If doing 10 simple exercises each day could dramatically drop your chances (or those of your kids) of tearing your ACL or spraining your ankle, would you try them? And if they did help, should soccer teams nationwide use them?

Switzerland has tested this idea, and the results are impressive. True, it isn’t the United States. But it is thought that about 600,000 Swiss play soccer each year. In 2003, there were over 42,000 soccer-related injuries there. Those injuries created about $130 million in healthcare costs.

Charleston Battery soccer playerIn an article published in the American Journal of Sports Medicine, Astrid Junge, PhD and others presented the results of their program in Switzerland. They utilized a program called “The 11,” which included 10 exercises performed during every training session. The exercises needed no equipment other than a soccer ball. Players could complete them in only 10 to 15 minutes. These exercises were designed with the goal of decreasing common soccer injuries, such as ACL tears, hamstring strains, groin injuries and ankle sprains.

Many sports medicine programs here in the United States work with schools, teams, and even individual athletes on injury prevention programs. What makes this program remarkable is that the researchers tried to make it a standard program for soccer teams throughout the country.

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Since all licensed coaches have to complete a basic education program in Switzerland, “The 11” was introduced into this education. A sports physical therapist taught program instructors how to get coaches to adopt the program. Instructors then taught all of the coaches the program and sent them regular educational materials. Coaches had to perform the exercises themselves while being evaluated for technique by the instructors.

Did the coaches use the program with their teams?

In 2008, four years after “The 11” was introduced, almost 80% of coaches interviewed knew the exercises. 57% used the program, or at least some of its exercises, with their teams. Of the coaches whose teams did not perform “The 11,” about half didn’t know the program. Other reasons offered by these coaches included “not having enough time,” “doing similar exercises,” and “other priorities.”

Did “The 11” work?

I think the program was effective, based on their data:

• Teams that performed “The 11” had a 25.3% lower incidence of training injuries than the teams that did not use the program.
• Teams that performed “The 11” had an 11.5% lower incidence of match injuries in the 4 weeks before the survey compared to the teams that didn’t.
• Teams that performed “The 11” had a 27% lower incidence of noncontact match injuries than teams not doing the exercises.

“‘The 11’ program was developed to reduce the most frequent and most severe types of soccer injury, such as ankle sprains, hamstring and groin strains, and ligament injuries in the knee,” wrote Dr. Junge. “…the prevention program ‘The 11’ was successfully implemented in a countrywide campaign and proved effective in reducing soccer injuries in amateur players.”

Would this program work in the United States?

I would love for some sort of soccer-specific injury prevention program to be used here. I don’t necessarily mean this particular one (The 11), as many different programs exist. As long as an exercise program meets a few key criteria, I think it is worth considering.

For an injury prevention program like this to work, it must have these features:

• Easy for coaches to learn
• Relatively small number of exercises that players can perform daily in a short amount of time each day
• Targets multiple body parts to decrease common soccer injuries

I don’t know how we could “require” it across the country unless it is mandatory as part of coaching certification or soccer league/organization participation. The cost of creating, teaching and overseeing the program could be high, so US Soccer or another organization would have to figure out how to best allocate costs.

The Dr. David Geier ShowDo ACL injury prevention programs work? In the Zone segment from Episode 58 of The Dr. David Geier Show

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Right now, these types of programs can be started and used individually by athletes who pay to work with sports medicine physical therapists or athletic trainers. Athletic trainers of schools often teach them to their soccer teams. Or teams and leagues hire sports medicine programs to teach injury prevention programs. The programs are out there – and I strongly advocate them.

I do think it would be a huge step towards lowering youth sports injuries if we can figure out how to make them standard across the country.

What do you think? Do you or your kids use an injury prevention program in soccer? Would you like to see them required across the country? Coaches or soccer administrators out there, do you have any ideas for how such a program could work in this country?

Reference: Junge A, Lamprecht M, Stamm H, Hasler H, Bizzini M, Tschopp M, Reuter H, Wyss H, Chilvers C, Dvorak J. Countrywide Campaign to Prevent Soccer Injuries in Swiss Amateur Players. Am J Sports Med. 2011;39(1):57-63.