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The Effect of Ten-Week FIFA 11+ Injury Prevention Program for Kids on
Performance and Fitness of Adolescent Soccer Players

Article in Asian Journal of Sports Medicine · May 2018

DOI: 10.5812/asjsm.61013

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Asian J Sports Med. 2018 September; 9(3):e61013. doi: 10.5812/asjsm.61013.

Published online 2018 May 26. Research Article

The Effect of Ten-Week FIFA 11+ Injury Prevention Program for Kids on
Performance and Fitness of Adolescent Soccer Players
Mostafa Zarei 1 , Parisa Namazi 1 , Hamed Abbasi 2 , Mahshid Noruzyan 1 , Sara Mahmoodzade 1 and Tohid
Seifbarghi 3, *
1
Sport Rehabilitation and Health Department, Faculty of Sport Sciences, Shahid Beheshti University, Tehran, Iran
2
Department of Sport Injuries and Corrective Exercises , Sport Sciences Research Institute, Tehran, Iran
3
Sports Medicine Research Center, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
*
Corresponding author: Tohid Seifbarghi, MD, Assistant Professor of Sports and Exercise Medicine, No7, Ale-Ahmad Highway, Opposite of Shariati Hospital, Tehran, Iran. Tel:
+98-2188678427-8, Fax: +98-2188098439, E-mail: [email protected]

Received 2017 August 29; Revised 2018 February 21; Accepted 2018 March 04.

Abstract

Background: Soccer is the world’s most popular sport, with most players being younger than 18 years. “FIFA 11+ Kids” has been
recently introduced to prevent soccer injuries in adolescent players. This program would be more accepted and followed by coaches
and players if it were to also promote performance and physical fitness in players. The purpose of this study was to assess the effect
of a ten-week FIFA 11+ for kids Injury prevention program on performance and physical fitness in adolescent soccer players.
Methods: 56 adolescent players participated in this study from Tehran province, Iran. They were divided into intervention and
control groups. The intervention group underwent 10 weeks of FIFA 11+ warm-up exercise for kids, while the control group followed
its routine warm-up. Both groups took the slalom dribbling, Illinois, sit and reach, standing long jump, triple hop, Y balance, 40
and 20-yard sprint, plank and side plank tests one week before and after the program.
Results: Covariance analysis showed that the intervention group gained significantly better results in Y balance, triple hop distance,
and 40-yard speed tests compared to the control group as the result of the ten-week FIFA 11+ injury prevention program for kids. No
significant difference was seen in the slalom dribbling, Illinois, sit and reach, standing long jump, 20-yard sprint, plank, and side
plank between the groups.
Conclusions: Y balance, triple hop distance and 40-yard speed tests could benefit from the11+ kids program owing to the specificity
principle of training; since the main focus of the11+ kids program is on plyometric and balance exercises. As the 11+ Kids program
does not contain the related drills to improve the performance and other fitness components, it is therefore not expected to improve
the slalom dribbling, Illinois, sit and reach, standing long jump, 20-yard sprint, plank, and side plank. However, the 11+ kid’s program
could enhance some of the related physical fitness components such as balance which has been shown to be related to sport injuries
and may probably be effective in sport injury prevention.

Keywords: Injury Prevention Program, Performance, Fitness, Adolescent Players

1. Background intrinsic) athlete-related risk factors and external (or ex-

trinsic) environmental risk factors (3). In case of sport in-
Playing soccer requires players to cope with varying jury prevention and management, risk factors are divided
degrees of asymmetrical kinetic patterns (1) and mechani- into modifiable and non-modifiable factors. To prevent or
cal workloads imposed on the musculoskeletal structures, decrease the sport injuries, it is necessary to manipulate
consequently, leading to anincreased risk of injury (1). It modifiable factors in order to eventually come up with a
is shown that playing soccer presents a higher risk of in- lower risk of injuries. Physical fitness is one of the internal
juries in the lower extremities (ranging from 2.3 to 6.4 and modifiable risk factors. The important components
injuries per 1000 athlete-exposure hours) compared with of fitness are physical strength, muscular endurance, car-
other team sports (2). Children and adolescent players diorespiratory endurance, coordination, balance, flexibil-
seem to be more likely to be injured than other age groups ity, and body composition (7). Studies have clearly shown
(3), which is probably due to less skill (4), lower muscle that individuals with lower levels of fitness are more likely
strength (5), less endurance and coordination (6). to be injured (7) and that improving fitness lowers risk of
Risk factors are traditionally divided into internal (or

