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New Study Finds Link Between Injury Prevention and Winning

Bert R. Mandelbaum, MD, DHL (Hon)


November 19, 2015

In This Article

You Can't Win With an Injured Team

Injury prevention works.

A study my colleagues and I published this month in the American Journal of Sports Medicine shows that the Fédération Internationale de Football Association (FIFA) 11+ warm-up program can cut injuries—not just knee or ankle injuries but all injuries—by about half.[1] It can cut missed days by one third.

Moreover, from unpublished data, presented in this column for the first time, we know that teams using this program win more games.

What coach wouldn't want to put a program like this in place? As it turns out, most of them. Coaches across the country are shirking their responsibilities.

For this study, we wrote to every National Collegiate Athletic Association (NCAA) Division I and II men's soccer team to solicit their participation. We emailed them. We called them. We told them we had strong evidence already that the program was working in women and that the preliminary evidence in men was extremely positive as well.

Tepid Response From Coaches

I had a lot of those conversations myself, and the responses broke down into three categories:

  • "Thank you for calling. We're using the program. It's the best in the world."

  • "I don't know what you're talking about. We have a short season. I don't have time."

  • "Let me get our trainer to call you."


The trainers seldom called. In the end, only one in six teams took the opportunity we were offering.

A Game-Changing Program

To understand what the opportunity is, we need a little context: Back in the 1990s, many of us who practice sports medicine began noticing a spike in the rate of knee injuries. The injuries seen in my practice went from 80% male to 80% female as a surge of girls began playing competitive sports—and blowing out their anterior cruciate ligaments (ACLs) at a shocking rate.

The number of ACL injuries more than tripled in NCAA soccer players from 1990 to 2000.[2]

I and other researchers from around the world watched many hours of video to determine how these injuries were happening. Again and again, we documented that they were most likely to take place when knees are in dynamic valgus alignment.[3]

In force-plate studies, we confirmed that a stiff valgus landing delivers more force to the joint.[3]

The problem was most striking in adolescent female soccer players, but we have also observed it in males playing basketball, team handball, and American football.[4]

In addition, there is evidence that athletes whose hamstrings are relatively weak in relation to their quadriceps are also more likely to sustain ACL injuries.[5]

From these observations, we developed programs to strengthen the relevant muscles, teach athletes better movement techniques, and improve proprioception.

After years of testing, these efforts culminated in the FIFA 11+ warm-up program. The just-published study on its effectiveness mentioned earlier is only the latest validation of the program. The program has proved itself not only in boys' and girls' soccer but in basketball as well.[6] I believe that the same program could help athletes in just about any sport where knee injuries are a problem.

And not only injuries to knees. In the new study, we were able to show a reduction in injuries to almost every body part—including the head, wrist, and hand.[1]


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