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Development and implementation of the ACC SportSmart Warm-up programme: a nationwide sports injury prevention initiative in New Zealand
  1. Mark L Fulcher1,2,3,
  2. Isaac Carlson4,
  3. Cameron Mitchell3,
  4. Mario Bizzini5,
  5. Jiri Dvorak6,7
  1. 1Axis Sports Medicine Specialists, Auckland, New Zealand
  2. 2General Practice and Primary Healthcare, University of Auckland, Auckland, New Zealand
  3. 3New Zealand Football, Auckland, New Zealand
  4. 4Accident Compensation Corp, Wellington, New Zealand
  5. 5Schulthess Clinic, Zurich, Switzerland
  6. 6Swiss Concussion Center, Zurich, Switzerland
  7. 7Spine Unit, Schulthess Clinic, Zurich, Switzerland
  1. Correspondence to Dr Mark L Fulcher; m.fulcher{at}

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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.

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 …

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  • Contributors MLF, IC and CM: involved in the development and implementation of the ACC SportSmart Injury Prevention warm up. JD and MB: were instrumental in the design and validation of the 11+ injury prevention programme (which the ACC programme has been based on). JD and MB: provided valuable direction on the development of this programme. MLF: drafted and revised the paper. IC, CM, JD and MB: revised the paper.

  • 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.

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