Football Injury Prevention – Fifa 11+

football injury prevention

The football season is stepping into full swing once again, and it is important to know that football injury prevention via sports conditioning is effective. Developed in 2009 and rapidly utilised worldwide, the Fifa 11 + Injury Prevention Program has consistently demonstrated injury reductions of 30-50% when implemented at least twice a week. The Fifa 11 + is designed to improve lower limb and core strength, develop neuromuscular control and body awareness to significantly reduce injury.

The warm up program follows a progressive number of exercises from running, to strengthening and balance that is both individual and partner focused. The program identified the most common mechanisms behind common football injuries, such as rapid changes of directions with insufficient knee control and ACL rupture. Through a 3 part program it aims to address and change the factors that contributed to the injury mechanism – retraining movement patterns, body awareness, core strength and control.

So what does Fifa 11 + involve?

Part 1: Running exercises

Part 2: Strength, Plyometrics, Balance.

Part 3: High level running exercise.

In total, the Fifa 11+ only takes 20 minutes to complete, with minimal equipment and space requirements. It can be completed individually, or as part of a team, with a number of exercises partner focused to challenge proprioception, balance and agility.

The Fifa 11+ program is a tool we advocate for our football players over the age of 12. If you have any questions regarding the program, how you can implement it, or where to begin, feel free to email us. If you are serious about football then your team should be doing the FIFA 11+ before each training. For an individualised football training program, book an appointment with one of our physiotherapist’s.

Watch our Facebook and Instagram over the next month for video and comments on each of the exercises in Part 2 of the FIFA 11+.

Starting off 2018 Pain Free and Positive

42345147 - side view of smiling business colleagues looking at each other

With 2018 under way and the upcoming uni semester fast approaching and workloads increasing, it is important to consider how to best maintain our health and bodies at home and at work. Particularly for those of us on campus working long hours at desks, computers and various projects, a large risk is the onset of neck pain. Not only is this uncomfortable, but impacts on our day to day routine and often effectiveness at the tasks so important to us.

As campus gets increasingly busy, it’s more important than ever to keep moving, and keep an eye on our work related postures. Although pain often follows trauma, it is often a consequence of remaining too long in one posture, whether this is sitting or standing. This may be seated at the computer desk, looking at our phones, or standing and chatting to colleagues. Chances of injury or pain is then increased with any kind of stress that may be experienced throughout the day.

As a university physiotherapy clinic that has been on campus for 14 years, NU Moves understands the workplace demands on staff, including the regular postural demands and time constraints. We are also familiar with treating a range of resulting issues such as neck, arm and lower back pain. Manual therapy or exercise prescription are extremely useful tools that our qualified physiotherapists can use to get you on track to moving well and feeling great. A great goal to aim for in terms of movement is 30 minutes a day, and 150 minutes a week, whether this is walking to lunch, your car, or to grab a coffee.

If you are experiencing pain at work, or wanting to maximise your health and movement, NU Moves Physio can help. With post graduate qualifications and experience in musculoskeletal assessment, manual therapy, exercise prescription and outstanding problem solving, out physiotherapists are here to help. One on one treatment sessions involve a thorough assessment to determine what is causing your pain, and a treatment plan explained in depth, so you know how to approach improving your health from your first appointment.

Managing an acute injury – the first 48 hours

acute injury

Uh-oh I’ve pulled a muscle, what do I do? Firstly, please, don’t stretch an acute injury. This is likely to further tear a muscle and cause more bleeding.

Its winter sport pre-season training time again! Which means I’m about to see a bunch of active, healthy 20-40 somethings (and some really enthusiastic 50 somethings) with an acute muscle strain. I frequently see people 24-48 hours after the injury has happened. These go getters and weekend warriors have often done all the usual injury management recommendations, which is now P.O.L.I.C.E. by the way.


Protection – don’t keep playing through an injury. This will make your recovery period much longer, and cause more pain once you cool down.

Optimal Loading – Initially, minimal loading is ideal, then gradual increases in load. However amount and type of loading depends on the injury. So best get it checked out.

