Making Football Safer: Optimizing the efficacy and implementation of the 11+ Program

Although football (soccer) has the highest participation of any sport worldwide, the potential for injury is high due to its intense nature. In the elite setting, injury may impact on immediate and future playing capacity, however in the sub-elite setting, injury may also impact on employment outside of football. To consistently evaluate the prevalence and aetiology of injuries in football, a consensus method was developed to allow for ongoing injury data collection. Despite a number of injury studies in the elite setting, there has been little research performed in the sub-elite setting that complies with the football consensus, and no injury research performed in Australia. The 11+ program was designed as a football specific surrogate warm-up that included specific exercises to reduce injury risk in sub-elite football. Despite extensive research showing the injury prevention capacity of the program when players perform the program a minimum of 2 × per week, there has been low uptake of the 11+ program. Issues related to: (i) program duration; (ii) player and coach support; and (iii) potential fatigue related to some of the exercises; are all established reasons for the poor uptake. Consequently, the aims of this thesis were: (i) determine the types, frequency and severity of injury observed as per the football injury consensus statement in sub-elite football in Australia, (ii) assess the prevalence and impact of non-time loss injury and associated time loss injury risk in sub-elite football, (iii) investigate the attitudes, beliefs and behaviours of coaches, players and medical staff towards injury prevention strategies and find potential options to overcome barriers to injury prevention in sub-elite football, (iv) investigate the effect of a novel 11+ program delivery method on player compliance and overall program efficacy.