The Impact of the FIFA 11+ Neuromuscular Training Programme on Ankle Injury Reduction in Football Players: A Systematic Review and Meta-Analysis

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Abstract
This systematic review and meta-analysis was conducted to evaluate the effectiveness of the FIFA 11+ injury prevention programme, a neuromuscular training intervention involving muscular strength, proprioception, balance, and plyometric exercises, in reducing ankle injury incidence among football players. Included are randomised controlled trials (RCTs) involving players of any age, sex, or competition level, comparing the FIFA 11+ programme with standard warm-up routines. Studies were eligible if they had a minimum follow-up of five months and reported at least two of the following: number of ankle injuries, incidence rate, and exposure hours. Searches were conducted in PubMed, MEDLINE (via OVID), Scopus, and SPORTDiscus up to October 2024. Risk of bias was assessed using the revised Cochrane Risk of Bias tool (RoB 2), and a random-effects meta-analysis was conducted. Three RCTs, involving 3833 participants and 286,827 exposure hours, met the inclusion criteria. The pooled analysis showed that the FIFA 11+ programme significantly reduced ankle injury rates compared to control groups (rate ratio (RR) = 0.67, 95% confidence interval (CI): 0.46–0.96, p = 0.03, I2 = 52%), reflecting a 33% lower risk. The certainty of the evidence was rated as moderate due to bias in two studies. In conclusion, the FIFA 11+ programme significantly reduces ankle injury incidence and supports implementation at all levels. However, further research is needed to examine long-term effects, optimal doses, and applicability across diverse football populations.

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