Ice – Analgesic (helps with pain), widely used. There is no research published on effectively reducing recovery time with ice.

Compression – Bandages, tubigrip, compression socks, skins! Etc. This helps to control swelling and slows inflammatory fluids leaking into all the surrounding tissue. This will then slow the recovery and increase periods of immobility.

Elevation – put your injured part, above your heart. Vessels that remove swelling work best with gravity assistance – so place them up high, you can’t fight gravity.

Once you have the initial management under control, it is important to get the injury assessed by a qualified physiotherapist. This is because the management program and time to return to play varies dramatically by injury site, mechanism, severity and sporting demands. This injury may require a completely different strategy to your last muscle strain or your teammates, even if it is the same muscle.

Unfortunately, poorly managed muscle injuries have the possibility of becoming a persistent problem. We will often see athletes with an old muscle injury that has reached the chronic injury stage. This then requires a long term targeted rehabilitation intervention. These are usually successfully rehabilitated but can take some time to improve, and can be frustrating for the keen athlete wanting to play at 100%.

The role of medication is a frequent question asked in the clinic. Non-steroidal anti inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac are frequently used. It is a complex topic, but the take home message is that there may be a small improvement in recovery time. Allowing 48 hours before taking anti-inflammatories is ideal to reduce bleeding within the affected muscle. Unfortunately, these medications carry some potentially serious adverse effects, which can cause damage to the stomach, kidneys and cardiovascular system.

In conclusion, use the P.O.L.I.C.E. principles, get an assessment, get a plan and give your body the best chance to make a full recovery prior to returning to sport. If you are unsure about any of the above, please contact us on 4921 6879 or email


Managing Recovery and Fatigue

Recovery and Fatigue

There is plenty being spoken about the health benefits of getting a good night sleep and we agree that if you sleep well it has a multitude of positive flow on effects on how we feel. Exercise is sometimes a means to providing an improvement to the quality of our sleep but excessive exercise can lead to general fatigue which can erode the desired overall health benefit. This article is a follow-on to our last blog on exercise addiction.

In this article we will refer to fatigue as a level of exhaustion or tiredness. One definition of fatigue is extreme tiredness resulting from mental or physical exertion illness. Whether you should continue to exercise when you feel fatigued depends on the severity and cause.

Some of the negative effects of exercising when fatigued are:

  • Lack of recovery time can increase risk of injury and becoming unwell
  • Doing too much when you aren’t medically well can prolong recovery from illness
  • Specific muscle fatigue in a certain muscle area from repetitive exercise increases the likelihood of musculoskeletal injury due to lack of variation in exercise program

Simple advice for when you feel fatigued is to consider your exercise routine as a cause relative to recent illness or an endurance exercise event. If you determine that your fatigue is not caused by anything but your regular exercise program then a reduction in exercise load is advised. If there is no obvious physical cause, consider whether stress or mental well-being might be a contributor and similarly consider the amount of quality sleep. Inadequate nutrition and energy intake can also lead to symptoms of excessive fatigue. Once you identify a cause then you are in a better position to work out what to do with your exercise routine.

Excessive amounts of exercise without adequate rest / recovery time is not recommended for healthy living nor for athletic or sports performance. Its worth a few minutes of thought.

Click the links to read our last two blogs in the series on the benefits of exercise on depression and when exercising can become a problem.

When is too much exercise a problem?

exercise problemExercise plays an important role in assisting in the management of mental well-being. Research exists that agrees with the idea that if we are regularly active the symptoms of depression may improve (Click here to read our previous blog on exercise and depression). If we then exercise harder, it sometimes makes us feel even better and this good feeling can both mentally and physically become addictive.

A recent practice article from Heather Hausenblas and James Smoliga in the British medical journal discusses ‘addiction to exercise’, where exercise is an essential element to every day. The discussion surrounding the difference between healthy regular exercise and an addiction to exercise is important especially when injury occurs, as a reliance on exercise is difficult to overcome.

