Imaging of soccer injuries in adolescent female athletes.

Soccer participation is increasing among female adolescents with a concomitant rise of injuries in this group. Age- and sex-related factors, such as the transition from skeletal immaturity to skeletal maturity as well as anatomic, physiologic, neuromuscular, and behavioral differences between females and males, all play a role in injury patterns for these athletes. Anterior cruciate ligament (ACL) tears in this group have received a great deal of attention in the medical literature and the media in recent years with increasing knowledge about causative factors, surgical management, and injury prevention. There have been fewer studies specifically focused on female adolescent soccer players in relation to other types of injuries, such as patellar dislocation/instability; other knee and ankle ligament tears; hip labral tears; muscle strains and tears; and overuse injuries such as apophysitis, patellofemoral pain syndrome, and bone stress injuries. Because imaging plays a critical role in diagnosis of soccer-related injuries in female adolescents, knowledge of the mechanisms of injury, imaging findings, and clinical considerations are essential for radiologists involved in the care of these patients.

Unlocking the Potential: Increasing Muscle Strength in Lower Limbs of Youth Soccer Players over Five Weeks through Mat Pilates Training-A Pilot Study.

The interest in soccer generally starts during childhood, with children and young people often looking for opportunities in sports. New exercise techniques can be effective in improving training. The aim of this study was to compare the effects on the strength and physical posture of a group practicing Pilates with another not practicing Pilates, both undergoing continuous football training. In this controlled randomized clinical trial, the participants were 15 soccer club members, who had a training frequency of least three times weekly. The sample was divided into a control group (n = 7) of players who did not undergo any therapeutic intervention (only the usual training) and a Pilates group (n = 8) of players who participated in the mat Pilates program. The intervention consisted of fifteen sessions. Postural evaluations were performed using biophotogrammetry and force analysis. Significant improvements were obtained in terms of increased muscle strength (p = 0.001) for the Pilates group, but there were no significant postural alterations when comparing the two groups. Five weeks of mat Pilates was sufficient to increase lower limb muscle strength in young football players. This pilot study indicates that Mat Pilates as a method that could be planned to be included in training.

Well-being fluctuations and injuries during an entire season in male professional soccer players: an observational study.

This study aimed to describe and relate the well-being perception and injury incidence of soccer players in an entire soccer season. For 37 weeks, twenty-eight male professional soccer players (25.2 ± 4.3 years old; 22.8 ± 1.4 kg/m2) daily scored (from 1: bad; to 5: perfect) well-being perception (fatigue, sleep, muscle soreness, stress and mood and Hooper Index (HI) as general status). Injuries were also registered. Results showed that players had the lowest well-being perception during Preseason (in terms of HI, fatigue, muscle soreness and stress), being lower than EarlySeason (ps < 0.05, ds > 1.0) and/or InSeason (ps < 0.05, ds > 1.0). The injury incidence was 8.3 ± 9.2/1000 h, being always higher in training compared to competition (35.0 vs 11.1/1000 h). A lower stress perception (worse) correlated with a higher rate of new injuries during PreSeason (r = -0.84), while a greater muscle soreness and fatigue correlated with the new injuries occurring in the following week during the whole season (r = -0.38 and r = -0.39, respectively). As a conclusion, the well-being perception of professional soccer players was especially low during Preseason, with fatigue, muscle soreness and stress as the most affected items that correlated with injury incidence.

Interindividual differences in physical function and their impact on regular player selection among junior high school soccer athletes.

[Purpose] Unlike professional teams that use comprehensive evaluations, player selection in local and school-level soccer teams relies on the coaches' practical experience. This study investigated the differences in physical function between regular and non-regular male junior high school soccer players to provide valuable insights into player selection. [Participants and Methods] We assessed grip strength, rebound jumps, muscle strength, agility, short-distance running, anaerobic power, and countermovement jumps in 55 Japanese junior high school boys, who were divided into regular (R) and non-regular (NR) groups. Moreover, the age, height, and weight of the groups were compared. [Results] The analysis revealed significant differences in countermovement jumps and anaerobic power, while accounting for age and physique. [Conclusion] These results suggest that countermovement jumps and anaerobic power may constitute determining factors for regular and non-regular players, even when age and physical characteristics are considered.

