Roland Rössler

A new injury prevention programme for children’s football – FIFA 11+ Kids – can improve motor performance: a cluster-randomised controlled trial

ABSTRACT The present study evaluated the effects of a newly developed injury prevention programme for children’s football (“FIFA 11+ Kids”) on motor performance in 7–12-year-old children. We stratified 12 football teams (under-9/-11/-13 age categories) into intervention (INT, N = 56 players) and control groups (CON, N = 67). INT conducted the 15-min warm-up programme “FIFA 11+ Kids” twice a week for 10 weeks. CON followed a standard warm-up (sham treatment). Pre- and post-tests were conducted using: single leg stance; Y-balance test; drop and countermovement jump; standing long jump; 20-m sprint; agility run; slalom dribble; and wall volley test. We used magnitude-based inferences and linear mixed-effects models to analyse performance test results. We observed likely beneficial effects favouring INT in Y-balance (right leg; +3.2%; standardised mean difference (SMD) = 0.34; P = 0.58) and agility run (+3.6%; SMD = 0.45; P = 0.008). Possibly beneficial effects were found in Y-balance, drop jump reactive strength index, drop jump height, countermovement jump, standing long jump, slalom dribble and wall volley test. At least possibly beneficial improvements in favour of “FIFA 11+ Kids” were observed in nearly all parameters. Most effects were small, but slight improvements in motor performance may potentially contribute to a reduction of injury risk.

Soccer Injuries in Players Aged 7 to 12 Years A Descriptive Epidemiological Study Over 2 Seasons

Background: As part of a risk-management approach, sound epidemiological data are needed to develop prevention programs. A recent review on soccer injuries of players younger than 19 years concluded that prospective data concerning children are lacking. Purpose: To analyze the incidence and characteristics of soccer injuries in children aged 7 to 12 years. Study Design: Descriptive epidemiological study. Methods: The present survey was a prospective descriptive epidemiological study on soccer injuries over 2 seasons in the Czech Republic and Switzerland. Exposure of players during training and match play (in hours) and injury data were reported by coaches via an Internet-based registration system. Location, type, and severity of injuries were classified according to an established consensus. Injury characteristics are presented as absolute numbers and injury incidence rates (injuries per 1000 hours of soccer exposure). An injury was defined as any physical complaint sustained during a scheduled training session or match play resulting in at least 1 of the following: (1) inability to complete the current match or training session, (2) absence from subsequent training sessions or matches, and (3) injury requiring medical attention. Results: In total, 6038 player-seasons with 395,295 hours of soccer exposure were recorded. The mean (±SD) age of the players was 9.5 ± 2.0 years, and 3.9% of the participants were girls. A total of 417 injuries were reported. Most (76.3%) injuries were located in the lower limbs, with 15.6% located in the upper limbs. Joint and ligament injuries comprised 30.5%, contusions 22.5%, muscle and tendon injuries 18.5%, and fractures and bone injuries 15.4% of all injuries; 23.7% of injuries led to more than 28 days of absence from sport participation. The overall injury incidence was 0.61 (95% CI, 0.53-0.69) injuries per 1000 hours of soccer exposure during training sessions and 4.57 (95% CI, 4.00-5.23) during match play. Injury incidence rates increased with increasing age. Conclusion: The observed injury incidences were lower compared with studies in youth players. Children showed a relatively high proportion of fractures and bone stress and of injuries to the upper limbs. Clinical Relevance: The study provides an evidence base for injury incidence rates and injury characteristics in children’s soccer. These data are the basis to develop an age-specific injury-prevention program.

Risk factors for football injuries in young players aged 7 to 12 years

Football (soccer) is very popular among children. Little is known about risk factors for football injuries in children. The aim was to analyze potential injury risk factors in 7‐ to 12‐year‐old players. We collected prospective data in Switzerland and the Czech Republic over two seasons. Coaches reported exposure of players (in hours), absence, and injury data via an Internet‐based registration system. We analyzed time‐to‐injury data with extended Cox models accounting for correlations on team‐ and intra‐person levels. We analyzed injury risk in relation to age, sex, playing position, preferred foot, and regarding age‐independent body height, body mass, and BMI. Further, we analyzed injury risk in relation to playing surface. In total, 6038 player seasons with 395 295 hours of football exposure were recorded and 417 injuries occurred. Injury risk increased by 46% (Hazard Ratio 1.46 [1.35; 1.58]; P < .001) per year of life. Left‐footed players had a higher injury risk (Hazard Ratio 1.53 [1.07; 2.19]; P = .02) for training injuries compared to right‐footed players. Injury risk was increased in age‐adjusted taller players (higher percentile rank). Higher match‐training ratios were associated with a lower risk of match injuries. Injury risk was increased on artificial turf (Rate Ratio 1.39 [1.12; 1.73]; P < .001) and lower during indoor sessions (Rate Ratio 0.68 [0.52; 0.88]; P < .001) compared to natural grass. Age is known as a risk factor in older players and was confirmed to be a risk factor in childrens football. Playing surface and leg dominance have also been discussed previously as risk factors. Differences in injury risks in relation to sex should be investigated in the future.

Considerations and interpretation of sports injury prevention studies

Promoting sports participation for health is part of the public health agenda worldwide. The same holds true for preventing sports injury, an unfavorable consequence of sports. In order to transfer research findings to practice, however, clinicians should consider the particulars of design, outcome measures, and data analyses of sports injury prevention studies. This article provides a summary of approaches used to assess the effect of injury prevention strategy in sports. This summary is intended to support clinicians on the decision-making process to apply research findings in the area of sports injury prevention in their practice.

