Frequency of foot and ankle injuries in professional footballers following the introduction of Prehab that incorporates elements of the FIFA 11+ NPM Jain1, DJ Murray1, P Hayward2, S Kemp2 Specialist Registrar, North West Deanery, Manchester, United Kingdom 2 Wolverhampton Wanderers Football Club, Wolverhampton, United Kingdom 1
Mr Neil Jain FRCS Tr & Orth
I have no financial conflicts to disclose
Introduction •
Foot and ankle injuries are a common occurrence amongst all footballers
•
Previously looked at the epidemiology of foot and ankle injuries at the club
•
Introduced prehab based on FIFA 11+ – Proven in women’s soccer in Canada – Men’s elite basketball in Italy
Introduction • Prehab – Not strictly 11+ – Incorporates ankle proprioception exercises of 11+ – Used as part of warm up before every training session and game
Aim • To compare the frequency of injuries prior to and after the introduction of prehab at a professional football club
• To evaluate use of Prehab in Professional Football setting
MATERIALS AND METHODS
Materials & Methods • Data was collected prospectively for all foot and ankle injuries suffered by first team players over the 2008-09, 09-10, 10-11, 11-12 & 12-13 seasons at one club • Each player’s demographics were recorded along with various factors concerning or influencing the injury including: – playing surface - type and side of injury – recovery time - ability to continue playing – pitch condition - type of footwear – foot posture index score (FPIS) - mechanism of injury – dominant side
Materials and Methods
RESULTS
BEFORE……
Results •
48% of players suffered at least one foot and ankle injury
•
5.5% of all injuries were foot injuries and 14.4% ankle
•
The commonest injury was 5th metatarsal fracture seen in 33% – Lateral ligament sprain was seen in 28% (37% in first team) – syndesmosis injury in 17%
Results • The mean recovery time following 5th metatarsal fractures was 69 days
• 67% of all injuries were sustained while wearing blade footwear
• 89% of injuries were suffered on grass and 55% in wet conditions
Graph 2: Mean time (days) to return to play by injury
AFTER…….
Results • 33% of players suffered a F&A injury • Ankle lateral ligament sprain within first team had a frequency of 10.7% • Time unable to train was 3 days • Proportion of F&A injuries in training was 36% • How did that compare?
Results Percentage of players suffering a foot and ankle injury 60.00% 50.00% 40.00%
Percentage of players suffering a foot and ankle injury
30.00% 20.00% 10.00% 0.00%
BEFORE Prehab
AFTER Prehab
Results Frequency of Lateral Ligament Injury – First Team 40.00% 35.00% 30.00% 25.00%
Frequency of Lateral Ligament Ankle sprains
20.00% 15.00% 10.00% 5.00% 0.00%
BEFORE Prehab
AFTER Prehab
Results Mean absence from Training (days) 16.00 14.00 12.00 10.00
Mean absence from Training (days)
8.00 6.00 4.00 2.00 0.00
BEFORE Prehab
AFTER Prehab
Results 100% 90% 80% 70% 60% Injury in game (%) Injury in Training (%)
50% 40% 30% 20% 10% 0%
BEFORE Prehab
AFTER Prehab
DISCUSSION
Discussion • Foot and ankle injuries remain common • Prehab shown to be useful in decreasing frequency of F&A injuries in other sports – Volleyball – Basketball
• FIFA 11+ useful in decreasing injury in youth and amateur players • We have demonstrated its use and benefit in professional environment
Conclusions •
The introduction of a Prehab protocol including the ankle exercise components of the FIFA 11+ results in a decrease in the frequency and severity of ankle sprains within the setting of a professional football club
•
We would advocate its use
Thank you
E-mail: npmjain@hotmail.com NB – There are no disclosures or conflicts of interest with this study