Comparison of body composition and muscle mass by age in amateur soccer players.

[Purpose] This study aimed to elucidate the changes in body composition components associated with aging in amateur male soccer players. Specifically, we investigated the alterations in the phase angle and regional muscle mass distribution. [Participants and Methods] The study included a cohort of 163 male participants categorized into three age groups: U15 (12-15 years), U18 (16-18 years), and O19 (≥19 years). Precise body composition assessments were performed, employing the InBodyS10 body composition scale. [Results] The findings revealed substantial age-related disparities in various body composition parameters. Data revealed a consistent trend of increasing basic body composition metrics with age. Notably, the body fat percentage progressively increased with age. Muscle mass and phase angle exhibited age-related increases with nuanced variations in different anatomical regions. [Conclusion] In the general Japanese population, muscle mass tends to decrease with age after 18 years. However, in this study on amateur soccer players, we observed a plateau in the height and lower limb phase angle around the age of 18 years, whereas muscle mass exhibited an increasing trend.

Predicting the occurrence of in-season groin pain in male high school soccer players: a cohort study.

[Purpose] This study investigated whether pre-season HAGOS (Japanese Copenhagen Hip and Groin Outcome Scores) and eccentric muscle strength of the hip muscles predict in-season groin pain incidences in high school soccer players. [Participants and Methods] This study had a cohort design. The participants were male high school players under 18 years playing in the Japan Soccer League, which is an elite-level soccer league of that age category in Japan. The HAGOS and the strength of hip abductor and adductor muscles in eccentric contraction were measured before the season, and hip and groin pain incidences were recorded during the season. Multiple logistic regression analysis was performed to investigate the factors derived from the pre-season HAGOS and hip muscle strength tests, presumably pertaining to the development of in-season groin pain. [Results] The eccentric adductor muscle strength of the dominant leg and the HAGOS were selected as factors associated with groin pain during the season. [Conclusion] Low pre-season HAGOS and weak dominant-leg eccentric adductor muscle strength were suggested as factors to predict in-season groin pain occurrence in male high school soccer players.

Majority of competitive soccer players return to soccer following hip arthroscopy for femoroacetabular impingement: female and older aged players are less likely to return to soccer.

PURPOSE: To determine return to soccer rates and soccer performance in a large cohort of competitive soccer players after hip arthroscopic surgery for the treatment of femoroacetabular impingement (FAI) and to identify possible risk factors associated with not returning to soccer. METHODS: An institutional hip preservation registry was retrospectively reviewed for patients identified as competitive soccer players who underwent primary hip arthroscopy for FAI performed between 2010 and 2017. Patient demographics and injury characteristics as well as clinical and radiographic findings were recorded. All patients were contacted for return to soccer information using a soccer-specific return to play questionnaire. Multivariable logistic regression analysis was used to identify potential risk factors for not returning to soccer. RESULTS: Eighty-seven competitive soccer players (119 hips) were included. 32 players (37%) underwent simultaneous or staged bilateral hip arthroscopy. The mean age at surgery was 21.6 ± 7.0 years. Overall, 65 players (74.7%) returned to soccer, of which 43 players (49% of all included players) returned to pre-injury level of play or better. Most common reasons for not returning to soccer were pain or discomfort (50%) followed by fear of re-injury (31.8%). The mean time to return to soccer was 33.1 ± 26.3 weeks. Among 22 players who did not return to soccer, 14 (63.6%) reported satisfaction from surgery. Multivariable logistic regression analysis revealed female players (odds ratio [OR] = 0.27; confidence interval [CI] = 0.083 to 0.872; p = 0.029) and older aged players (OR = 0.895; 95% CI = 0.832 to 0.963; p = 0.003) were less likely to return to soccer. Bilateral surgery was not found to be a risk factor. CONCLUSION: Hip arthroscopic treatment for FAI in symptomatic competitive soccer players allowed three-quarters of them to return to soccer. Despite not returning to soccer, two-thirds of players who did not return to soccer were satisfied with their outcome. Female and older aged players were less likely to return to soccer. These data can better guide clinicians and soccer players with realistic expectations related to the arthroscopic management of symptomatic FAI. LEVEL OF EVIDENCE: III.

