Introduction

There is an increasing body of literature showing that the risk of sustaining a sports-related injury can be substantially reduced. The best examples relate to the prevention of anterior cruciate ligament (ACL) and hamstring injuries.1–5 Multimodal programmes which incorporate aerobic, balance/proprioception and plyometric exercises are the most widely studied initiatives. One of these programmes, the 11+, was developed specifically for use in football. It has been shown to be effective in both men’s and women’s football, has been shown to improve measures of a player’s performance and has been shown to be cost-effective.2 6–8 More than 40 scientific papers have now been published demonstrating the programme’s efficacy.9 

Despite these good quality data, evidence-based injury prevention programmes are not widely implemented. Players, coaches and administrators have not widely engaged with these initiatives for a variety of reasons.9 Most current injury prevention strategies used in both recreational and professional sport are not validated and may lack efficacy.10 11

New Zealand, along with Switzerland, is often highlighted as a country where the 11+ has been successfully implemented.12 However, despite efforts to roll this programme out at a national level in New Zealand (starting in 2005), the uptake and penetration of the warm-up programme was initially relatively poor. In 2013, a survey showed that only 11% of all football players in New Zealand had ‘heard’ of the 11+ programme—meaning that the number regularly completing the programme was likely to be substantially lower than this figure.13 Despite the relatively poor uptake, the return on investment for each dollar spent on implementation was found to be NZD$8.20 for each invested dollar.12

New Zealand has a national insurance company called the Accident Compensation Corporation (ACC). This is a government-run 24-hour, no-fault insurance scheme that covers personal injury caused by accident. In …