From the years of 2000 to 2015 the annual incidence pf ACL reconstructions has increased by 43% (from 54.0 to 77.4 per 100 000 population), and by 74% among those under 25 years of age.(( (Zbrojkiewicz, Vertullo and Grayson, 2019) ))
In comes the role of ACL injury prevention.
The FIFA 11+ is an ACL injury prevention program designed to be performed by players prior to training and before competitive games.
Teams that performed the “11+” regularly at least twice a week had 37% fewer training injuries and 29% fewer match injuries. Severe injuries were reduced by almost 50%.
The “11+” has three parts with a total of 15 exercises, which should be performed in the specified sequence at the start of each training session.
A Three-part program consisting of
1. Running exercises.
2. Strength Plyometrics and Balance.
3. Running exercises (mod/high speed and planting/cutting movements).
A key point in the programme is to use the proper technique and alignment during all the exercises.
ROLE OF THE PHYSIOTHERAPIST
“ The choice of the instructors is crucial, and the FIFA Medical Assessment and Research Centre (F-MARC's) best experiences have been with sports physiotherapists or athletic trainers who have an active involvement in football, because they already ‘live and speak the football language’.”
Neuromuscular control and balance: Neuromuscular control does not represent a single entity, but rather complex interacting systems integrating different aspects of muscle actions (static, dynamic, reactive), muscle activations (eccentric more than concentric), coordination (multi-joint muscles), stabilisation, body posture, balance and anticipation ability. There is strong empirical and growing scientific evidence that sport-specific neuromuscular training programmes can effectively prevent knee and ankle injuries.
Players must possess sufficient strength and neuromuscular control in their hip and trunk muscles
Plyometrics are defined as exercises that enable a muscle to reach maximum strength in as short a time as possible
Plyometrics and agility drills were the important components of the programme that proved to be effective in prevention, especially of ACL injuries.
Soligard T, Myklebust G, Steffen K, Holme I, Silvers H, Bizzini M, Junge A, Dvorak J, Bahr R, Andersen TE (2008) A comprehensive warmup programme to prevent injuries in female youth football: a cluster randomised controlled trial. BMJ Dec 9; 337:a2469. doi: 10.1136/ bmj.a2469
Soligard T, Nilstad A, Steffen K, Myklebust G, Holme I, Dvorak J, et al. Compliance with a comprehensive warm-up programme to prevent injuries in youth football. Br J Sports Med 2010;44(11):787-793.
Zbrojkiewicz, D., Vertullo, C. and Grayson, J. (2019). Increasing rates of anterior cruciate ligament reconstruction in young Australians, 2000-2015.
www.fifa.com. (2019). FIFA Committees - F-MARC: from Football Medicine to Football for Health - FIFA.com. [online] Available at: https://www.fifa.com/about-fifa/who-we-are/committees/committee/1882044/ [Accessed 24 Sep. 2019].