Quantification of training load across two competitive seasons in elite senior and youth male soccer players from an English Premiership club.

This study aimed to compare the daily training load (TL) in first-team and U-18 soccer players from an English Premiership club. 36 first-team (age 23.2 ± 5.9 years, weight 75.2 ± 8.1 kg, height 1.83 ± 0.06 m), and 22 U-18 players (age 17.5 ± 1.1 years, weight 71.1 ± 8.2 kg, height 1.78 ± 0.08 m) participated. GPS metrics were measured during all pitch training sessions throughout the 2020-21 and 2021-22 seasons. Linear mixed-effect model analyses revealed that, irrespective of training day, U-18 players covered greater total and explosive distance than first-team players, and performed a higher number of accelerations and decelerations, whereas first-team players covered greater sprint distance. Irrespective of the team, all examined variables were greater at match-day (MD)-3, while the number of accelerations and decelerations were higher at MD-4. Significant team-by-training day interactions revealed that U-18 players covered greater total and high-intensity distances than first-team players at MD-4, MD-2, and MD-1, whereas first-team players covered greater total and high-intensity distances at MD-3. Sprint distance was greater for first-team players at MD-3 and MD-4, while explosive distance was greater for U-18 players at MD-2. Also, U-18 players performed a higher number of accelerations than first-team players at MD-3 and MD-2, and a higher number of decelerations at MD-4. The present results provide novel information on TL patterns in English Premiership soccer and contribute to understanding how training methods to physically develop players are implemented in different countries and leagues.

Female athlete triad cross-sectional study of soccer players by level of competition.

[Purpose] To determine the actual status of the Female Athlete Triad (low energy availability, menstrual dysfunction, and bone mineral density loss) in soccer players. [Participants and Methods] The survey was conducted between February 1 and March 1, 2022. It included 115 females between the ages of 12 and 28 registered with the Japan Football Association, from teams at different levels. [Results] Players in the top league did not differ in height and weight but were older and had a better understanding of caloric intake. There were no differences in amenorrhea or history of bone fractures based on league. [Conclusion] Of the female soccer players in the four different levels of competition, only the players in the top league had a better understanding of available energy and took preventive measures against the Female Athlete Triad.

The Effects of a Visual Stimuli Training Program on Reaction Time, Cognitive Function, and Fitness in Young Soccer Players.

The purpose of the present study was to examine whether a visual stimuli program during soccer training can affect reaction time (RT), cognitive function, and physical fitness in adolescent soccer players. Thirty-eight male soccer players aged 10−15 were randomly assigned to either the intervention (Group A) or the control group (Group B). At baseline and at the end of the 6-month study FITLIGHT Trainer, the Cognitive Function Scanner Mobile Test Suite, a Virtual Reality (VR) game, and the ALPHA­Fitness and the Eurofit test batteries were used to measure participants' abilities. After the baseline assessment, Group A followed their regular soccer training combined with a visual stimuli program, while Group B continued their regular soccer training program alone for 6 months. At the end of the 6-month study, Group A showed statistically significant improvements in simple RT by 11.8% (p = 0.002), repeated sprints by 13.4% (p ≤ 0.001), and Pen-to-Point Cognitive Function by 71.62% (p < 0.001) and 72.51% for dominant and non-dominant hands, respectively. However, a between-groups analysis showed that there was no statistically significant difference between the two groups in most of the measurements studied. In conclusion, a visual stimuli training program does not seem to add any value to the traditional soccer training program for adolescents. Nevertheless, this study helps to underline the potential of newly emerging technology as a tool for the assessment of RT.

