The effectiveness of the Copenhagen adduction exercise on improving eccentric hip adduction strength among soccer players with groin injury: a randomized controlled trial.

INTRODUCTION: Groin injuries are common in soccer players and often involve adductor muscle strains. The Copenhagen Adduction Exercise (CAE) is a targeted intervention whose effectiveness in rehabilitation for these injuries warrants investigation. OBJECTIVE: To investigate the impact of a rehabilitation program, which includes the CAE, on eccentric hip adduction (EHAD) strength, hip joint range of motion (ROM), self-reported disability, and pain among soccer players with adductor-related groin pain. It was hypothesized that the addition of CAE to the rehabilitation program would yield greater improvements. METHODS: Employing a randomized controlled trial with a two-group parallel design, thirty male soccer players with a mean age of 26.4 ± 3.9 years were randomized into an intervention group (IG) including CAE (n = 15) and a control group (CG) without CAE (n = 15), based on a power analysis to ensure 80% power to detect significant differences. Both groups engaged in their respective rehabilitation programs twice a week for eight weeks. The primary outcome measured was EHAD strength, while secondary outcomes included hip joint ROM, self-reported disability measured by the Copenhagen Hip and Groin Outcome Score (HAGOS), and pain levels. RESULTS: Significant improvements within groups were observed across all measures (p < 0.001). The IG demonstrated a greater increase in EHAD strength (Mean Difference [MD] = 0.49 Nm/kg, 95% Confidence Interval [CI] [0.31, 0.66]), a more pronounced reduction in pain (MD = -1.60, 95% CI [-2.18, -1.02]), and betterment in all HAGOS subscale scores compared to the CG. There were no significant between-group differences in hip joint ROM. CONCLUSION: Incorporating the CAE into rehabilitation programs significantly improves EHAD strength, decreases pain scores, and reduces self-reported disability in soccer players with adductor-related groin pain. REGISTRATION: ClinicalTrials.gov identifier: NCT05589623.

Does Headgear Prevent Sport-Related Concussion? A Systematic Review and Meta-Analysis of Randomized Controlled Trials Including 6311 Players and 173,383 Exposure Hours.

CONTEXT: A sport-related concussion (SRC) is a traumatic brain injury that is caused by biomechanical stresses and results in a complex pathophysiological process in the brain. Some in the sporting community believe that headgear (HG) can prevent SRC, and several professional Australian sports organizations, including rugby, football, and soccer clubs, recommend its use. OBJECTIVE: The purpose of this study is to determine whether HG is effective in lowering the prevalence of SRC in sports. DATA SOURCES: A systematic search for related studies published between 1985 and 2023 was conducted using the following databases: Cochrane Library, AMED, PubMed, Web of Science, and Physiotherapy Evidence Database (PEDro). STUDY SELECTION: Only randomized controlled trials (RCTs) that investigated the effectiveness of HG in reducing SRC rate were included. STUDY DESIGN: Systematic review and meta-analysis of RCTs. LEVEL OF EVIDENCE: Level 1a. DATA EXTRACTION: Two researchers independently completed the title and abstract search and performed full-text reviews. A third reviewer was consulted to reach a consensus if any discrepancies were noted. The PEDro scale was used to evaluate the quality of the included RCTs. Data recorded from each study included authors, year of publication, type and number of players, study design, duration of the study, injury rate, compliance (%), sports/level, and exposure hours. RESULTS: The pooled results of 6311 players and 173,383 exposure hours showed 0% SRC reduction per 1000 hours of exposure in the experimental group compared with the control group, with an injury risk ratio of 1.03 (95% CI, 0.82-1.30; P = 0.79). CONCLUSION: This systematic review and meta-analysis demonstrates that HG does not prevent SRC among soccer and rugby players, and therefore the findings from this meta-analysis do not currently support the use of HG to prevent SRC in soccer or rugby.

Effectiveness of Injury Prevention Programs With Core Muscle Strengthening Exercises to Reduce the Incidence of Hamstring Injury Among Soccer Players: A Systematic Review and Meta-Analysis.

