Researchers from England and Italy tested the "FIFA 11+" warm-up program -- created primarily to prevent knee and leg injuries in soccer -- on young male players for an elite Italian basketball club.

The FIFA 11+ program, which combines running, jumping and stretching exercises, has already been shown to reduce injuries among soccer players. One study of female youth-league soccer players found that it cut injury risk by up to 40 percent.

In the United States alone, more than 30 million children and teens play sports. High-school athletes, alone, account for nearly two million sports-related injuries each year, according to the Centers for Disease Control and Prevention.

The FIFA 11+ exercises (bit.ly/sU8zw0) aim to strengthen the core muscles -- abs, hips and glutes -- and promote proper body mechanics when running, jumping and twisting, according to the researchers.

"We hypothesized that the FIFA 11+ program would be effective in preventing injuries in other high speed sports where sudden changes of direction, and lots of hopping, jumping, and landing is required," said study author Dr. Nicola Maffulli, an orthopedic surgeon at the Centre for Sports and Exercise Medicine at Mile End Hospital in London, in an email to Reuters Health.

To test their theory, Maffulli and fellow researchers followed 11 teams in one basketball club. They randomly assigned seven of the teams to use the FIFA 11+ training program during practices and before matches and four of the teams to warm up as usual during the season. Players ranged in age from 11 to 24 years old.

Before the season began, researchers met with coaches and team captains to show them how to perform the exercises.

Over the course of the nine-month season, injury rates were significantly lower in the group using the FIFA 11+ training program compared to those warming up as usual.

Overall, 14 of 80 players in the FIFA 11+ group were injured, while 17 of 40 players in the other group had injuries. The results translated to a rate of 0.95 injuries for every 1,000 combined hours spent playing matches and practicing during the season in the FIFA 11+ group, while players in the comparison group had 2.16 injuries per 1,000 hours of time on the court.

"This shows that a dynamic, active warm-up program designed around injury prevention has the potential to really cut risks," Timothy Hewett, director of research at Ohio State University Sports Medicine and Cincinnati Children's Hospital Sports Medicine Biodynamics Center, told Reuters Health. Hewett was not involved in the study.

The FIFA 11+ program did not, however, significantly reduce the players' risk of knee or ankle injuries, the two most commonly injured sites in basketball, according to findings in the American Journal of Sports Medicine.

And it's not clear these results would translate to girls, other age groups or athletes of different ability levels, said the researchers.

"While the results are provocative, more research is needed before we can say that all basketball players should be using this program," said Dr. Kristina Wilson, a pediatric sports medicine specialist at Phoenix Children's Hospital in Arizona who also was not involved in the study.

According to Hewett, significant limitations in the design of the study may have affected results, too.

For instance, the coaches and all the athletes knew whether or not they were assigned to the FIFA 11+ program, and all were well aware of the expected outcomes of using the program, which has a track record of reducing injuries. That, according to Hewett, could potentially lead to a placebo effect among players using the specialized warm-up.

Players on teams that didn't use the FIFA 11+ program were also older -- they averaged 15.2 years old -- and as a result, were taller and heavier than athletes on teams that used the program, who were on average 13.5 years old.

You would expect more injuries in bigger, taller kids no matter what warm-up they did, said Hewett. "It's simple physics -- the bigger they are, the harder they fall."

In addition to exercises that strengthen the core muscles, rest is key to injury prevention in child and teen athletes too, said Wilson.

"Kids need at least two days a week to recover, and a couple months off each year from their primary sport," she told Reuters Health.

SOURCE: bit.ly/H0elTe American Journal of Sports Medicine, online March 13, 2012.

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