Arthroscopic resection as a rapid recovery treatment for Os acetabuli in soccer players who had undergone hip arthroscopy: a case series with 1-year follow-up.

INTRODUCTION: Os acetabuli (OSA) is defined as a radiopaque structure located around the acetabular rim highly related to Femoroacetabular Impingement (FAI). Its treatment depends on the perspective of post-surgical joint instability. Ossicle resection is recommended if the femoral head is covered enough by the labrum. Previous research has described the results of this technique in general population. The aim of this study is to describe the outcomes and the time and rate of return to play (RTP) after hip arthroscopy and OSA removal in soccer players. METHODS: This study is a retrospective analysis of a prospective database containing all the consecutive soccer players who had undergone hip arthroscopy between 2018 and 2019. The subjects diagnosed with OSA and a center-edge angle (CEA) > 25 ° were included in the analysis. All the patients were treated with arthroscopic removal of the OSA and femoral osteoplasty. Hip function was assessed using the Modified Harris Hip Score (MHHS) before and at 3 and 12 months after surgery. Rate of RTP and competitive level at RTP were assessed at a 1-year follow-up. RESULTS: Between 2018 and 2019, 90 soccer players were treated with hip arthroscopy in our facilities. Six of them (6.6%) were diagnosed with OSA. Mean (SD) MHHS values were 69.7 (12.1) before the surgery, 89.7 (6.7) at 3 months post-surgery and 95.7 (5.1) at 12 months post-surgery. All the subjects reported significant improvements in their MHHS scores at 3 and 12 months post-surgery compared with pre-surgery levels (p < 0.01). Non-significant differences were found between 3 and 12 months post-surgery (p > 0.05). All the subjects (100%) returned to previous competitive levels. CONCLUSIONS: After surgery, all the soccer players returned to previous competitive level. Preoperative MHHS improved significantly at 3 months maintained for up to 12 months.

Effect of physical training on parathyroid hormone and bone turnover marker profile in relation to vitamin D supplementation in soccer players.

The aim of the study was to assess the impact of vitamin D supplementation and regular physical activity on 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH) and bone turnover marker concentrations in healthy male athletes. Twenty-five youth soccer players were divided into groups: non-supplemented (GN) and supplemented (GS) with a vitamin D dose of 20 000 IU twice a week for 8 weeks. The study was conducted during an 8-week preseason period, from mid-January to mid-March. At baseline (T1) and at the end of this period (T2), the serum concentrations of 25(OH)D, (PTH), osteocalcin (OC) and ß-isomerized C-terminal telopeptide of type I collagen (ß-CTx) were measured. At T2, 25(OH)D increased by 70% in GS (p = 0.004) and by 6% in GN (p > 0.05). Significant differences between GS and GN groups were observed throughout the study in the group-by-time interaction and changes of 25(OH)D (p = 0.002; η 2 p = 0.36) and OC (p = 0.008; η 2 p = 0.26). Increased OC (ES = 0.74; moderate) and ß-CTx (ES = 1.31, large) in GN athletes who had an optimal baseline vitamin D level (GO) were observed. In GN, at T2, ß-CTx positively correlated with PTH and OC (p = 0.007 and p = 0.002). In GS, ß-CTx positively correlated with OC at both time points (T1, p = 0.027 and T2, p = 0.037). A negative correlation between 25(OH)D and PTH was observed at T2 (p = 0.018). The obtained results suggest that the 20 000 IU vitamin D3 dose applied twice a week for 8 weeks is effective for vitamin D compensation and sufficient to maintain the correct PTH concentration, as revealed by changes in the bone marker concentrations. In conclusion, the results suggest that the applied vitamin D supplementation dose in athletes leads to intensive bone remodelling and has protective effects on bone under intensive physical effort.