CONTEXT: Muscles in the hamstring group are frequently injured in sporting activities. Injury prevention programs (IPPs), including eccentric training of the hamstrings, have proven to be of great value in decreasing the injury rate of hamstring muscles. OBJECTIVE: To examine the effectiveness of IPPs that include core muscle strengthening exercises (CMSEs) in reducing hamstring injury rates. DATA SOURCES: This systematic review with meta-analysis was based upon the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search was conducted for relevant studies published from 1985 to 2021 using the following databases: Cochrane Library, MEDLINE, AMED, PubMed, Web of Science, and Physiotherapy Evidence Database (PEDro). STUDY SELECTION: The initial electronic search found 2694 randomized controlled trials (RCTs). After removing duplicate entries, 1374 articles were screened by their titles and abstracts, and 53 full-text records were assessed, of which 43 were excluded. The remaining 10 articles were reviewed in detail, from which 5 studies met our inclusion criteria and were included in the current meta-analysis. STUDY DESIGN: Systematic review and meta-analysis of RCTs. LEVEL OF EVIDENCE: Level 1a. DATA EXTRACTION: Two researchers independently completed the abstract review and performed full-text reviews. A third reviewer was consulted to reach a consensus if any discrepancies were noted. Details were recorded about the participants, methodological aspects, eligibility criteria, intervention data, and outcome measures, including age; number of subjects in the intervention/control group; number of injuries in each group; and the duration, frequency, and intensity of the training conducted in the intervention. RESULTS: The pooled results of 4728 players and 379,102 exposure hours showed 47% hamstring injury reduction per 1000 h of exposure in the intervention group compared with the control group with an injury risk ratio of 0.53 (95% CI [0.28, 0.98], P = 0.04). CONCLUSION: The results indicate that CMSEs incorporated with IPPs reduce susceptibility and risk of hamstring injuries in soccer players.

The FIFA 11+ Kids Injury Prevention Program Reduces Injury Rates Among Male Children Soccer Players: A Clustered Randomized Controlled Trial.

BACKGROUND: The Fédération Internationale de Football Association (FIFA) 11+ Kids is an exercise-based injury prevention program developed by an international group of experts to prevent injuries among child soccer players. HYPOTHESIS: It was hypothesized that the FIFA 11+ Kids program would be more effective than performing a typical warm-up regimen in reducing overall injuries among soccer players aged 7 to 13 years. STUDY DESIGN: A clustered randomized controlled trial. LEVEL OF EVIDENCE: Level 1. METHODS: A total of 94 boys' soccer teams, including 780 players, were randomly allocated into an experimental or control group. Complete datasets were collected from 45 teams (377 players) and 43 teams (363 players) in the experimental and control groups, respectively. The experimental group underwent the FIFA 11+ Kids program as a warm-up during training sessions and matches at least twice a week, and the control group continued performing their usual warm-ups. Participants were prospectively followed during 1 season (6 months). The primary outcomes included the incidence of overall and recurrent injuries and their mechanism and severity. The secondary outcome was the rate of compliance with the intervention program. RESULTS: A total of 43 injuries were reported in the experimental group in 50,120 hours of exposure (0.85 injuries/1000 exposure hours). A total of 86 injuries were reported in the control group in 42,616 hours of exposure (2.01 injuries/1000 exposure hours). The injury risk ratio was 0.43 (0.29-0.61), suggesting that the experimental group experienced 57% fewer injuries than those in the control group. CONCLUSION: The FIFA 11+ Kids program reduced overall injury rates in children playing soccer more than the usual warm-ups. CLINICAL RELEVANCE: The results of this study provide evidence for children's coaches to consider including the FIFA 11+ Kids program in their warm-up regimen. Such a program may prevent injury risk and decrease absenteeism and injury-related financial burdens.

Injury prevention programs that include plyometric exercises reduce the incidence of anterior cruciate ligament injury: a systematic review of cluster randomised trials.

