The FIFA 11+ Shoulder Injury Prevention Program Was Effective in Reducing Upper Extremity Injuries Among Soccer Goalkeepers: A Randomized Controlled Trial

Abstract

Background: Soccer is one of the most popular sports worldwide. Goalkeepers are more likely to injure their upper limbs, particularly their shoulders, than outfield players. To reduce upper extremity injuries, the FIFA 11+ Shoulder Injury Prevention Program (FIFA 11+S) was developed. Purpose: The purpose of this study was to assess the effectiveness of the FIFA 11+S program in reducing the incidence of upper extremity injuries among amateur soccer goalkeepers. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 726 goalkeepers, who were blinded to study intent, were randomly assigned to the experimental group (n = 360) or control group (n = 366). The experimental group was instructed to perform the FIFA 11+S program before all training sessions for 1 season (6 months). The control group was instructed to continue performing their usual routine warm-up program before training sessions for 1 season. Primary outcomes included the incidence of upper extremity injury and incidence of mechanism, type, and severity of injury measured using injury risk ratios (IRR); compliance with the experimental and control interventions was also recorded. Results: A total of 50 injuries (0.62 injuries per 1000 exposure-hours) were reported in the experimental group, and 122 injuries (1.94 injuries/1000 hours) were reported in the control group. The FIFA 11+S program reduced the total number of upper extremity injuries by 68% (IRR = 0.32 [95% CI, 0.27-0.34]) compared with the usual warm-up. The FIFA 11+S program reduced the incidence of contact injury (IRR = 0.30 [95% CI, 0.25-0.31]), noncontact injury (IRR = 0.40 [95% CI, 0.35-0.43]), initial injury (IRR = 0.34 [95% CI, 0.29-0.36]), recurrent injury (IRR = 0.20 [95% CI, 0.17-0.21]), and overuse injury (IRR = 0.40 [95% CI, 0.35-0.43]). Participants in the experimental group demonstrated a significant decrease in injuries of minor (IRR = 0.32 [95% CI, 0.27-0.34]) and moderate severity (IRR = 0.33 [95% CI, 0.29-0.35]) compared with the control group. We noted no difference in compliance between the experimental and control groups (80% vs 73%, respectively; P = .92). Conclusion: The FIFA 11+S program resulted in 50% fewer upper extremity injuries among soccer goalkeepers, compared with a regular warm-up. Registration: ACTRN12618001080213 (Australian New Zealand Clinical Trials Registry).