An intervention plan for preventing and handling amateur soccer players' injuries.

Background: The majority of amateur soccer players are vulnerable to soccer-related injuries and many such injuries are avoidable with an adequate education. Aim: The present study aimed to measure the impact of an intervention educational plan on improving amateur soccer players' knowledge and skills in preventing and handling soccer-related injuries. Subjects and Methods: The study design is a group-clustered randomized intervention-control trial, and it was carried out in Taif city, Saudi Arabia. The "Neighborhood League of Football" players were randomly allocated to a soccer injury prevention education group (intervention group) and a control group. A predesigned and validated questionnaire was used to study the changes in knowledge and skills about soccer injuries before the intervention (response a) and after (response b). Results: The study included 246 participants in the intervention group and 256 in the control group (n = 502). The median age was 22 years. The comparison of both groups' participants' performance showed significant differences in response b analyses and participants in the intervention group achieved significantly higher scores than the control group in total score levels (P < .0001), injury mechanisms (P < .0001), injury treatment and prevention (P < .0001), and health status (P < .034). The intervention group's scores on response b (after the educational sessions) were significantly higher than response a (before the educational sessions, P < 0.001). Conclusions: In multiple scales and overall score levels, intervention group participants achieved significantly higher scores than their control group counterparts. Educational assistance appears to have had a good impact on their knowledge and skills.

Drug use and abuse and the risk of adverse events in soccer players: results from a survey in Italian second league players.

Summary: Objective. Drug use in athletes has been frequently investigated in the last three decades, especially regarding its misuse for doping. However, little is known about the use of permitted drugs for medical purposes and less studies have investigated the relationship between adverse drugs reactions (ADRs) and sports. Methods. An observational cross-sectional investigation analyzing a group of second league soccer players (the second-highest division in Italy) was performed. Anamnestic and physical examinations as well as a validated questionnaire (AQUA©) were performed in a group of 378 Italian second league soccer players. Results. Most players (91.8%) reported the use of NSAIDs in the previous year, and one third of them were regular users. Analgesics were used in 64% of the players, while 52.1% had taken antibiotics in the previous year. 29.20% of players used intraarticular treatments in the previous year. In 7,4% of players, an ADRs was reported: 3,47% reacted to NSAIDs, 2,6% to antibiotics, 1,05% to analgesics and 1 of them to supplements. For intra-articular injections, only 2 players experienced ADRs. One quarter of players experienced reactions as urticaria-angioedema syndrome or more severe conditions as bronchospasm or anaphylaxis. Conclusions. This study shows that drug misuse/abuse in soccer is a real matter of debate, especially with regards to NSAIDs, exposing athletes to predictable and/or unpredictable risks for their health.

Changes in the awareness and understanding of trunk muscle training in high school athletes.

[Purpose] This study aimed to compare the results of two questionnaires administered in 2013 and 2020, on the level of awareness and understanding of trunk muscle training. [Participants and Methods] In total, 238 soccer club members in high schools responded to our questionnaire regarding trunk muscle training. Two teams were recruited from the top (top 4), middle (top 16), and bottom levels (first-round losers), according to the prefectural tournament's results in 2019. This questionnaire comprised questions divided into four parts: 1. Prevalence of trunk muscle training; 2. Knowledge of the classification of trunk muscles (local and global); 3. Consciousness of local and global muscles during trunk muscle training; and 4. Knowledge of the role of each muscle. These results were compared to those obtained from the survey in 2013. [Results] A significant difference was observed only in the responses to question 2. Regarding question 2 in 2020, several student-athletes in the top-level teams were aware of muscle classification compared to those in the middle- and lower-level teams. [Conclusion] The number of athletes who understood the classification of trunk muscles increased significantly in 2020. Therefore, in the future, we would need to better educate young athletes concerning the purpose of trunk muscle training and the role of each muscle.