Copyright © 2018, Asian Journal of Sports Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0
International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the
original work is properly cited.
 Zarei M et al.

injury (3). Those who are more fit perform the activity at examine its effects on performance and physical fitness in
a lower percentage of their maximal capability and so can Asia, the purpose of this study was to investigate the effect
perform the task for a longer period of time, fatigue less of FIFA 11+ kids’ comprehensive warm-up program on per-
rapidly, recover faster, and have greater reserve capacity formance and some physical fitness elements of Iranian
for subsequent tasks. Such athletes maintain high levels of adolescent soccer players.
physical fitness, not only for optimal performance in tasks
but also to reduce injury risk (7).
2. Methods
In the recent years, some prevention programs have
been designed and carried out to prevent soccer injuries 56 adolescent soccer players participated in this
(8-12). Soligard et al. (2008) stated that the 11+ program can study. The participants were recruited from three football
prevent injuries in the young female soccer players and it schools of Tehran province, Iran, and were divided into
can generally reduce one third of the injuries while reduc- intervention (24 players) and control groups (32 players)
ing half of the severe injuries (11). Beside the relative suc- based on block randomization method. Written informed
cess of these programs in preventing the incidence of sport consent was obtained prior to the commencement of the
injuries, they would be more accepted and employed by study from coaches or parents as caretakers, on behalf of
coaches and players, if in addition to preventing injuries, the minors involved. The research was approved by the
they were effective in improving performance and physical ethical committee of Shahid Beheshti University. To be
fitness in soccer players (12). It has been reported that the included in the research, the players were to be between
11+ program has significant effects on speed (13), dribbling 9 to 14 years old and healthy at the time of entry. The
speed, shooting accuracy (13), players’ agility and vertical absence in the pre-test, post-test or in three introductory
jump in soccer players (14). Zareei et al. (2016) reported sig- sessions would exclude the participants. The players were
nificant improvements in the Sargent vertical jump, Bosko reqired to take three sessions of 90 minutes exercise each
repetitive jump and dynamic balance tests following one week, including two training sessions and at least one
season of 11+ exercises in Iranian adolescent male soccer match. Five players of the intervention group and nine
players. However, no significant improvements were ob- of the control group withdrew due to not completing the
served in the Illinois agility, 40-yard speed, 20-yard speed pre-test or post-test. The final analysis included the data
and Yo-Yo intermittent recovery test level 1, flexibility and of 42 players (19 players in the intervention group and 23
dribbling tests (15). players in the control group).
FIFA’s 11+ injury prevention program has been struc- The intervention group took the 11+ kids’ exercises for
tured for the above 14 players (10, 16). Recently the ex- 10 weeks. While the control group was asked to follow the
perts at FIFA Medical assessment and research center (F- routine warm-up during the season. Before starting the re-
MARC) have designed “FIFA 11+ Kids” while keeping the fea- search, all the managers and players of the intervention
tures of puberty and the more common child injuries in group were trained by the authors. A poster was provided
mind (17). This exercise program has been designed to en- illustrating the certain exercises for the 11+ Kids warm-up
hance the spatial orientation, prediction, and attention, in- program and the guidebook for 11+ Kids program rendered
crease the body stability and movement coordination, and by the authors.
finally teach the appropriate landing techniques (17). The The 11+ Kids has been expanded and improved by F-
main goal of this program is to manipulate the internal MARC. It focuses on three key quantities such as enhancing
risk factors such as muscle strength and balance in order the coordination and balance, strengthening the leg and
to reduce the risk of injury. It is thought that weakness of core muscles, and improving the landing techniques. The
both power and strength in muscles are important risk fac- 11+ consists of seven types of exercises that should be done
tors for injuries among child players. Therefore, two dis- at the start of each training or competition session. Each
tinct parts of the 11+ Kids program are allocated to plyo- exercise includes five difficulty levels. The program starts
metric and jumping exercises. Rossler et al. (2015) investi- from level one and progresses to level five gradually (18).
gated the effects of this program on the kids’ neuromuscu- The intervention group took the 20-minute-long ex-
lar performance compared to a regular warm-up program ercises instead of the routine warm-up. The noteworthy
and showed the effectiveness of this program in enhanc- point in this program is the emphasis on performing the
ing the kids’ motor performance (18). FIFA intends to ex- exercises with appropriate technique. The program re-
pand and develop the FIFA 11+ Kids comprehensive warm- quires players to maintain correct posture and body con-
up program. Since the number of studies to confirm the ef- trol while performing the movements.
fect of this program on performance and physical fitness is All players took part in the pre and post-tests of per-
too limited and to date, no research has been carried out to formance and the physical fitness one week before and af-

