Introduction
Football is an evolving sport, and the modern game continues to increase expectation of players, to run further, sprint more often and tolerate increasingly congested fixture schedules, limiting recovery time. This poses a growing demand on modern day athletes, in turn increasing exposure and likelihood of injury. As a result, injury prevention is more important than ever to protect player health, maintain peak performance and ensure career longevity.
Injury related absence can cost professional football clubs millions of pounds each season, whilst players in lower leagues can face considerable time out from sport, daily activities, and in more severe cases, work. Injuries may also affect key players and limit team availability which could correlate to how successful a season is.
As medical professionals, it is imperative to optimise every opportunity we have, particularly in congested periods, to improve or maintain athletic potential and resilience among individuals. Micro-dosing injury prevention strategies is a common method used by professional sports teams, to create daily exposure for a desired goal, an example being tendon health exercises like longer yielding isometrics. This is often individual and should involve personalised structure based on the needs of a person, such as past medical history. One effective and time efficient method to micro-dose injury prevention strategies are structured warm up programmes. An effective warm up should aim to prime a person both physically and neurologically for upcoming activity, increasing overall readiness to perform.
The Demands of Football
Football is aerobic and anaerobic in nature, interspersed with multiple short bursts of high intensity actions over a 90-minute match (Bortnik L 2024). In a typical game, players run up to 12k, whilst frequently exposed to repeated explosive efforts; sprinting, rapid acceleration, deceleration, changes of direction, jumping and ball striking. These demands are unique to each context and unpredictable in both intensity and duration (Diez A 2025). Explosive actions are often inferred to be key moments that may influence a match result, such as a sprint into the box, winning a header or a shot.
These repeated high force movements place considerable stress on the musculoskeletal system. Therefore without correct preparation and adequate resilience for these tasks, risk of injury may increase. Deceleration and change of direction specifically, are common mechanisms for significant injuries like ACL tears. Therefore, frequent exposure to strength and neuromuscular training may give a player more robustness to tolerate demands of the sport. Before a bout of activity, priority should remain on a structured warm up to optimise readiness.
Traditional warm ups over the years have followed a RAMP protocol, consisting of 4 sections. These are: RAISE – ACTIVATE – MOBILISE – POTENTIATE. Please check our last blog on this for further information.
Whilst RAMP remains the cornerstone of athletic preparation, more structured football specific warm ups have emerged. FIFA 11+ is a structured warm up protocol, developed by FIFA’s medical team and research centre. Over recent years, FIFA 11+ has shown to be a more effective warm up protocol, positively influencing improvements on agility, balance and proprioception, with aims to contribute to a reduction in injury risk. These improvements have been studied in new systematic reviews.
The FIFA 11+ framework is divided into three sections. Each part is approximately 8 minutes long, designed to address physical qualities associated with injury risk in football.
- Part 1: Running exercises — low intensity running, dynamic mobility, controlled contacts, landing mechanics, acceleration and deceleration exposure.
- Part 2: Strength, balance and core — six exercises with three progressive difficulty levels designed to improve strength, balance, muscle control, and core stability. More specifically it looks at single leg balance, hamstring strengthening and plyometric exercises.
- Part 3: Sport-specific movement — running exercises combined with dynamic sport-specific movements likely to be seen frequently throughout a game. This includes advanced plyometrics like bounding as well as cutting, sprinting, change of direction and reactive movement patterns. This latter stage of the protocol uses near maximal efforts to prime the CNS and musculoskeletal system for the velocity it may experience in session.
Injury Reduction
The efficiency of FIFA 11+ to prevent non contact injuries has been proven in young male amateur football players, emphasising frequency of at least twice a week (Bizzini M 2015). Older research portrays a 30–50% reduction in injuries (Soligard et al 2008) when a group of female players aged 13–18 performed the warm up twice a week (Steffen et al 2013). It aims to do this by training qualities that underpin football actions. One quality being neuromuscular control, how well a person has control across multiple body joints, like the hip, knee and ankle. This can be seen in dynamic actions like landing from a header or a cutting movement to chop away from an opposition player (Ghannam et al).
Strength elements seen in the programme, specifically the Nordic hamstring curl, place large eccentric load on the hamstring which develops hamstring strength, specifically in the biceps femoris, and has been shown to reduce risk of hamstring strain. Nordics have also been shown to have positive effects on sprint performance and muscle activation (H Nunes 2024). Reviews discuss that exercises including the Nordic hamstring curl need to be tailored to individuals, so vary in volume. One benefit of the FIFA 11+, not seen in most traditional warm ups, is that it has different skill tiers, enabling players to self prescribe their own progressions and regressions, based on their competency or previous medical history.
