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The 11+ injury prevention programme decreases rate of hamstring strain injuries in male collegiate soccer players
  1. Holly Silvers-Granelli1,2,
  2. Richard Silverman3,
  3. Mario Bizzini4,5,
  4. Kristian Thorborg6,
  5. Robert H Brophy7
  1. 1Velocity Physical Therapy, Santa Monica, California, USA
  2. 2Research, Major League Soccer, New York, New York, USA
  3. 3Washington University in St Louis School of Medicine, Saint Louis, Missouri, USA
  4. 4Research, Schulthess Klinik Human Performance Lab, Zurich, Switzerland
  5. 5Swiss Sport Physiotherapy Association, Leukerbad, VS, Switzerland
  6. 6Sports Orthopaedic Research Center–Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark, Hvidovre Hospital, Hvidovre, Denmark
  7. 7Orthopaedic Surgery, Washington University in Saint Louis School of Medicine, Chesterfield, Missouri, USA
  1. Correspondence to Holly Silvers-Granelli, Velocity Physical Therapy Inc, Santa Monica CA 90405, California, USA; hollysilverspt{at}


Objectives To investigate if the 11+ injury prevention programme decreases the risk of hamstring injury and improves recovery time and determine whether compliance with the 11+ affects hamstring injury risk.

Methods This study is a secondary analysis from a prospective cluster randomised controlled trial that included 65 National Collegiate Athletic Association (NCAA) division I and II men’s soccer teams over the fall 2012 season. Thirty-one teams were randomised to the intervention group that were using the 11+ as their warm-up and 35 teams to the control group that continued to use their traditional warm-up. Each certified athletic trainer (ATC) collected data on demographics, hamstring injury (HSI), mechanism of injury, position, playing surface, time lost due to injury and compliance to the 11+ programme.

Results The 11+ decreased the risk of HSI by 63% compared with the control group (RR=0.37, 95% CI 0.21 to 0.63). Difference in return to play after HSI between the control (9.4±11.2 days) and intervention groups (10.2±11.3 days) was not significant (p=0.8). High compliance (>2 or more doses on average per week) reduced the risk of HSI by 78% (RR=0.22, 95% CI 0.06 to 0.87) compared with low compliance (<1 dose on average per week), and moderate compliance (1 to <2 doses on average per week) decreased the risk of HSI by 67% (RR=0.33, 95% CI 0.11 to 0.97) compared with low compliance. There was no significant difference between high and moderate compliance.

Conclusion The 11+ decreased the risk of HSI by 63% but did not improve recovery time. High to moderate compliance is essential and makes the programme more effective at reducing HSI.

  • Hamstring Muscles
  • Athletic Injuries
  • Soccer
  • Sports medicine
  • Lower extremity

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • X @hollysilverspt, @KThorborg

  • Contributors HS-G is the primary investigator and was responsible for designing the study methodology, recruitment, implementing the study and for the data collection. MB was an investigator in the study and assisted with methodology design and with writing the manuscript. RS and RHB were responsible for performing the statistical analysis and writing the manuscript. KT was responsible for consulting on the interpretation of the data and writing the manuscript. HS-G is the primary investigator and assumes responsibillity for all of the content and serves as the guarantor and primary contact.

  • Funding This study was funded by the Fédération Internationale De Football Association (FIFA) and the Santa Monica Sports Medicine Foundation.

  • Competing interests The authors have not indicated any direct competing interests in conjunction with this manuscript. HS-G is a research consultant for Major League Soccer (MLS), National Football League (NFL) and the Aspetar Scientific Board. KT and MB both have editorial board positions with the British Journal of Sports Medicine.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting or dissemination plans of this research. Refer to the Methods section for further details.

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