QUESTION: Do injury prevention programs that include plyometric exercises reduce the incidence of anterior cruciate ligament (ACL) injuries in sport? DESIGN: Systematic review of (cluster) randomised trials with meta-analysis. PARTICIPANTS: Sporting participants of any age, sex or competition level. INTERVENTIONS: The experimental intervention was an injury prevention program that included plyometric exercises. The control intervention was the usual warm-up program, which did not include plyometric exercises. OUTCOME MEASURES: Exposure-based ACL injury rates. RESULTS: The initial search yielded 7,302 articles, of which nine met the inclusion criteria. All nine articles reported cluster randomised trials, providing data on 14,394 participants. The pooled results showed that injury prevention programs that include plyometric exercises reduce the risk of ACL injury by 60% per 1,000 hours of exposure compared with the control group, with an injury risk ratio (IRR) of 0.40 (95% CI 0.26 to 0.63). Data from subgroups of these trials estimated that this preventative effect may be stronger in males (IRR 0.21, 95% CI 0.07 to 0.62) and weaker in females (IRR 0.51, 95% CI 0.30 to 0.87), albeit with less precise estimates. Subgroup analysis also suggested a stronger effect on non-contact ACL injuries (IRR 0.34, 95% CI 0.18 to 0.65), whereas the effect on contact ACL injuries remained uncertain (IRR 0.59, 95% CI 0.15 to 2.30). CONCLUSIONS: Injury prevention programs that incorporate plyometric exercises substantially decrease the risk of ACL injuries more than warm-up programs that do not include plyometric exercises. The preventive effect appears to be stronger among males and in the prevention of ACL injuries that do not involve contact with another player. PROSPERO CRD42020196982.

Injury prevention programs that include balance training exercises reduce ankle injury rates among soccer players: a systematic review.

QUESTION: What is the effect of injury prevention programs that include balance training exercises on the incidence of ankle injuries among soccer players? DESIGN: Systematic review of randomised trials with meta-analysis. PARTICIPANTS: Soccer players of any age, sex or competition level. INTERVENTIONS: The experimental intervention was an injury prevention program that included balance training exercises. The control intervention was the soccer team's usual warm-up program. OUTCOME MEASURES: Exposure-based ankle injury rates. RESULTS: Nine articles met the inclusion criteria. The pooled results of injury prevention programs that included balance training exercises among 4,959 soccer players showed a 36% reduction in ankle injury per 1,000 hours of exposure compared to the control group with an injury risk ratio (IRR) of 0.64 (95% CI 0.54 to 0.77). The pooled results of the Fédération Internationale de Football Association (FIFA) injury prevention programs caused a 37% reduction in ankle injury (IRR 0.63, 95% CI 0.48 to 0.84) and balance-training exercises alone cause a 42% reduction in ankle injury (IRR 0.58, 95% CI 0.41 to 0.84). CONCLUSIONS: This meta-analysis demonstrates that balance exercises alone or as part of an injury prevention program decrease the risk of ankle injuries. PROSPERO CRD42017054450.

The association between sedentary behavior and low back pain in adults: a systematic review and meta-analysis of longitudinal studies.

Background: Low back pain (LBP) is a common musculoskeletal problem globally. While spending a longer time in sedentary behaviors is linked to several health problems; the quantitative association between different amounts of sedentary time and LBP is still unknown. This study aims to systematically review studies that examined the association between sedentary behavior and LBP development and LBP-related outcomes. Methods: This systematic review and meta-analysis retrieved journal articles published from inception to March 2020 and were obtained by searching bibliographical databases. We included longitudinal study designs, including adult (aged ≥18) individuals with nonspecific LBP, and reporting estimates of the association between sedentary behavior and LBP development and LBP-related outcomes (i.e., pain intensity and disability). Results: Sixteen longitudinal studies with 100,002 participants were included in this review (eight studies included in quantitative syntheses with 83,111 participants). The results of meta-analyses showed that a sedentary time of 3-<6 (Odds ratio (OR) 0.95, 95% CI [0.85-1.07]), 6-8 (OR 0.95, 95% CI [0.88-1.02]), and >8 (OR 0.92, 95% CI [0.85-1.00]) hours per day (h/d) was not associated with LBP development. A sedentary time of ≥3 h/d was associated with poor LBP-related disability (OR 1.24, 95% CI [1.02-1.51]), but not with pain intensity. Conclusion: A meta-analyses of longitudinal studies indicated that sedentary behavior of different durations was not associated with LBP development. However, the results showed that sedentary behavior ≥3 h/d was associated with worse LBP-related disability. These conclusions are tentative as the evidence was derived from mostly fair-quality studies using subjective measures of sedentary behavior. Systematic review registration: PROSPERO (registration number CRD42018107078).