2 Asian J Sports Med. 2018; 9(3):e61013.

 Zarei M et al.

ter the intervention. To measure the performance and the The normality of data, the homogeneity of gradient re-
physical fitness, we used dribbling, Illinois agility, flexibil- gression lines, and the linear relation between the covari-
ity, standing high jump, triple hop, Y balance, 20 and 40- ate and dependent variables were analyzed and approved.
yard speed, plank, and side plank tests. All Measurements Therefore, the covariance analysis was used to test the hy-
were taken in one session with the same protocol includ- potheses. Based on Table 1, the results of covariance analy-
ing the start time, the order of tests, and the rest periods sis showed a significant difference between the groups for
for all players in the pre-test and the post-test. All tests were the 40-yard speed test (P = 0.002), the Y balance test at pos-
conducted under the supervision of researchers and by the terior (P = 0.001), medial (P = 0.001) and lateral (P = 0.001)
same raters. directions and also the triple hop test (P = 0.002). No signif-
For the speed dribbling test, the player dribbles 6 cones icant difference was observed between the groups for the
placed in straight line with 1.5 meters distance in zigzag, 20-yard speed, Illinois, dribbling, plank, side plank, long
after making a U-turn at the last one, back to the start line jump and flexibility tests (P > 0.05).
(15, 19).
In the Illinois agility test (20, 21), four cones are located
4. Discussion
in a 3.05-meter distance. The player runs 10 meters straight
forward, turns back toward the first cone, zigzags between FIFA 11+ injury prevention program for kids mainly
the cones, turns back in the same manner, and runs 10 me- focuses on improving the coordination and balance,
ters. Finally, the player turns back the distance directly and strengthening the leg muscles, the core and optimizing
passes the finish line (15, 20). the landing techniques, so it was presumably expected to
The forward-bending test was used to measure the flex- have positive effects on the quantities which it emphasizes.
ibility (22). The jumping distance was measured by a me- As observed in this study, our results revealed that the in-
ter settled on the floor. The triple-hop test was applied to tervention group performed significantly better than the
measure the lower limb performance. In this test, the par- control group on the Y balance, the triple hop, and the 40-
ticipant stands behind the start line with the target foot in yard speed tests.
front and makes three consecutive hops (23). Regarding the positive effect of the FIFA 11+ injury pre-
In order to measure the isokinetic strength of the vention program for kids on Y balance test, Padua et al.
lower limb muscles of the subjects, a Biodex system 4 (2009) (28), DiStefano et al. (2010) (29), Bizzini et al. (2013)
isokinetic dynamometer (20 Ramsay Rode, Shirley, New (13) got similar results on the dynamic balance of soccer
York, USA) was used. To calculate the maximum torque of players. The existence of balance drills, especially on one
quadriceps and hamstrings, angular velocity was consid- foot, such as number 2 and 3 exercises is the most prob-
ered 60 and 90 degrees per second (15). able reason for the success of “the 11+ kids” exercises in
For the Y balance test, the participant stands on her/his enhancing the dynamic balance of the adolescent players
dominant foot and reaches as far as possible in each direc- (29). Balance exercises lead to the enhancement of the neu-
tion with the other foot. The reaching distance is counted rological adaptation and inhibitory irritability of spinal
and divided by foot length in centimeter and multiplied by reflexes such as stretching reflex and enhancement of co-
100 to be normalized (24). contraction pattern in the agonist and antagonist muscles
The total time for the 40 yard and 20-yard distances (30) which in turn end up with improved balance.
were recorded (25). The time to keep plank and side plank The FIFA 11+ Injury Prevention Program for Kids also
were recorded to evaluate the trunk muscular endurance made a significant improvement in the triple hop test.
(12, 20, 26). Kilding et al. (2008) also showed that 6 weeks of 11+ exer-
The independent t-test was used to show differences cises for the above 14 years players can improve the perfor-
between the groups for general characteristics. The covari- mance of the triple hop test (31). These results could be as-
ance analysis was used to determine the pretest, posttest cribed to the hop drills in “the 11+ Kids” program (exercise 1,
and intergroup test differences. The intergroup variable 2, and 3) and also the correct maintaining of knee and an-
consisted of the group (two levels: control, exercise) and kle positions; but Steffen et al. (2013) could not show the
covariate variable of pretest (27). same outcome in triple hop test in 13 - 18 female players (12)
which could be due to the differences in age, gender and
3. Results time in contrast to the present study.
For the positive influence of the 11+ Kids on the 40-
Anthropometric data are presented in Table 2. Groups yard speed running, Kilding et al. (2008) also have indi-
did not differ in age, body height, body mass, and BMI (P > cated the significant effect of 11+ exercises on the speed of
0.45). soccer players. Bizzini et al. (2013) and Impellizzeri et al.

