Background Soccer referees and assistant referees have a significant risk of injury, particularly to the lower extremity. A growing body of research supports the use of injury prevention programs to prevent such injuries, yet participation rates in these programs by soccer referees and assistant referees remains largely unexplored.

Objective To assess soccer referees and assistant referees’ awareness, implementation and opinion of the Fédération Internationale de Football Association (FIFA)11+ referees injury prevention program.

Design A cross-sectional study.

Setting An online survey for all continental football federations.

Patients (or Participants) A total of 727 soccer referees and assistant referees completed the survey.

Interventions (or Assessment of Risk Factors) The questionnaire consisted of questions relating to the awareness level, implementation rate, and opinion of the FIFA 11+ referees injury prevention program. Questions development was guided by several authors whose expertise is in sport medicine and injury prevention.

Main Outcome Measurements The primary outcomes were awareness level, implementation rate, and opinion of the effectiveness of the FIFA 11+ referees injury prevention program in reducing injuries.

Results A total of 234 (32.2%) participants reported awareness of the FIFA 11+ referees injury prevention program and 208 (28.6%) reported implementing the FIFA 11+ referees injury prevention program in their current practice. Participants who implemented the FIFA 11+ referees injury prevention program reported a positive attitude towards the program efficacy, with a score of 7.5 ±1.3 out of 10.

Conclusions In order to increase the awareness and implementation of the FIFA 11+ referees injury prevention program, the football federations should focus on improving referees and assistant referees education, courses that emphasize injury prevention programs should be mandatory for all soccer referees, soccer assistant referees, and their coaches.