Similarly, plyometric exercises aim to improve landing mechanics and force absorption to reduce excessive stress on vulnerable tissues or injury sites e.g. patellar tendon or achilles. If an athlete fails to prepare for the force of these explosive movements, risk of injury can be large. Controlled exposure may allow better preparation. Similarly, enhancing qualities such as proprioception may also help players react more effectively to unexpected movements, contact situations and vulnerable positions seen throughout a game. Good balance helps footballers control their bodies, and prepare for sharp twists. As previously discussed these are common mechanisms for significant injuries like ACL ruptures or ankle sprains. If many injuries happen during deceleration, landing phases and change of direction tasks, specific training exposure under controlled environments are beneficial.
Performance Benefits
The FIFA 11+ has great performance benefits too. One study (Ghannam et al) found an increase in agility, movement competency and balance. These were measured using objective tests such as the Illinois agility and Y balance system. Over a 10 week period, agility scores increased 1.68%. These characteristics underpin many actions within football, which could subsequently lead to improved performance. Another study found positive effects in functional movement screen (FMS) test scores.
Further research reports improved physical fitness scores across dynamic balance, change of direction speed and vertical jump height scores. These benefits induced larger benefits over short training duration of less than 9 weeks when performed three times per week. This research also showed it was more effective in older and male athletes in a ‘higher performance’ category.
Practical Implications
Training qualities taken from the FIFA 11+ have been proven to reduce injury risk, however there is room to delve deeper. Coach delivery and player compliance have been previously highlighted. Steffen et al 2013 reports that different delivery methods of the FIFA 11+ from coaches affected outcomes minimally. On the other hand, evidence suggests that compliance is the main factor for success in the FIFA 11+. Many studies report a minimum dose of twice a week, whilst others reporting performance benefits state three times per week is effective. However this can be time consuming. A team environment may allow for flexible implementation, coaches can implement these exercises into technical and tactical sessions when under time constraints. Depending on the session ahead, coaches can pick relevant sections of the programme. Preparation for extensive higher load days will look different to shorter more intense days with more acceleration and deceleration work.
Despite strong evidence, football and injuries are multi factorial. So it is important to look holistically across multiple performance factors, including training load, nutrition and recovery. Football schedules are typically busy, incur high travel demand and players are subject to high overall load.
Here at Remedy, we believe that injury prevention should be integrated and micro-dosed frequently across all levels of sport. The FIFA 11+ provides an evidence based framework with strategies that work to improve athletic readiness for demands of football — this is just one pillar. If you would like more insight into how a FIFA 11+ warm up looks, check out our page. We like to follow up to date literature to provide gold standard practices for any desired goals. Our RTP sessions for football include the FIFA 11+ as well as many more evidence based practices. For a periodised and tailored approach to warming up for your sport, in the gym, or wherever you are in the world, visit our performance services on the page now.
References
- Ghannam, H., Cerbezer, N. & Çil, E.T. Comparing the effects of FIFA 11+ and traditional warm-up protocols on agility, balance, and proprioception in professional football players: a randomized controlled trial. Sport Sci Health 22, 214 (2026). https://doi.org/10.1007/s11332-026-01803-9
- Nunes H, Fernandes LG, Martins PN, Ferreira RM. The Effects of Nordic Hamstring Exercise on Performance and Injury in the Lower Extremities: An Umbrella Review. Healthcare (Basel). 2024 Jul 23; 12(15): 1462. doi: 10.3390/healthcare12151462. PMID: 39120165; PMCID: PMC11311354.
- Bortnik L, Bruce-Low S, Burger J, Alexander J, Harper D, Morgans R, Carling C, McDaid K, Rhodes D. Physical match demands across different playing positions during transitional play and high-pressure activities in elite soccer. Biol Sport. 2024 Mar; 41(2): 73–82. doi: 10.5114/biolsport.2024.131815. Epub 2023 Apr 10. PMID: 38524824; PMCID: PMC10955741.
- Bizzini M, Dvorak J. FIFA 11+: an effective programme to prevent football injuries in various player groups worldwide—a narrative review. Br J Sports Med. 2015 May; 49(9): 577–9. doi: 10.1136/bjsports-2015-094765. PMID: 25878073; PMCID: PMC4413741.
- Soligard T, Myklebust G, Steffen K, et al. Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ. 2008; 337: a2469. doi: 10.1136/bmj.a2469.
- Steffen K, Emery CA, Romiti M, et al. High adherence to a neuromuscular injury prevention programme (FIFA 11+) improves functional balance and reduces injury risk in Canadian youth female football players: a cluster randomised trial. British Journal of Sports Medicine 2013; 47: 794–802.