The clinical evidence for the FIFA 11+

The incidence of Anterior Cruciate Ligament (ACL) injury in Australia is amongst the highest in the world and is growing annually. (Lewis et al., 2016). Australians are nearly twice as likely to injure their ACL when compared with other developed countries. For example, Janssen et al. (2012) calculated Australia’s population‐based incidence rate to be 52 per 100,000 population (95% confidence intervals (CI): 51.6; 52.5), whereas in Scandinavia this was 32-38 per 100,000 population.

ACL injury can cause significant disability potentially leading to reduced levels of physical activity, increased rates of obesity and long-term health problems such as an increased risk of arthritis (Arthritis Australia, 2014). Considering the large number of Australians playing community sport (approximately 40%) (Active for Life, 2010), the worrying increase in younger athletes tearing their ACL (Shaw, 2018) and the healthcare costs involved with managing knee osteoarthritis (knee joint replacements alone cost over $46 million a year), academics agree that preventative measures are a national public health priority (Arthritis Australia, 2014; Finch et al., 2009).

There is abundant evidence that preventative neuromuscular Lower Limb (LL) Injury Prevention Programs (IPP) are effective and are shown to reduce the risk of Anterior Cruciate Ligament (ACL) injuries by up to 85% (Finch et al., 2009; Sadoghi, von Keudell, Vavken, 2012). However, the adoption and implementation rates of these programs by sports coaches are low (Joy et al., 2013; O’Brian and Finch, 2016), with recent evidence reporting coach uptake rates for IPPs to be between 19.8 - 53% (Barnett et al., 2015; Joy et al., 2013; Norcross et al., 2016). Studies have attempted to address the poor uptake of IPP by coaching staff. It appears that providing more education, via coach educational workshops, is not enough to increase implementation compliance (Barnett et al., 2015). Additionally, negative attitudes regarding injury prevention or doubts about the effectiveness of IPPs were not significant factors influencing high school coaches’ adoption rates (Norcross et al., 2016). 

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