Sports injury prevention programmes from the sports physical therapist's perspective: An international expert Delphi approach.

OBJECTIVE: To provide consensus on how to plan, organize and implement exercise-based injury prevention program (IPP) in sports. DESIGN: Delphi. SETTING: LimeSurvey platform. PARTICIPANTS: Experienced sports physical therapists from the International Federation of Sports Physical Therapy member countries. MAIN OUTCOME MEASURES: Factors related to sports IPP planning, organization and implementation. RESULTS: We included 305 participants from 32 countries. IPP planning should be based on an athlete's injury history, on pre-season screening results, and on injury rates (respectively, 98%, 92%, 89% agreement). In total 97% participants agreed that IPP organization should depend on the athlete's age, 93% on the competition level, and 93% on the availability of low-cost materials. It was agreed that IPP should mainly be implemented in warm-up sessions delivered by the head or strength/conditioning coach, with physical training sessions and individual physical therapy sessions (respectively, 94%, 92%, 90% agreement). CONCLUSION: Strong consensus was reached on (1) IPP based on the athlete's injury history, pre-season screening and evidence-based sports-specific injury rates; (2) IPP organization based on the athlete's age, competition level, and the availability of low-cost materials and (3) IPP implementation focussing on warm-up sessions implemented by the strength/conditioning coach, and/or individual prevention sessions by the physical therapist.

The effect of combining plyometrics exercises and balance exercises in improving dynamic balance among female college athletes: A randomized controlled trial.

INTRODUCTION: Plyometrics and balance exercises have been shown to reduce the incidence of lower limb injury. The effects of combining these exercises on dynamic balance have not been investigated. OBJECTIVE: To evaluate the effect of plyometrics, balance exercises, and a combination of both exercises on postural stability among female athletes compared to those who did not perform any specific exercise (control). DESIGN: Randomized controlled trial. SETTING: Sports medicine laboratory. PARTICIPANTS: Two hundred female athletes (mean age 21.9 ± 2.4 years) were assigned randomly to a plyometrics exercise group (n = 50), a balance exercise group (n = 50), a combination of both exercises group (n = 50), or a control group (n = 50). One hundred seventy-nine female college athletes completed the study. INTERVENTIONS: Plyometrics exercises, balance exercises, and a combination of both exercises. OUTCOME MEASURES: Limits of stability, which was assessed using the Biodex Stability System to evaluate the performance of the dynamic balance. It was measured pre- and post-intervention after 6 weeks. RESULTS: There were no differences in baseline data between groups (p = .557). All groups showed significant improvement in limits of stability (p < .001). The most marked improvement in the limits of stability was shown in the combination group compared to the control group (MD = 4.1%, 95% CI [2.8, 5.3], p < .001). CONCLUSIONS: Combining plyometrics and balance exercises significantly increases the dynamic balance performance post-intervention among female athletes compared to the control group.

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

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).

Physiotherapists' knowledge and the implementation of COVID-19 infection prevention and control measures.