Having a physio practice in a gym based environment means we have seen clients with a reliance on exercise to the point of it being an addiction. As a general observation it is more common now than 10 years ago, but a greater number of people have a level of awareness of their need to exercise. The greatest time of concern with exercise addiction relates to when injury occurs and the ability to exercise has decreased.

Managing an unhealthy reliance on exercise involves starting with reflecting on the motivation or reasons for needing to exercise. What are your goals for exercising? If an exercise addiction is present, then we do not need to stop exercising, but rather understand the reasons and work towards a healthy exercise routine with less risk of injury and improved health benefits. Hausenblas refers to it as reducing the rigidity of an exercise routine. If you are over-reliant on running, then we may try to change the exercise routine initially and replace a run with a swim. Gradually work towards a healthy volume of exercise is the goal.

If you are reliant on exercise and don’t feel you can stop then discuss it with your GP or a psychologist. Alternatively give us a call and we can discuss your exercise routine. We will not ask you to stop but can assist with strategies to start moving towards a healthy exercise routine.

Housenblas H, Shreiber K, Smoliga J. (2017): Addiction to exercise. The British Medical Journal.

Depression and the Benefits of Exercise

Exercising for depressionExercise is a useful method of managing depression but is not a stand-alone treatment. There is research based reviews that support that exercise can reduce the symptoms of depression, and now a recent article by Harvey et. al in the American Journal of Psychiatry has found exercise / activity can prevent future cases of depression.

There are several features of the researcher’s interpretations that are useful. They concluded that exercise intensity was not relevant to the prevented cases of depression. This means that any exercise is better than no exercise. Just going for a walk is one of the simplest and easiest forms of exercise to start with. If you can’t walk due to pain or injury then we would encourage water based exercise or an exercise bike. Even a short walk will release endorphins to begin to make you feel better.

The findings of an 11 year prospective study were that as little as 1 hour of physical activity per week prevented 12% of future cases of depression. So if you are not currently exercising then just being active for 1 hour a week can help with depression. The recommended 30 minutes per day remains an ideal amount of exercise for healthy living (combining physical, cardiovascular and metabolic health) and if you achieve this you are way above the 1 hour per week required for assisting with depression.

The researchers did not find that exercise was not helpful in preventing future cases of anxiety. If you have anxiety or depression use the resources such as websites such as beyond blue and black dog institute and discuss it with your GP.

Click here to read the black dog institute’s fact sheet on exercise and depression.

Harvey (2017). Exercise and the Prevention of Depression: Results of the HUNT Cohort Study: AJP in advance. doi: 10.1176/appi.ajp.2017.16111223,

Strength exercise – more evidence that it is worth doing

Strength Training

The reason for doing the recommended 2 strength based exercise sessions per week has been given another boost from a recently published study. Stamatakis et al analysed adults over 30 in the United Kingdom that were selected from a pool of 80,000 people completing an annual survey then further assessed via interview and questionnaires over a 9 year period.

Strength based exercise on its own has been shown to reduce diabetes risk and when combined with cardio exercise gave even greater benefits. This study looked at reductions in mortality that could be attributed to different types of exercise that is recommended by the world health organisation. Namely 150-300 minutes of cardiovascular exercise and 2 strength exercise sessions per week.

They found 36.2% of the sample group met only the aerobic exercise guidelines. 3.4% met only the strength exercise guidelines and 5.5% met both aerobic and strength exercises recommendations.

Participation in any form of strength exercise led to a 23% reduction in mortality from all causes and a 31% reduction in mortality from cancer. Combining the strength and aerobic exercise guidelines further reduced the rate of mortality than aerobic physical activity alone.
The definition of strength exercise included both gym and body weight exercises but they analysed whether one was better than the other. The study found bodyweight exercises gave the same benefit to gym-based activity. Previous studies have indicated that increasing muscle strength has been associated with reduced cancer mortality independent of aerobic fitness. Also higher muscle strength, as opposed to just participating in strength exercise led to reductions in mortality.

