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The 11+ of the future: a primary injury prevention framework for sub-elite football
  1. Matthew Whalan1,2,3,4,
  2. Ric Lovell4,5,
  3. Kristian Thorborg6,7,
  4. John Andrew Sampson1,4
  1. 1 Centre of Medical and Exercise Physiology, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
  2. 2 Figtree Physiotherapy, New South Wales, Australia
  3. 3 Football Federation Australia, Sydney, Australia
  4. 4 NSW Football Medicine Association, Sydney, Australia
  5. 5 School of Science and Health, Western Sydney University, Penrith South, New South Wales, Australia
  6. 6 Department of Orthopaedic Surgery, Sports Orthopaedic Research Centre - Copenhagen (SORC-C), Amager-Hvidovre Hospital, Copenhagen University, Copenhagen, Denmark
  7. 7 Department of Physical Medicine and Rehabilitation - Copenhagen (PMR-C), Amager-Hvidovre Hospital, Copenhagen University, Copenhagen, Denmark
  1. Correspondence to Dr Matthew Whalan, Centre of Medical and Exercise Physiology, School of Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia; matt{at}

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Originally developed as a way to integrate injury risk mitigating exercises into the warm-up,1 the 11+ importantly reduces injury incidence and burden by ~40% in men’s sub-elite football.2 Despite its efficacy as a primary injury mitigation strategy, challenges remain regarding 11+ compliance and adoption.3 This editorial presents a new framework that modernises the programme and tackles issues related to 11+ adoption.

Current issues

A lack of coach/player buy-in, complaints regarding its prolonged duration, and concerns that some exercises (part 2: strength exercises and plyometrics) induce fatigue, are established barriers to 11+ adoption.3 Although recent research has identified strategies to improve the efficacy and adoption of the 11+, it has not been updated since its 2009 launch.2 The challenge, thus, remains to develop a framework that facilitates implementation of risk reduction strategies, while maintaining the initial philosophy of the original 11+, that is, deliverable by a coach with minimal experience or equipment. The proposed new framework is outlined in figure 1.

Figure 1

New framework incorporating the key elements of education, risk …

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  • Twitter @FigtreePhysio, @ric_lovell, @KThorborg, @jsampson77

  • Contributors MW, RL and JAS all drafted the initial version of this manuscript. MW, RL, KT and JAS modified the subsequent versions. All authors approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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