BACKGROUND: Physiotherapists are required to recognize their role in managing patients with Coronavirus Disease-19 (COVID-19), and to adopt preventive measures to limit transmission of the disease. OBJECTIVE: The aim of this study was to assess the perception, knowledge, and application of the preventive measures taken by physiotherapists in managing issues with confirmed or suspected patients suffering from COVID-19. METHODS: A self-administered survey comprising 15 questions was divided into four sections related to precautions when interacting with patients with COVID-19: (1) knowledge of the physiotherapy role, (2) knowledge of preventive measures to limit transmission of the virus, (3) practicing these measures, and (4) managing patients with COVID-19. RESULTS: A total of 456 physiotherapists from 139 countries participated in the study. Most physiotherapists were knowledgeable regarding their role in the management of COVID-19 patients (M = 94.3%; SD = 15.4) and the management of potential COVID-19 patients (M = 84.5%; SD = 20.1). The rating of knowledge and practices of preventive measures to limit transmission of COVID-19 were lower (M = 74.3%; SD = 25.7, and M = 62.5%; SD = 31.3, respectively). Participants from the European region (M = 83; SD = 15.8) had a higher score than participants from the Asia Western Pacific region (M = 78; SD = 18.49; P = 0.01). CONCLUSIONS: Physiotherapists are highly knowledgeable about their role in managing COVID-19 patients. Most of them are adopting preventive measures to limit the transmission of the disease. Yet, physiotherapists are required to enroll in medical education, training and infection control workshops and courses to remain updated with the recent advances in such fields.

Effectiveness of the FIFA 11+ Referees Injury Prevention Program in reducing injury rates in male amateur soccer referees.

OBJECTIVE: The Fédération International de Football Association (FIFA) 11+ Referees Injury Prevention Program (FIFA 11+ Referees Program) is a structured warm-up program specially designed to prevent injuries in soccer referees. However, its effectiveness has yet to be fully documented in the literature. Therefore, the purpose of this study was to investigate the effectiveness of the FIFA 11+ Referees Program in reducing injury rates among soccer referees. METHODS: A randomized controlled trial was conducted. Two hundred male amateur soccer referees (mean ± SD age, 31.6 ± 4.1 years) participated in this study. Participants were randomly allocated to the experimental and control groups. The experimental group performed the FIFA 11+ Referees Program as a warm-up during training sessions at least twice a week, and the control group performed their usual warm-ups. The participants were followed up for one season. The outcome measures were the incidence of overall injury, initial injury, recurrent injury, injury mechanism, and injury severity (primary), and the rate of adherence to the intervention program (secondary). RESULTS: A total of 24 injuries were reported among 100 referees in the control group in 16 606 h of exposure (1.45 injuries/1000 exposure h), and a total of nine injuries were reported across 100 referees within the experimental group in 17 834 exposure h (0.50 injuries/1000 exposure h). The Injury Risk Ratio (IRR) was 0.35 (95% CI 0.26-0.45). CONCLUSION: The results indicated that the FIFA 11+ Referees Program effectively reduced injuries in the experimental group by 65% compared to the control group.

A meta-analysis of meta-analyses of the effectiveness of FIFA injury prevention programs in soccer.

FIFA has a Medical and Research Centre (F-MARC) which has designed a comprehensive program targeting muscle strength, kinesthetic awareness, and neuromuscular control during static and dynamic movements to decrease injury risk for soccer players. A number of meta-analyses now exist on how effective FIFA's programs to prevent and reduce injury actually are, with various degrees of injury reduction reported. This research aimed to carry out a systematic review and to meta-analyse the existing meta-analyses so that a conclusion can be drawn on how effective the injury programs are. Relevant studies were identified by searching five databases for the period January 1990 till 1 July 2018. Results of each meta-analysis were combined together using risk ratios (RR) in a summary meta-analysis. QUOROM checklist and AMSTAR 2 assessment were used to assess the quality of reporting and methodology in the meta-analyses. Four meta-analyses met the inclusion criteria covering fifteen primary studies. All four meta-analyses scored quite highly on QUOROM, but two were rated by AMSTAR 2 as moderate quality, and two were found to be of critically low quality. An overall risk reduction in 34% (RR = 0.66 [0.60-0.73]) for all injuries and a reduction in 29% (RR = 0.71 [0.63-0.81]) for injuries to the lower limbs were revealed by this meta-analysis of meta-analyses. Combining every previous meta-analysis into a single source in this paper produced decisive evidence that the risk of injuries while playing soccer is reduced as a result of FIFA's injury prevention programs.