Comparison of the ‘11+ Kids’ injury prevention programme and a regular warmup in children’s football (soccer): a cost effectiveness analysis

Objective To evaluate a potential reduction in injury related healthcare costs when using the ‘11+ Kids’ injury prevention programme compared with a usual warmup in children’s football. Methods This cost effectiveness analysis was based on data collected in a cluster randomised controlled trial over one season from football teams (under-9 to under-13 age groups) in Switzerland. The intervention group (INT) replaced their usual warmup with ‘11+ Kids’, while the control group (CON) warmed up as usual. Injuries, healthcare resource use and football exposure (in hours) were collected prospectively. We calculated the mean injury related costs in Swiss Francs (CHF) per 1000 hours of football. We calculated the cost effectiveness (the direct net healthcare costs divided by the net health effects of the ‘11+ Kids’ intervention) based on the actual data in our study (trial based) and for a countrywide implementation scenario (model based). Results Costs per 1000 hours of exposure were CHF228.34 (95% CI 137.45, 335.77) in the INT group and CHF469.00 (95% CI 273.30, 691.11) in the CON group. The cost difference per 1000 hours of exposure was CHF−240.66 (95%CI −406.89, −74.32). A countrywide implementation would reduce healthcare costs in Switzerland by CHF1.48 million per year. 1002 players with a mean age of 10.9 (SD 1.2) years participated. During 76 373 hours of football, 99 injuries occurred. Conclusion The ‘11+ Kids’ programme reduced the healthcare costs by 51% and was dominant (ie, the INT group had lower costs and a lower injury risk) compared with a usual warmup. This provides a compelling case for widespread implementation.

Effects of the ‘11+ Kids’ injury prevention programme on severe injuries in children’s football: a secondary analysis of data from a multicentre cluster-randomised controlled trial

Background To assess the effects of the injury prevention programme ‘11+ Kids’ on reducing severe injuries in 7 to 13 year old football (soccer) players. Methods Football clubs (under-9, under-11 and under-13 age groups) from the Czech Republic, Germany, the Netherlands and Switzerland were cluster-randomised (clubs) into an intervention (INT) and a control group (CON). INT replaced their usual warm-up by ‘11+ Kids’ two times a week. CON followed their regular training regime. Match and training exposure and injury characteristics were recorded and injury incidence rates (IRs) and 95% CIs calculated. For the present analysis, only severe injuries (absence from training/match ≥28 days) were considered. Hazard ratios (HR) were calculated using extended Cox models. Results The overall IR of severe injuries per 1000 football hours was 0.33 (95% CI 0.25 to 0.43) in CON and 0.15 (95% CI 0.10 to 0.23) in INT. There was a reduction of severe overall (HR 0.42, 95% CI 0.24 to 0.72), match (0.41, 0.17 to 0.95) and training injuries (0.42, 0.21 to 0.86) in INT. The injury types that were prevented the most were: other bone injuries 66%, fractures 49% and sprains and ligament injuries 37%. Severe injuries located at the knee (82%), hip/groin (81%), the foot/toe (80%) and the ankle (65%) were reduced tremendously. Conclusions ‘11+ Kids’ has a large preventive effect on severe injuries by investing only 15 to 20 min per training session. The present results should motivate coaches to implement effective injury prevention programmes such as the ‘11+ Kids’ in children’s football. Trial registration number NCT02222025.

Head injuries in children's football - results from two prospective cohort studies in four European countries.

Head injuries are considered harmful in children. We analyzed head and neck injuries in organized football in 7‐ to 12‐year‐old children. Data for this analysis were obtained from a prospective cohort study over two consecutive football seasons in two European countries, and a randomized intervention trial over one season in four European countries. Football exposure and injuries were documented through an online database. Detailed information regarding injury characteristics and medical follow‐up was retrieved from coaches, children and parents by phone. Thirty‐nine head injuries and one neck injury (5% of all 791 injuries) were documented during 9933 player‐seasons (total football exposure 688 045 hours). The incidence was 0.25 [95%CI 0.15, 0.35] head/neck injuries per 1000 match hours (N=23 match injuries) and 0.03 [95%CI 0.02, 0.03] per 1000 training hours. Eleven concussions (27.5%), nine head contusions (22.5%), eight lacerations or abrasions (20%), two nose fractures (2.5%), and two dental injuries (2.5%) occurred. The remaining eight injuries were nose bleeding or other minor injuries. Thirty injuries (75%) resulted from contact with another player, and ten injuries were due to collision with an object, falling or a hit by the ball. Whereas 70% of all head injuries (N=28) were due to frontal impacts, 73% of concussions (N=8) resulted from an impact to the occiput. The incidence and severity of head injuries in children′s football are low. Coaches and parents, however, should be sensitized regarding the potential of concussions, particularly after an impact to the occiput.

Epidemiology in Young Football Players

Football (soccer) is the world’s most popular sport with most players being younger than 18 years. Playing football can induce beneficial health effects, but there is also a high risk of injury. In order to prevent football injuries in children and adolescent players, it is necessary to obtain valid epidemiological data on injury incidence and characteristics. Injury incidence tends to increase with age through all age groups in youth football. Maturational status seems to have an influence on injury characteristics. Injury characteristics in adolescent players were similar to adult football. In particular, adolescent girls seem to have a considerable risk to sustain an anterior cruciate ligament rupture. Players younger than 15 years seem to have partly different injury patterns. Particularly, fractures, mainly at the growth plates at the epiphyseal–metaphyseal junction, and growth-related osteochondral disorders may result in long layoff times and may have serious consequences in (pre)pubescent children. Specific data for players under the age of 11 years are nearly completely missing. As injury characteristics in adolescent players are comparable to adults, prevention programs proven beneficial in adults are also efficacious in youth football players. Injury prevention programs particularly tailored to children before and during puberty based on the specific needs and characteristics in these age groups need to be developed and evaluated.