Asian J Sports Med. 2018; 9(3):e61013. 3

 Zarei M et al.

Table 1. FIFA 11+ Warm-Up Program for Kids

Exercise Repetition and Set
1- Smooth running and paying attention to the instructor
Stop by the instructor signal 5*3
Stop by observing the instructor signal 5*3
Keeping ball on hand with hearing instructor order 5*3
Ball keeping on hand by observing instructor sign 5*3
Playing ball on feet by hearing the instructor order 5*3
2- Hopping
Landing on one foot 10 jumps*2 (5 jumps on each foot)
Holding ball on hands 10 jumps*2 (5 jumps on each foot)
Ball balance on one hand 10 jumps*2 (5 jumps on each foot)
Keeping the ball on the ground 10 jumps*2 (5 jumps on each foot)
Keeping balance and stretching forward with ball 10 jumps*2 (5 jumps on each foot)
3- Single leg standing
Ball throwing 1*left and right
Passing ball through feet and throwing it 1*left and right
Passing ball 1*left and right
Throwing ball and playing with partner 1*left and right
Challenging balance 1* left and right (20 seconds)
4- Plank position
Rolling ball under the body 2*1 rolling
Plank position and rolling the ball with the foot 3*15 second
Plank position and rolling the ball with hand 3*15 second
Plank position with rolling the ball between the feet and the hands 3*15 second
Hands-on ball and challenging position 3*15 second
5- Single leg jumping
Forward jumping 2*5 jumps on left and right foot
Forward and backward jumping 2*5 jumps on left and right foot
Side jumping 2*5 jumps on left and right foot
Jumping with instructor side order 2*5 jumps on left and right foot
Jumping with instructor side order with ball in hand 2*5 jumps on left and right foot
6- Spiderman move
Touching ball with replacing feet 3*15 seconds
Stretching in this position 3*15 seconds
Crawling 3*5 - 10 meter
Crawling and moving ball between feet 3*5 - 10 meter
Crawling with hands and moving ball with feet 3*5 - 7 meter
7- Rolling
Bending and rolling Each direction * 5 - 7
Rolling smoothly from standing position Each direction * 5 - 7
Rolling fast from standing position Each direction * 5 - 7
Walking Slowly and Rolling Each direction * 5 - 7
Running Smoothly and Rolling Each direction * 5 - 7

(2013) have shown the significant influence of the FIFA 11+ Lindblom et al. (2011) tested the professional soccer play-
program; but Daneshjoo et al. (2013), Zareei et al. (2016) ers while the other two studies tested the amateur soccer
(15), Steffen et al. (2008) (12), Lindblom et al. (2011) (32) players. In this respect, it can be declared that since the
have reported contrary results. This disagreement might professional soccer players have highly developed physical
be owing to the difference in the skill level of the players, characteristics and limited capacity left to improve, they
in which, Daneshjoo et al. (2013), Zareei et al. (2016) and accomplished little changes. On the other hand, the phys-

4 Asian J Sports Med. 2018; 9(3):e61013.

 Zarei M et al.