Can the stroke impact scale 3.0 detect cognitive impairments in patients with a recent stroke?

[Purpose] The aim of this study was to identify cognitive impairments in patients with a recent stroke using Stroke Impact Scale 3.0 (SIS). [Participants and Methods] A retrospective cohort study was conducted to evaluate 50 medical records in patients with a recent stroke who have completed a stroke rehabilitation programme. All data were evaluated at St. Finbarr's Hospital in Cork, Ireland. [Results] A total of 41 records met the inclusion criteria, of which 53.7% were male. Regarding the risk factors, most patients complained of hypertension (85.4%), with most being diagnosed with embolic stroke (56.1%). The SIS identified numerous issues in stroke patients, such as persistent problems with memory (36.6%), concentration (29.3%), and solving everyday problems (43.9%). In addition, some patients' responses were negative regarding their emotion such as feeling sad (51.2%), not enjoying things as much as ever (39%), feeling life is not worth living (85.4%) and not smiling or laughing at least once a day (80.5%). [Conclusion] The inclusion of the SIS in the stroke review clinic identified cognitive deficits that may not have otherwise been detected. By using SIS in a systematic and standardised way, deficits can be identified, and appropriate rehabilitation can be provided.

Adding a post-training FIFA 11+ exercise program to the pre-training FIFA 11+ injury prevention program reduces injury rates among male amateur soccer players: a cluster-randomised trial.

QUESTION: Does adding a post-training Fédération Internationale de Football Association (FIFA) 11+ exercise program to the pre-training FIFA 11+ injury prevention program reduce injury rates among male amateur soccer players? DESIGN: Cluster-randomised, controlled trial with concealed allocation. PARTICIPANTS: Twenty-one teams of male amateur soccer players aged 14 to 35 years were randomly assigned to the experimental group (n=10 teams, 160 players) or the control group (n=11 teams, 184 players). INTERVENTION: Both groups performed pre-training FIFA 11+ exercises for 20minutes. The experimental group also performed post-training FIFA 11+ exercises for 10minutes. OUTCOME MEASURES: The primary outcomes measures were incidence of overall injury, incidence of initial and recurrent injury, and injury severity. The secondary outcome measure was compliance to the experimental intervention (pre and post FIFA 11+ program) and the control intervention (pre FIFA 11+ program). RESULTS: During one season, 26 injuries (team mean=0.081 injuries/1000 exposure hours, SD=0.064) were reported in the experimental group, and 82 injuries were reported in the control group (team mean=0.324 injuries/1000hours, SD=0.084). Generalised Estimating Equations were applied with an intention-to-treat analysis. The pre and post FIFA 11+ program reduced the total number of injuries (χ2 (1)=11.549, p=0.001) and the incidence of initial injury (χ2 (2)=8.987, p=0.003) significantly more than the pre FIFA 11+ program alone. However, the odds of suffering a recurrent injury were not different between the two groups (χ2 (1)=2.350, p=0.125). Moreover, the severity level of injuries was not dependent upon whether or not the pre and post FIFA 11+ program was implemented (χ2 (1)=0.016, p=0.898). CONCLUSION: Implementation of the FIFA 11+ program pre-training and post-training reduced overall injury rates in male amateur soccer players more than the pre FIFA 11+ program alone. TRIAL REGISTRATION: ACTRN12615001206516. [Al Attar WSA, Soomro N, Pappas E, Sinclair PJ, Sanders RH (2017) Adding a post-training FIFA 11+ exercise program to the pre-training FIFA 11+ injury prevention program reduces injury rates among male amateur soccer players: a cluster-randomised trial. Journal of Physiotherapy 63: 235-242].

Effect of Injury Prevention Programs that Include the Nordic Hamstring Exercise on Hamstring Injury Rates in Soccer Players: A Systematic Review and Meta-Analysis.

