March 01, 2013
3 min read

New program teaches warm-up exercises to prevent ACL injuries in soccer players

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Renowned physicians and professional soccer players are holding injury prevention clinics in 16 cities as part of a program that uses warm-up exercises proven in level 1 trials to reduce ACL tears and other soccer-related injuries.

The Sports Injury Prevention Program incorporates exercises from the FIFA 11+ program that focus on running, plyometrics, balance and strength to guard against injuries. American soccer stars such as Cobi Jones, Alex Morgan and Alexi Lalas and physicians such as Bert R. Mandelbaum, MD, are involved in the initiative to teach parents, coaches and soccer players the exercises.

“Prevention for an orthopedic surgeon is a little bit of our core,” Mandelbaum, a sports medicine orthopedist who is a team physician for the U.S. Soccer Federation, the U.S. Gymnastics Federation and the FIFA World Cup USA, told Orthopedics Today. “I cannot believe the number of orthopedic surgeons that I have worked with teaching and helping get involved into these programs. It is exciting to watch how gratified they are doing it.”

FIFA 11+ exercises

The FIFA 11+ program consists of six running exercises, six strength, plyometrics and balance exercises and three running exercises. Mandelbaum said the program takes 20 minutes to complete and should be done at least twice a week.

Bert R. Mandelbaum

Bert R. Mandelbaum

Jones, who played for Los Angeles Galaxy, told Orthopedics Today that injuries often occur because some kids will immediately play soccer once they arrive on the field.

“A lot of people will [get] out of their car, and kids will just be excited to play and just go and start kicking the ball around,” Jones said. “But if you go through this process, you are properly warmed up, it helps you with your balance, helps you with your core strength — all these important parts to make sure you are preventing injuries. Whenever I decide to do a pickup game, I go through this program to make sure that I am warmed up and properly ready to go.”

FIFA 11+ program developed from the Prevent Injury Enhanced Performance Program (PEP), which was created by Mandelbaum and colleagues at the Santa Orthopaedic and Sports Medicine Foundation after they noticed an increase in ACL tears among young, female soccer players.

“These injuries were occurring in young girls by [them] not having the biomechanical readiness to deal with landing, jumping, accelerating, position of the hip, knee or foot. We can now even use a non-invasive technique of transmagnetic stimulation (TMS) to evaluate neuroplasticity, which is the cerebral cortex modifiable control of all of these critical activities for injury prevention,” Mandelbaum said.

How the exercises work

He noted that exercises in the PEP program work by using a hip dominant strategy where the athletes “control their lower extremity through their gluteus.”

“By simply training the gluteus, it makes a dramatic difference how you land, jump and control your lower extremities during game participation,” he said. “We have looked at this in the laboratory, and we find that we can change a variety of kinematic and kinetic parameters that improve as you train with some of these programs.”

Mandelbaum and colleagues found the PEP program reduced ACL injuries in 14-year-old female soccer players by 88% the first year and 74% the second year. Julie Gilchrist, MD, and colleagues found the program reduced overall injuries in 72% of NCAA Division I female soccer players in 61 different universities and prevented ACL injuries in 100% of players during practice.

The PEP program evolved into the FIFA 11+ program after the CDC request that the program become national and include other soccer injuries, Mandelbaum said. A Swedish study by Torbjørn Soligard, PhD, and colleagues found the FIFA 11+ program significantly reduced knee and other lower extremity injuries among soccer players.

In the future, Mandelbaum plans to test the program on NCAA male soccer players.

“At the moment, we have a study in Division I and II that is going on this season 2012,” he said. “We have 60 programs that are enrolled. We await the data coming from that.”

For more information on FIFA 11+ and the Sports Injury Prevention Program, sponsored by DePuy Mitek, visit the program’s Facebook page: – by Renee Blisard Buddle

Mandelbaum BR. Am J Sports Med. 2005;33:1003-1110.
Gilchrist J. Am J Sports Med. 2008;36:1476-1483.
Soligard T. BMJ. 2008;doi:10.1136/bmj.a2469.
For more information:
Bert R. Mandelbaum, MD, can be reached at Santa Monica Orthopaedic and Sports Medicine Group, 2020 Santa Monica Blvd., 4th Floor, Santa Monica, CA 90404; email:
Disclosure: Mandelbaum receives unrestricted grant money for FIFA 11+ from the International Football Association. Depuy Mitek sponsors the Sports Injury Prevention Program.