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Effects of the ‘11+ Kids’ injury prevention programme on severe injuries in children’s football: a secondary analysis of data from a multicentre cluster-randomised controlled trial
  1. Florian Beaudouin1,
  2. Roland Rössler2,3,
  3. Karen aus der Fünten1,
  4. Mario Bizzini4,
  5. Jiri Chomiak5,
  6. Evert Verhagen3,
  7. Astrid Junge4,6,
  8. Jiri Dvorak4,
  9. Eric Lichtenstein2,
  10. Tim Meyer1,
  11. Oliver Faude2
  1. 1 Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
  2. 2 Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
  3. 3 Amsterdam Collaboration for Health and Safety in Sports, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Movement Sciences Institute, Amsterdam, The Netherlands
  4. 4 Schulthess Klinik and Swiss Concussion Center, Zurich, Switzerland
  5. 5 Department of Orthopaedics, 1st Faculty of Medicine, Charles University and Hospital Na Bulovce, Prague, Czech Republic
  6. 6 Medical School Hamburg, Hamburg, Germany
  1. Correspondence to Florian Beaudouin, Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, 66123, Germany; florian.beaudouin{at}


Background To assess the effects of the injury prevention programme ‘11+ Kids’ on reducing severe injuries in 7 to 13 year old football (soccer) players.

Methods Football clubs (under-9, under-11 and under-13 age groups) from the Czech Republic, Germany, the Netherlands and Switzerland were cluster-randomised (clubs) into an intervention (INT) and a control group (CON). INT replaced their usual warm-up by ‘11+ Kids’ two times a week. CON followed their regular training regime. Match and training exposure and injury characteristics were recorded and injury incidence rates (IRs) and 95% CIs calculated. For the present analysis, only severe injuries (absence from training/match ≥28 days) were considered. Hazard ratios (HR) were calculated using extended Cox models.

Results The overall IR of severe injuries per 1000 football hours was 0.33 (95% CI 0.25 to 0.43) in CON and 0.15 (95% CI 0.10 to 0.23) in INT. There was a reduction of severe overall (HR 0.42, 95% CI 0.24 to 0.72), match (0.41, 0.17 to 0.95) and training injuries (0.42, 0.21 to 0.86) in INT. The injury types that were prevented the most were: other bone injuries 66%, fractures 49% and sprains and ligament injuries 37%. Severe injuries located at the knee (82%), hip/groin (81%), the foot/toe (80%) and the ankle (65%) were reduced tremendously.

Conclusions ‘11+ Kids’ has a large preventive effect on severe injuries by investing only 15 to 20 min per training session. The present results should motivate coaches to implement effective injury prevention programmes such as the ‘11+ Kids’ in children’s football.

Trial registration number NCT02222025.

  • soccer

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  • Contributors FB and RR: contributed equally. OF, AJ and RR: designed the study protocol for the cluster-RCT. JD, EV, JC, KadF and TM: contributed to the design of the cluster-RCT. FB, RR, JC and EV: organised the study in the respective countries (ie, recruitment, data collection, quality control). RR: conducted the overall data management and organised the data preparation. EL: contributed to the data preparation and merged the data files. MB and KadF: checked the plausibility of injury information. FB and RR: analysed the data on severe injuries and wrote the present manuscript. All authors contributed to writing, reviewing, and revising the manuscript, and agreed on the final version.

  • Funding The original study was fully funded by the Fédération Internationale de Football Association (FIFA).

  • Competing interests RR, KadF, MB, JC, EV, AJ and OF were responsible for the conception of ‘11+ Kids’. MB, AJ and JD were involved in the conception of ‘The 11’ and ‘The 11+’.

  • Patient consent Not required.

  • Ethics approval Ethics Committee of Northwestern and Central Switzerland, ref. no.: 2014-232.

  • Provenance and peer review Not commissioned; externally peer reviewed.