Table 2. Anthropometric Characteristicsa , b

Variable Control Group 11+ for Kids Group
Pre-Test Post-Test Pre-Test Post-Test
Age, y 12.16 ± 1.13 12.32 ± 1.09 11.93 ± 1.91 12.13 ± 1.75
Height, cm 153.12 ± 10.92 154.3 ± 11.01 147.36 ± 7.50 149.02 ± 8.15
Weight, kg 43.02 ± 4.30 43.72 ± 4.98 40.09 ± 4.03 40.90 ± 4.34
Body mass index 19.03 ± 0.64 19.60 ± 0.65 18.03 ± 0.99 18.34 ± 0.72
Fat, % 6.45 ± 1.38 6.50 ± 1.23 5.58 ± 1.3 5.51 ± 1.12
a
Values are expressed means ± SD.
b
No differences between groups in pre-tests values were found.

Assessed for eligibility

n = 14 Football Schools

Refused to participate
n = 11 Football Schools

Randomized
n = 3 Football schools
including n = 56 Players

Allocated to control group Allocated to intervention group

n = 2 Football Schools n = 1 Football Schools
including n = 32 players including n = 24 players

Pre-test Pre-test

Warming-up as usual for 10 weeks Performing the 11+ for kids as warm-up
for 10 weeks

Post-test accomplished and analyzed Post-test accomplished and analyzed

n = 23 players n = 19 players
Excluded from analysis (N = 9 players): Excluded from analysis (N = 5 players):
N = 5 players were absent on post-test day N = 4 players were absent on post-test day
N = 1 players sustained an injury N = 1 player left football school
N = 3 player left football school

Figure 1. Flow of study participants

ical characteristics of the amateur players have not grown result, they could have benefited from the protocol in this
enough so that the appropriate exercise programs can de- study as shown.
velop those characteristics (14). Contrary to professional
According to the results, no significant difference was
soccer players, kids have larger potential for progress; as a
seen between the groups for the Illinois agility, 20 yard

Asian J Sports Med. 2018; 9(3):e61013. 5

 Zarei M et al.

Table 3. Results of Covariance Analysis Test for Variables

Test SS df MS F Sig.
Illinois, s
Pretest 12.601 1 12.601 7.046 0.11
Training 0.165 1 0.165 0.92 0.763
Error 69.749 39 1.788
40 yard speed, s
Pretest 1.409 1 1.419 6.630 0.14
Training 2.251 1 2.251 10.521 0.002*
Error 8.346 39 0.214
20 yard speed, s
Pretest 0.397 1 0.397 5.890 0.20
Training 0.23 1 0.23 3.54 0.06
Error 2.63 39 0.67
Dribbling, s
Pretest 28.27 1 28.27 0.43 0.51
Training 19.73 1 19.73 0.30 0.58
Error 2515.12 39 64.49
Flexibility, cm
Pretest 161.24 1 161.24 6.08 0.18
Training 59.82 1 59.82 2.25 0.14
Error 980.37 37 26.49
Plank, s
Pretest 72.36 1 72.36 2.28 0.13
Training 20.82 1 20.82 0.65 0.42
Error 1140.44 36 31.67
Side plank, s
Pretest 2.76 1 2.76 7.40 0.10
Training 0.44 1 0.44 1.17 0.28
Error 13.07 35 0.37
Posterior Y, cm
Pretest 0.14 1 0.14 0.00 0.09
Training 1355.36 1 1355.36 12.21 0.001*
Error 4328.66 39 110.99
Medial Y, cm
Pretest 92.72 1 92.72 0.96 0.32
Training 1219.66 1 1219.33 12.71 0.01*
Error 3742.33 39 95.95
Lateral Y, cm
Pretest 11.47 1 11.47 0.14 0.70*
Training 1123.77 1 1123.77 13.87 0.01*
Error 3159.68 39 81.01
Triple hop, cm
Pretest 0.43 1 0.43 0.98 0.32
Training 5.14 1 5.14 11.62 0.02*
Error 17.27 39 0.44
Long jump, cm
Pretest 6641.74 1 6641.74 12.75 0.10
Training 630.67 1 63.67 1.21 0.27
Error 20310.18 39 520.77