Meeting the strength exercise recommendations of twice per week was found to be as important as achieving the weekly aerobic exercise recommendations for health benefits and reducing the risk of mortality.


  • Get into strength exercises even if it’s just body weight exercise
  • Make it challenging enough to increase your strength
  • If you are just starting out, don’t go too hard too fast or you may increase your risk of injury
  • If you are not sure what strength exercise program is suitable for you, let us know and we can help you get started on a program that is safe and effective to achieve your health goals

Stamatakis et al 2017, Does strength promoting exercise confer unique health benefits? A pooled analysis of eleven population cohorts with all-cause, cancer, and cardiovascular mortality endpoints. Am J of Epidemiology.

Lifting and stooping- the latest in lifting related research


Should we avoid stoop lifting? There has been plenty of lifting related research in the past but none of it is conclusive. We rely on expert opinion that says the squat lift is safer than stoop lifting but recent discussion amongst clinical experts and researchers surrounds other factors being more important than the classic type of described lift when it comes to avoiding injury. The original review of van Dieen at el in 1999 highlights the very little amount of good quality research existing in the area and recent research from Dreischarf et al 2016 has provided data that challenge existing beliefs on lifting.

A summary on our recent masterclass session on the topic of lifting and avoiding injury concluded the following 5 factors were valuable:

  1. Keeping the load close to the body reduces the forces on the lower back more when compared with the type of lift (stoop vs squat).
  2. Strength and conditioning to the chosen method of lifting is important. I.e. if you never stoop lift and then have to because of where the object is then you are more likely to have an injury than if you stoop lifted more often.
  3. The timing of the movement is important. This is a difficult concept to simplify but refers to when the knees and hips straighten during a lift and what the back is doing at the same time. A common observation in the clinic is that over-arching the back during a lift often leads to pain.
  4. Cumulative loading is important. If you sit and slouch through the pelvis for long periods then it will increase your risk when lifting but if you get up regularly and change posture from sitting to standing or walking then the effect of cumulative loading is reduced.
  5. Semi squat lifting places less stress on the knees than the full squat which is important if you have knee pathology. If the timing is correct and you are conditioned to lift this way it remains the optimal choice of lifting.

For those who are interested, the references referred to in this blog are:

Dreischarf et al, 2016. In vivo loads on a vertebral body replacement during different lifting techniques; Journal of Biomechanics. 49(2016):890-895

Van Dieen et al, 1999. Stoop or squat: a review of biomechanical studies on lifting technique; Clinical Biomechanics. 14(1999):685-696


The effect of static stretching on performance and preventing injury


Historically many people have used static stretching – a long hold and the end of available muscle length – as a part of a “warm up” routine before sport or exercise. But the research doesn’t back it up, and it may be detrimental.

Let’s talk about performance first. Static stretching actually decreases muscle power for a period of time – the period is debatable, but at least 5 minutes and up to 3 hours – after stretching is performed1,2. This also applies for contract-relax or proprioceptive neuromuscular facilitation (PNF) stretching. This could easily impair athletic performance, especially in sports where high force generation is required. Dynamic exercise/facilitation exercises do not seem to have this power loss effect.

What about injury prevention? Nope, no help there either. A very large study by Lauersen et al. (2014) which synthesises the best quality research surrounding injury prevention to date reported no reduction (or increase) in injury risk for people who performed static stretching3. What they did find was that proprioceptive training, strength training and a dynamic warmup did reduce the risk of acute and overuse type injuries4,5,6.

It’s hard to break old habits, but if static stretching can impair your performance and doesn’t make any difference to injury risk, it may be time to change it up. Athletes can derive a greater benefit by spending that time on a dynamic proprioceptive, agility, strength and balance training program warmup.

If you aren’t about to perform a physically demanding athletic activity and you enjoy stretching, go for it. There is no harm in stretching and if you haven’t got the mobility to perform a sport or task then both static and dynamic stretches are options to achieve this.

To read more about avoiding running injuries, click here and to read up on how to prevent injuries during pre- season click here.

