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FIFA neuromuscular training programs on ankle injuries in football players: A meta-analysis with emphasis on evidence
Jinfa Gu1, Shiwei Chen1, Jingyuan Sun1
1Exercise & Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
Background:
Football causes over 4 million injuries each year, making injury prevention a priority. To mitigate the risks, FIFA neuromuscular programs (FIFA 11 +, FIFA 11 + Kids, and FIFA 11) are implemented to reduce injury risk. Nevertheless, their efficacy varies across populations and implementation protocols.
Methodology:
Databases such as PubMed, Web of Science, Cochrane Library, and EMBASE (2006-2025) were searched for randomized controlled trial (RCT) studies comparing FIFA programs to standard warm-ups. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Pooled relative risk (RR) with 95 % CIs were calculated using random-effects models. Prespecified subgroups were analyzed according to program version, sex, sample size, and training parameters (frequency/duration).
Results:
Nine RCTs (n = 11,687) found that FIFA programs, in general, reduced ankle injury risk by 38 % (RR=0.62, 95 % CI: 0.50-0.78; P < 0.001). Version-specific analyses revealed significant effects for FIFA 11 + (RR=0.57) and FIFA 11 + Kids (RR=0.56), but no effect for FIFA 11 (RR=0.94). Sex-specific analysis showed a 44 % reduction in males (RR=0.56) but no significant effect in females (RR=0.87). Exploratory subgroup analysis revealed small-study effects: smaller trials (n < 500) demonstrated greater efficacy (RR=0.33) than larger trials (n ≥ 1000; RR=0.73). Neither training frequency (1-2 vs. >2 sessions/week; P = 0.91) nor intervention duration (20-26 vs. ≥27 weeks; P = 0.09) modified efficacy. The quality of evidence was rated as moderate according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE).
Conclusion:
FIFA programs significantly reduce ankle injury risk in football players. However, efficacy differences primarily reflect program version (FIFA 11 ineffective) rather than biological sex, with insufficient female-specific data and diminished effects in larger trials. Future large-scale trials should confirm effectiveness in female and youth athletes, addressing limitations from small-trial bias.