Genomic analysis reveals association of specific SNPs with athletic performance and susceptibility to injuries in professional soccer players.

The development of specific and individualized training programs is a possible way to improve athletic performance and minimize injuries in professional athletes. The information regarding the sport's physical demands and the athletes' physical profile have been, so far, considered as exhaustive for the design of effective training programs. However, it is currently emerging that the genetic profile has to be also taken into consideration. By merging medical and genetic data, it is thus possible to identify the athlete's specific attitude to respond to training, diet, and physical stress. In this context, we performed a study in which 30 professional soccer players, subjected to standard sport medical evaluation and practices, were also screened for genetic polymorphism in five key genes (ACTN3, COL5A1, MCT1, VEGF, and HFE). This genetic analysis represents the central point of a multidisciplinary method that can be adopted by elite soccer teams to obtain an improvement in athletic performance and a concomitant reduction of injuries by tailoring training and nutritional programs. The genetic fingerprinting of single athletes led to the identification of two performance-enhancing polymorphisms (ACTN3 18705C>T, VEGF-634C>G) significantly enriched. Moreover, we derived a genetic model based on the gene set analyzed, which was tentatively used to reduce athletes' predisposition to injuries, by dictating a personalized nutrition and training program. The potential usefulness of this approach is concordant with data showing that this team has been classified as the healthiest and least injured team in Europe while covering the highest distance/match with the highest number of high-intensity actions/match.

Conservative treatment of Osgood-Schlatter disease among young professional soccer players.

BACKGROUND: The present-day conservative treatment algorithms of Osgood-Shlatter Disease (OSD) are often inadequate for young athletes because they require extremity immobilization and avoidance of sports, and hence the longer duration of rehabilitation. Therefore, the development of safe and efficacious treatment protocols for young athletes is of great practical importance. THE AIM OF THE STUDY: The aim of the study was to assess the efficacy and safety of the conservative treatment of Osgood-Schlatter disease in young professional soccer players. MATERIALS AND METHODS: Medical records of young soccer players from two different Russian soccer-academies from the period January 2016-July 2019 were analyzed in a retrospective cohort study. Trauma records of young soccer players aged 11-15 years were included in the analysis. Statistical analysis was performed using IBM SPSS Statistics software, 23.0. Descriptive statistics tools were applied for the analysis. RESULTS: A total of 280 soccer players were included in the study. The aged ranged between 11 and 15 years. Ten percent of players (n = 28, mean age 12.9 ± 1.3) were diagnosed with OSD during the observation period. The mean OSD treatment duration was 27.3 ± 13.9 days. Bilateral symptoms were observed in 42.9% of cases, and unilateral symptoms in 57.1%. In 53.6% of players, the first manifestation of OSD symptoms was observed during wintertime. All players were training on artificial turf playing fields. Conservative treatment without immobilization was applied to all patients. It included kinesiotherapy for quadriceps muscle lengthening and physiotherapy as well as gradual increase of physical activity. A total of 35.7% of players reported having discomfort upon resuming regular training, which caused some restrictions in exercise. However, the symptoms resolved spontaneously with time. Surgical treatment or complete avoidance of exercise was not used in any of the patients. CONCLUSION: High incidence of OSD was revealed among young soccer players of the leading Russian soccer academies. The OSD most commonly occurred during wintertime. Conservative treatment of OSD-i.e., physiotherapy and kinesiotherapy-enabled disease-free resuming of sports activity for the majority of patients.

Reliability assessment of the functional movement screen for predicting injury risk in Japanese college soccer players.