  1. Marek, S. M., Cramer, J. T., Fincher, A. L., & Massey, L. L. (2005). Acute effects of static and proprioceptive neuromuscular facilitation stretching on muscle strength and power output. Journal of Athletic Training40(2), 94.
  2. Behm, D. G., Bambury, A., Cahill, F., & Power, K. (2004). Effect of acute static stretching on force, balance, reaction time, and movement time.Medicine and science in sports and exercise36, 1397-1402.
  3. Lauersen JB(1), Bertelsen DM, Andersen LB. Br J Sports Med. 2014 Jun;48(11):871-7. doi: 10.1136/bjsports-2013-092538. Epub 2013 Oct 7. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials.
  4. Soligard, T., Nilstad, A., Steffen, K., Myklebust, G., Holme, I., Dvorak, J., … & Andersen, T. E. (2010). Compliance with a comprehensive  warm-up programme to prevent injuries in youth football. British journal of sports medicine44(11), 787-793.
  5. Soligard, T., Myklebust, G., Steffen, K., Holme, I., Silvers, H., Bizzini, M., … & Andersen, T. E. (2008). Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. Bmj,337, a2469.
  6. Herman, K., Barton, C., Malliaras, P., & Morrissey, D. (2012). The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review. BMC medicine10(1), 1.

Hamstring injury management – A breakdown of the latest research

Sliding exercise

Athletes rejoice! For decades our understanding of hamstring (HS) injuries has been improving and evolving, yet the frequency of HS injury rates in sport have not declined. Finally, a new paradigm has been developed which consolidates our knowledge of the anatomy and the physiology of this highly prevalent injury, applies effective rehabilitation strategies, accurate return to sport testing and re-injury prevention.

We can broadly define the typical hamstring strain into a sprinting type strain which occurs at high speed running versus a stretch type strain which occurs with high kicking or other stretching movements. Each of these will typically cause an injury to a different muscle in the hamstrings group. They can generally be diagnosed in the clinic without the need for any imaging. The most common type is the sprinting type, frequently seen in football codes, soccer, hockey, athletics and other running sports. The stretch type is more common in dancers, jumpers and hurdlers, although either type can occur in any sport. Knowing the type of injury gives us a chance to apply the right exercise rehab as well as gives a guideline for the return to sport time, which varies enormously between the type, location and grade of strain.

We know that most HS injuries occur when the muscle is working hard in its lengthening phase, therefore it is essential that the rehabilitation program targets this movement at high load. A comprehensive program is undertaken, which incorporates hamstring strength, but also hip, pelvis, trunk and general lower limb strength and stability. This addresses all the factors which will lead to re-injury – that’s not new. What is new is a set of 3 specific exercises, that when applied correctly in soccer players led to a re-injury rate of only 1 in 75 players over 12 months! That’s way down from the average 1 in 4 players with conventional rehab in professional soccer.

The protocol is based on 3 specific lengthening (eccentric) strength exercises and the technique, timing and progressions of these are of critical importance, they need to be integrated and complemented with other exercises and, as a rule, should be pain free. So what can you expect to gain from completing a modern rehab program like the one we provide at NU Moves? A research study by Askling and colleagues found that their protocol of exercises led to an average return to play time of 28 days, compared with 51 days for the conventional group. Combining this with the low reinjury rate means it was proven to be a much better approach to HS rehab. The research also provided an additional return to play testing procedure (H test), which we integrate into our comprehensive existing return to play algorithm in the clinic. It assesses apprehension or feeling of insecurity as well as pain when performing a high load eccentric braking action on the leg, similar to what happens during an injury but in a safe way.

So to put it all together, we have a rehab protocol that fits well with our current understanding of hamstring strains and their risk factors. It is easy and inexpensive to perform once taught. It also reduces the time to return to play and gives better long-term outcomes. If you are ever unlucky enough to be in this position, then things are looking better now than they ever have!

NU Moves physio provides sports physio services to clubs around newcastle. For more information contact us online or give us a call and to view our current sports teams or what services we provide, click here.