speed time, dribbling time, flexibility, plank, side plank exercises could not significantly affect players’ dribbling
and long jump tests. speed (15). Steffen et al. (2013) also showed that “the 11+”
exercises were not able to improve dribbling (12). Since
In line with the results of this study, Daneshjoo et al.
“the 11+ Kids” do not concentrate on the enhancement of
(2013) (14) and Zareei et al. (2016) also stated that “the 11+”

6 Asian J Sports Med. 2018; 9(3):e61013.

 Zarei M et al.

required soccer skills, therefore it is not expected to influ- 4.1. Conclusion

ence the players’ dribbling skill. The results of this study showed that performing 10
weeks of 11+ exercises for kids could improve the dynamic
Also, concerning emerged results for Illinois agility
balance, triple hop distance and speed in under 14 year
test, Zareei et al. (2016) and Impellizzeri et al. (2013) re-
old soccer players, although it is not successful in enhanc-
ported the same. Agility is a complex ability and depends
ing the outcomes of other tests. It can be concluded that
on neuromuscular coordination, the articulation system,
the FIFA 11+ injury prevention program for kids has com-
dynamic balance, power, stability and the speed (17); there-
ponents that can improve some of the physical fitness ele-
fore, improving agility is complex and requires specific
ments which are specifically covered by the content. Since
practices. Since the exercises of “11+ Kids” are carried out
the content of this protocol has been intentionally focused
with slow speed and a few changes in directions, thus it is
on related physical fitness factors to prevent sport injuries,
not anticipated that the components of “11+ Kids” could sig-
therefore, it cannot be expected to improve all aspects of
nificantly improve the agility.
physical fitness or players’ performance; unless the con-
Flexibility could not take advantage of “11+ Kids” in our tent is modified accordingly. According to the findings
study. Zareei et al. (2016) got the same outcomes by the of this study, the FIFA 11+ injury prevention program for
11+ program for the flexibility of adolescent players (15). kids can potentially influence some of the factors related
The lack of stretching exercises in this program is the most to sport injuries, which can benefit players by positively
liable reason for the ineffectiveness of “the 11+ Kids” in manipulating documented internal risk factors in favor of
flexibility. Whereas the researchers have shown that the preventing sport injuries.
stretching exercises cannot be effective in preventing the
incidence of injuries in soccer players (33, 34), the pro- Footnotes
grammers of “the 11+ Kids” have not placed any stretching
exercise in this warm-up program (15). Authors’ Contribution: Mostafa Zareei, suggesting re-
search idea, designing the study, analyzing and inter-
The results showed that using the “11+ Kids” exercises preting, writing manuscript, confirming final draft of
could not improve the explosive power. Steffen et al. manuscript for sending; Parisa Namazi, designing the
(2008) did not report a significant difference in relation to study, analyzing and interpreting, writing manuscript;
the vertical jump among the female soccer players as well Mahshid Noruzyan, designing the study, analyzing and in-
(12). In addition, Impellizzeri et al. (2013) did not observe a terpreting, writing manuscript; Sara Mahmoodzade, de-
significant difference between the two control groups and signing the study, analyzing and interpreting, writing
the FIFA 11+ in relation to the vertical jump (17). But Zareei et manuscript.
al. (2016) reported a significant enhancement in the tests Conflict of Interests: The authors reject any conflict of in-
of Sargent vertical jump following one season of 11+ exer- terests in designing, executing, analyzing and publishing
cises. In the mentioned studies, the anaerobic power of the the results of this study.
lower extremities has been measured by Sargent jump test.
Funding/Support: This project has been funded by Sport
However, in the present study, the long jump test was used
Sciences Research Institute, Tehran, Iran.
which has differences with the Sargent jump that might
possibly alter the results.
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