[Purpose] This study aimed to assess the reliability of the Functional Movement Screen and explore whether this evaluation tool can predict the risks of personal injuries in Japanese soccer players. [Participants and Methods] Seventy-five Japanese college soccer players who participated in our 1 year prospective cohort study underwent a Functional Movement Screen assessment. Demographic data, athletic characteristics, and types and frequency of injuries sustained, were analyzed with the assessment results. [Results] There was no significant difference in the mean Functional Movement Screen composite scores between genders. Although the Functional Movement Screen showed excellent inter-rater reliability (0.92), low overall internal consistency (0.35) was observed. A maximum score of 3 in straight leg raise occurred in 94% of the females and was considered a ceiling effect. None of the cut-off point scores of the Functional Movement Screen were associated with the number of overall injuries, lower limb injuries, and traumatic injuries, or time to return to play. The Functional Movement Screen composite score of ≤15 represented the maximum sensitivity of 76.92% and specificity of 34.78% with 0.56 in the area under the curve. [Conclusion] Functional Movement Screen composite scores do not have sufficient sensitivity and specificity for predicting injuries in Japanese college soccer players.

Premenstrual Syndrome, Inflammatory Status, and Mood States in Soccer Players.

OBJECTIVE: To evaluate the relationship between the inflammatory profile and mood states in the different phases of the menstrual cycle in soccer players with and without premenstrual syndrome (PMS). METHODS: Data on the menstrual cycle and mood states were collected using the Daily Symptom Report and the Brunel Mood Scale. Cytokine and stress hormone concentrations were measured in urine by flow cytometry before and after a game in the luteal phase and in the follicular phase of one menstrual cycle. RESULTS: In all, 59.6% of the athletes had PMS. The PMS group showed higher concentrations of interleukin (IL)-1ß, IL-6, and IL-8 than the athletes without PMS. After the game, IL-6 decreased in the follicular phase and the luteal phase. The tumor necrosis factor-α levels were higher in the group without PMS during the post-game follicular phase than before the game. In the PMS group, tension was higher in the follicular phase before the game and depression was higher in the pre-game luteal phase than in the group without PMS. The PMS group also presented a negative correlation between depression and IL-10 levels in the pre-game follicular phase. Finally, in the pre-game luteal phase were found positive correlations between growth hormone and IL-10. CONCLUSION: PMS influences the inflammatory condition related to mood states and stress hormones in female soccer players.

A concept mapping approach to identifying the barriers to implementing an evidence-based sports injury prevention programme.

BACKGROUND AND AIM: Understanding the barriers to programme use is important to facilitate implementation of injury prevention programmes in real-word settings. This study investigated the barriers to coaches of adolescent female soccer teams, in Victoria, Australia, implementing the evidence-based FIFA 11+ injury prevention programme. METHODS: Concept mapping with data collected from 19 soccer coaches and administrators. RESULTS: Brainstorming generated 65 statements as barriers to 11+ implementation. After the statements were synthesised and edited, participants sorted 59 statements into groups (mean, 6.2 groups; range, 3-10 groups). Multidimensional scaling and hierarchical cluster analysis identified a six-cluster solution: Lack of 11+ knowledge among coaches (15 statements), Lack of player enjoyment and engagement (14), Lack of link to football-related goals (11), Lack of facilities and resources (8), Lack of leadership (6) and Lack of time at training (5). Statements in the 'Lack of 11+ knowledge among coaches' cluster received the highest mean importance (3.67 out of 5) and feasibility for the Football Federation to address (3.20) rating. Statements in the 'Lack of facilities and resources' cluster received the lowest mean importance rating (2.23), while statements in the 'Lack of time at training' cluster received the lowest mean feasibility rating (2.19). CONCLUSIONS: A multistrategy, ecological approach to implementing the 11+-with specific attention paid to improving coach knowledge about the 11+ and how to implement it, linking the 11+ to the primary goal of soccer training, and organisational leadership-is required to improve the uptake of the 11+ among the targeted coaches.