Sports Medicine Corner

Dr. Don Kirkendall

One of the most requested presentations of those of us within FIFA’s Medical Assessment and Research Centre (F-MARC) is about injury prevention – a topic that is at the core of F-MARC’s mission.

In fact, during the 1994 FIFA World Cup in the US, then vice president Sepp Blatter casually commented something on the order of, “Can’t we make the game safer?”

The ensuing conversation was about the number of injuries to the game’s stars. This was the beginning of F-MARC and some resulting changes to things like interpretations of the Laws.

If you were involved with the game up into the mid 1990’s you might recall a play called ‘the professional foul’ where a player on a breakaway would be cut down from behind to prevent a goal. Injury evidence resulted in the International Football Association Board (IFAB, the keepers of the Laws) to outlaw that play. You rarely hear the term today, do you?

Giving the referee the authority to issue an immediate red card for intentional elbows to the head or the studs-up slide were also a result of F-MARC’s research.

It’ll be interesting to see how the Qatari organizing committee reacts to concerns from Dr. Michel D’Hooghe, the chair of FIFA’s Sports Medical Committee, regarding the wisdom of holding the 2022 FIFA World Cup in the oppressive heat of Qatar’s summer. Dr. D’Hooghe expressed more concern about travellers unprepared for the heat and less about the players whom you know will be well protected.

Another aspect of player safety that F-MARC was focused on from the start was preventing predictable injuries. Every sport has its own injury profile, soccer included. While everyone connected with the game intuitively knows that the targets of injuries are the legs and the most common types of injuries include ankle sprains, hamstring and groin strains, knee sprains, and head injuries. F-MARC’s research put solid numbers to verify what most knew, but couldn’t quantify.

If researchers knew WHERE the injuries occur is known and HOW they occurred, preventive activities could be developed and tested. And that’s what F-MARC did, by developing (with the Oslo Sports Trauma Research Centre) The11+, a generalized warm-up program that consistently has been shown to reduce overall injuries by about a third. That’s significant. Players can’t develop if they are hurt.

If you are unfamiliar with The11+, visit for the all details necessary to implement.

As an aside, when I watch youth training, the most poorly organized part of practice session is the warm-up. Most coaches are really good when it comes to ball-related training, but flounder when it comes to the warm-up. When given a ‘canned’ warm-up that’s been proven effective at reducing injury, coaches are very appreciative because they KNOW they could be doing better.

But if I hear a complaint from coaches, it’s their kids don’t want to take the time to do The 11+; “Takes too long” or “I’m bored, let’s play” or other such comments.

I’m kind of old school here. It’s the coach who plans the training based on the needs of the team and the players do what’s asked so that individually and collectively the team can improve.

One of the reasons I love this game is that training is coach-directed, but once the ref blows the whistle, the matches are player-directed; the outcome is now on the player’s feet (or brain. I agree with Cruyff’s statement, “Football is played with your brain”).

If I have a complaint about basketball is that the coach can have too much control over the game; that’s not the case in soccer. Teach ’em during the week. Let them apply what they’ve learned and figure things out during the match on their own.

So, my response to the coach whose players complain about some aspect of training could in essence be summarized as, “who’s in charge?” Maybe the players propose a compromise – how about just 3-4 of the exercises instead of the entire 11+.

The researcher in me says, “The entire program is proven to work. I wouldn’t know what to cherry-pick and get the same effect.” If I tried to do so, and the injuries returned, I’d be at fault and on some level might be considered somewhat negligent.

What I do think is that the thoughtful coach can take the concepts associated with The11+ and extend those into selected aspects of the rest of training. Break down The11+ into its components: strength, dynamic flexibility, balance, plyometrics, agility, and coordination.

Come up with additional activities from those components and create ways to include them in individual and small group activities (not that creative? Spend some time on YouTube. You’ll find plenty of inspiration).

A typical training session is generally composed of general warm-up (e.g. The11+), soccer-specific warm-up (small ‘games, like 5v2), individual, small group, and large group activities (I don’t include cool-down as I don’t think it does what most think it does). Watch what a college or professional team does before a match. They don’t skimp on anything. Plan, making efficient use of time. Keep the players moving and don’t give them much down time.

Now there are many (untested) theories behind injuries. One thought is that sport is too organized and kids specialize at far too young an age. By not experiencing pure free play in many different activities, kids have failed to learn general motor skills.

My statement at conferences is that kids are being taught an offside trap before they’ve learned how to skip. Thus, the coach needs to plan training that exposes children to skills they may have not sufficiently learned.

I recently asked a co-worker’s 10-year-old son about his team. He said he was his team’s holding midfielder! Seriously? At 10 years old?

Personally, I always liked the famous comment by Ferenc Puskas of the great mid-1950s Hungarians, “Ich bin ein Spieler!” I am a player! Guess I thought a 10-year-old should be learning how to play every position. But I digress.

I’ve seen the developmental plans for mega-successful academies like Barcelona and Fiorentina, At the U10-U11 ages, they spend over 60% of training time on basic motor skills and individual ball skills. I’ve been told that U10-U11 players at Fiorentina PLAY NO MATCHES outside of the club for TWO YEARS.

The staff is more physical education teacher than soccer coach, teaching the kids how to walk, run, jump, leap, hop, skip, land, fall, throw, catch, grab, roll/crawl, climb. A great deal of time is spent on posture: flex, bend, twist, abd-adduction, rolling, hurling, static and dynamic balance.

The kids also get a good dose of gymnastics learning basic tumbling skills like somersault, cart-wheels, hand stands, kips, forward/backward rolls, shoulder rolls, sliding and so much more. Their training teaches basic movement skills, all while keeping the ball at the center of attention. Imagine the outcry if a travel team spent that much time “not playing the game.”

I apologize for the rant. “Development” is not just about soccer development, it’s also about developing what has been missed and that includes basic motor skills, many of which make up the core of The11+.

Thank goodness that Claudio Reyna is working hard to encourage clubs to devise, organize, and implement age-appropriate training and not neglect basic motor skills in the attempt to ‘develop’ players more rapidly.
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