The meta-analysis of timing and muscle activity was performed in the feedforward (pre contact) and feedback (post contact) stages. There were no significant differences in the muscle activity of biceps femoris (MD = −12.01; 95% CI − 51.49 to 27.47; p = 0.55; I² = 87%), vastus medialis (MD = −53.46; 95% CI − 129.73 to 22.81; p = 0.17; I² = 91%), semimembranosus (MD = 1.81; 95% CI − 6.44 to 10.07; p = 0.67; I² = 0%), gluteus medius (MD = −3.14; 95% CI − 14.24 to 7.96; p = 0.58; I² = 48%), and rectus femoris (MD = −5.83; 95% CI − 14.57 to 2.92; p = 0.19; I² = 87%) in the pre contact phase between two sexes. There was a significant difference between men and women in the activity of vastus lateralis muscle in the post contact phase (MD = −34.90; 95% CI − 48.23 to − 21.57). No significant difference was observed between the men and women in the timing of semimembranosus (MD = 23.53; 95% CI − 14.49 to 61.54; p = 0.23; I² = 56%) and biceps femoris muscle activity (MD = −46.84; 95% CI − 97.50 to 3.83; p = 0.07; I² = 82%).

Conclusion

The results showed that in all lower limb muscles except vastus lateralis there were no significant differences between muscle activity and muscle contraction timing in both sexes before and after foot contact. Therefore, it can be concluded that the reason for the greater susceptibility of ACL injuries in women than men is maybe related to other factors such as biomechanical and hormonal. Additional good quality research in this regard is required to strengthen these conclusions.

Effect of Strength Training on Jump-Landing Biomechanics in Adolescent Females

BACKGROUND

Sex-based differences in neuromuscular characteristics relevant to anterior cruciate ligament (ACL) injury risk may arise as compensation for divergent strength development during puberty. Strength training during this period may prevent the development of these undesirable neuromuscular characteristics.

HYPOTHESIS

Strength-trained middle school girls will have improved jump-landing biomechanics compared with control participants.

STUDY DESIGN

Cohort study.

LEVEL OF EVIDENCE

Level 3.

METHODS

Maximum voluntary isometric contraction in hip extension and abduction and knee extension and flexion as well as Landing Error Scoring System (LESS) scores were collected for healthy female middle school students of grades 6 to 8. Strength-training participants (STR: N = 30; height, 1.63 ± 0.07 m; mass, 48.1 ± 7.6 kg; age, 12.5 ± 1.0 y) were matched with control participants (CON: N = 30; height, 1.60 ± 0.09 m; mass, 47.2 ± 8.9 kg; age, 12.6 ± 0.9 y). The training consisted of a 6-month strength-training program administered through a gym class curriculum that targeted the lower extremity. A repeated-measures mixed-model analysis of variance was used for comparisons between groups and across time (α = 0.05). Stepwise linear regression was used to examine the relationship between strength change and LESS score change.

RESULTS

Strength values (N·m/kg) increased across time and to a greater degree in STR for hip extension (baseline 3.98 ± 1.15 vs follow-up 4.77 ± 1.80), hip abduction (4.22 ± 1.09 vs 5.13 ± 2.55), and knee flexion (3.27 ± 0.62 vs 3.64 ± 1.40) compared with CON. LESS grades significantly decreased across time in STR (5.58 ± 1.21 vs 4.86 ± 1.44) and were significantly lower than CON (5.98 ± 1.42) at follow-up (P < 0.001). The change in hip extension and knee extension strength explained 67% of the variance (P < 0.001) in the LESS change score in the STR group.

CONCLUSION

A school-based strength-training program that focused on hip and knee musculature significantly improved jump-landing biomechanics (as determined by LESS) relevant to ACL injury risk. Further investigation using different strength-training approaches in this age group is warranted.

CLINICAL RELEVANCE

Strength training during adolescence holds promise as an injury prevention program. The use of a school-based approach is novel and may represent a robust opportunity for injury prevention programs, as physical education class is often mandatory in this age group.

Short-Term FIFA 11+ Improves Agility and Jump Performance in Young Soccer Players

Studies dealing with the effectiveness of the Fédération Internationale de Football Association (FIFA) 11+ prevention program to improve performance outcomes in children aged < 14 years are limited. This study aimed to point out the effects of the application of short-term FIFA 11+ warm-up program on physical performance in young football players. Participants were 36 youth male football players, divided into a FIFA 11+ (n = 19; mean (SD) age: 11.15 (0.79) y) and a control group (CG: n = 17; age: 10.87 (0.8) y) and trained for 4 weeks. Before and after the training period, standing long jump performance, agility, repeated sprint ability, sit and reach, and “30–15” intermittent fitness tests were assessed. A mixed ANOVA showed significant differences between the groups in the standing long jump test (FIFA 11+: 5.6% vs. CG: −1.9%) in favor of FIFA 11+ over CG. Additionally, the FIFA 11+ performance of the Illinois agility test was significantly better compared to the CG performance (FIFA 11+: −1.9% vs. CG: 0.03%). The main findings of this study suggest that just 4 weeks of implementation of the FIFA 11+ improves physical performance compared with traditional warm-up routines in young soccer players.