BACKGROUND: Hamstring injuries are among the most common non-contact injuries in sports. The Nordic hamstring (NH) exercise has been shown to decrease risk by increasing eccentric hamstring strength. OBJECTIVE: The purpose of this systematic review and meta-analysis was to investigate the effectiveness of the injury prevention programs that included the NH exercise on reducing hamstring injury rates while factoring in athlete workload. METHODS: Two researchers independently searched for eligible studies using the following databases: the Cochrane Central Register of Controlled Trials via OvidSP, AMED (Allied and Complementary Medicine) via OvidSP, EMBASE, PubMed, MEDLINE, SPORTDiscus, Web of Science, CINAHL and AusSportMed, from inception to December 2015. The keyword domains used during the search were Nordic, hamstring, injury prevention programs, sports and variations of these keywords. The initial search resulted in 3242 articles which were filtered to five articles that met the inclusion criteria. The main inclusion criteria were randomized controlled trials or interventional studies on use of an injury prevention program that included the NH exercise while the primary outcome was hamstring injury rate. Extracted data were subjected to meta-analysis using a random effects model. RESULTS: The pooled results based on total injuries per 1000 h of exposure showed that programs that included the NH exercise had a statistically significant reduction in hamstring injury risk ratio [IRR] of 0.490 (95 % confidence interval [CI] 0.291-0.827, p = 0.008). Teams using injury prevention programs that included the NH exercise reduced hamstring injury rates up to 51 % in the long term compared with the teams that did not use any injury prevention measures. CONCLUSIONS: This systematic review and meta-analysis demonstrates that injury prevention programs that include NH exercises decrease the risk of hamstring injuries among soccer players. A protocol was registered in the International Prospective Register of Systematic Reviews, PROSPERO (CRD42015019912).

How Effective are F-MARC Injury Prevention Programs for Soccer Players? A Systematic Review and Meta-Analysis.

BACKGROUND: The FIFA Medical and Research Centre (F-MARC) has designed a comprehensive warm-up program targeting muscular strength, body kinaesthetic awareness, and neuromuscular control during static and dynamic movements to decrease injury risk for soccer players. Prior studies have investigated the effectiveness of the F-MARC programs, but have not consistently reported a statistically significant reduction in injury and reduction in time loss due to injury from utilizing the program. OBJECTIVE: The purpose of this study was to conduct a systematic review and meta-analysis of randomized controlled trials and interventional studies that evaluated the efficacy of the F-MARC injury prevention programs in soccer. METHODS: Two independent researchers searched the relevant article databases. The keyword domains used during the search were 'F-MARC', 'FIFA 11+', 'the 11+', 'injury prevention programs', 'soccer', and variations of these keywords. The initial search resulted in 4299 articles which were filtered to nine articles that met the inclusion criteria. Main inclusion criteria were randomized controlled trials or interventional studies, use of F-MARC injury prevention programs, and the primary outcome measuring overall and lower extremity injuries. Extracted data were entered and analyzed using Comprehensive Meta-Analysis software, version 2 (CMA.V2). RESULTS: The pooled results based on total injuries per 1000 h of exposure showed that F-MARC injury prevention programs had a statistically significant reduction in the overall injury risk ratio of 0.771 (95% CI 0.647-0.918, p = 0.003) and the lower extremity injury risk ratio of 0.762 (95% CI 0.621-0.935, p = 0.009). Moreover, FIFA '11+' had a statistically significant reduction in the overall injury risk ratio to 0.654 (95% CI 0.537-0.798, p < 0.001) and the lower extremity injury risk ratio of 0.612 (95% CI 0.475-0.788, p < 0.001). However, FIFA '11' did not reach significance for the lower extremity and overall injury reduction. It can be suggested that teams involved in the FIFA '11+' warm-up program will reduce injury rates by between 20 and 50% in the long term compared with the teams that do not engage in F-MARC programs. CONCLUSIONS: This systematic review and meta-analysis indicated that use of F-MARC injury prevention programs, particularly the '11+' program, decreases the risk of injuries among soccer players. These data also support the case for the development and introduction of sport-specific programs.