The effect of the Fédération Internationale de Football Association (FIFA ) 11+ shoulder injury prevention program on reducing the incidence of upper extremity injuries among soccer goalkeepers.

The intervention group will be instructed to perform the FIFA 11+ shoulder injury prevention program (FIFA 11+S) during one season (6 months). Group sessions will be administered by an exercise physiologist and/ or athletic trainer and/ or soccer coaches and/ or strength and conditioning specialists and/ or physiotherapist.. The program consists of three parts: general warming-up exercises (part I), exercises to develop strength and balance of the shoulder, elbow, wrist, and finger muscles (part II), and advanced exercises for core stability and muscle control (part III). The FIFA 11+S takes ~20–25 minutes to complete and replaces the usual warm-up before training. All exercises focus on core stability, neuromuscular control, eccentric rotator strength, and agility. Part I – Warm-up exercises (should be performed for 7 minutes.) 1 Run Relaxed walking or running. The speed can be progressively increased. 5 min 2 Throw the ball in the chest line Ask for help from a partner. With both hands in front of the body, throw and catch the ball, first with your elbows flexed and then with your arms over your head. 1 min 3 Spinning movements with the hands Interlace the fingers and make spinning movements with the hands. 1 min. Part II – strength and balance of the shoulder, elbow, wrist, and finger muscles (should be performed in 9–10 minutes at 3 sets of 15 repetitions). Exercises should be changed according to the tolerance of the athlete (to A for B and C exercises) 1A External rotation Initial position: Standing with the elbow flexed at 90° to the side Exercise: Rotate the arm from neutral to external rotation. 1B External rotation Initial position: standing with the elbow flexed at 90° and 45° abducted Exercise: Rotate the arm from the neutral to external rotation. 1C External rotation Initial position: standing with the elbow flexed at 90° and 90° abducted Exercise: Rotate the arm from the neutral to external rotation. 2A Internal rotation Initial position: standing with the elbow flexed at 90° to the side Exercise: Rotate the arm from neutral to external rotation. 2B Internal rotation Initial position: standing with the elbow flexed at 90° and 45° abducted Exercise: Rotate the arm from neutral to internal rotation. 2C Internal rotation Initial position: standing with the elbow flexed at 90° and 90° abducted Exercise: Rotate the arm from neutral to internal rotation. 3A Scaption Rise the arm with external rotation in the scapular plane (30° in the frontal plane) to shoulder height. Hold a weight. 3B Scaption Rise the arm with external rotation in the scapular plane (30° in the frontal plane) to shoulder height. Hold heavier weight than the previous level. 3C Scaption Rise the arm with external rotation in the scapular plane (30° in the frontal plane) to shoulder height. Hold heavier weight than the previous level. 4A Push-up-plus In the prone position. The hands should be placed at a distance corresponding to the width of the shoulders. Exercise: Rise the body and then lower the body 4B Push-up-plus In the same position. Place an anklet of 5 kg on your back. Exercise: Rise the body and then lower the body. 4C Push-up-plus In the same position but on one foot. Place an anklet of more than 5 kg on your back. Exercise: Rise the body and then lower the body. 5A Inferior and mid trapezius In the prone position, arms in 90° abduction. After changing the arms to 120° of abduction. Exercise: Hold a weight and bring the arm back slightly. 5B Inferior and mid trapezius In the prone position, arms In 90° abduction. After changing the arms to 120° of abduction. Exercise: Hold heavier weight than the previous level and bring the arm back slightly. 5C Inferior and mid trapezius In the prone position, arms in 90° abduction. After changing the arms to 120° of abduction. Exercise: Hold heavier weight than the previous level and bring the arm back slightly. 6A Biceps Position: Arms at your sides, palms facing inwards. Hold a weight. Exercise: Bend your elbows, turning the palms upward. 6B Biceps Position: Arms at your sides, palms facing inwards. Hold heavier weight than the previous level. Exercise: Bend your elbows, turning the palms upward. 6C Biceps Position: Arms at your sides, palms facing inwards. Hold heavier weight than the previous level. Exercise: Bend your elbows, turning the palms upward. 7A Wrist flexors Position: Support the forearm, palm of the hand upward. Hold a weight. Exercise: Lower the weight as far as possible and then lift it up. 7B Wrist flexors Position: Support the forearm, palm of the hand upward. Hold heavier weight than the previous level. Exercise: Lower the weight as far as possible and then lift it up. 7C Wrist flexors Position: Support the forearm, palm of the hand upward.Hold heavier weight than the previous level. Exercise: Lower the weight as far as possible and then lift it up. 8A Wrist extensors Position: Support the forearm, palm of the hand down. Hold a weight. Exercise: Lift up weight as far as possible and then lift it up. 8B Wrist extensors Position: Support the forearm, palm of the hand down. Hold heavier weight than the previous level. Exercise: Lift up weight as far as possible and then lift it up. 8C Wrist extensors Position: Support the forearm, palm of the hand down. Hold heavier weight than the previous level. Exercise: Lift up weight as far as possible and then lift it up. 9A Finger flexors Position: Supported forearm and palm of the hand down on an elastic. Exercise: Close the hand, pulling the elastic. 9B Finger flexors Position: Supported forearm and palm of the hand down on an elastic. Increase the resistance of the elastic. Exercise: Close the hand, pulling the elastic. 9C Finger flexors Position: Supported forearm and palm of the hand down on an elastic. Increase the resistance of the elastic. Exercise: Close the hand, pulling the elastic. 10A Finger extensors Position: Supported forearm and palm of the hand upward on an elastic. The other hand holds the elastic. Exercise: Open the hand, stretching the elastic. 10B Finger extensors Position: Supported forearm and palm of the hand upward on an elastic. The other hand holds the elastic. Increase the resistance of the elastic. Exercise: Open the hand, stretching the elastic. 10C Finger extensors Position: Supported forearm and palm of the hand upward on an elastic. The other hand holds the elastic. Increase the resistance of the elastic. Exercise: Open the hand, stretching the elastic. Part III – Core stability and muscle control with advanced exercises (the athlete must do the exercises at high velocities with 5 or 6 sets of 15 to 20 repetitions, not exceeding 9–10 minutes.) 1 Jump and throw the ball over the head Ask for help from a partner. Jump and with the elbow extended and arm above the level of the head, throw and catch the ball. 2 Throw the ball over the head with an arm Ask for help from a partner. With the elbow extended and arm above the level of the head, throw and catch the ball with an arm. 3 Throw the ball to the sides With the elbow extended, throw and catch the ball one arm at a time. Make the movement with the arm by the body’s side and lift it up over the head. 4 Jump with your hands on the mini trampoline In prone position, firming yourself with the feet on the ground and the palms of the hands on the mini trampoline. “jump” with your hands, keeping the elbows straight. 5 Walking on hands Ask for a partner to hold your legs and, in prone position, “walk” using your hands. Move forward, backward and to the sides. 6 Plyometric external rotation Flexed elbow in 90° and flexed and abducted arm in 90°. Hold the elastic and make movements from neutral to lateral rotation quickly. These exercises should be performed three times per week and should be added to the training taken by the soccer goalkeeper. Part I exercises should be done for 7 minutes as a general warm-up. Part II exercises should be performed for 9–10 minutes in a low-resistance (light tubing strength or 2–3 kg), high-repetition format (three sets of 15–20 repetitions), in order to improve strength and local muscular endurance. Exercise should be changed according to the tolerance of the athlete (to A instead of B and C exercises). In part III, the athlete must do the exercises at high velocities with five or six sets of 15–20 repetitions not exceeding 9–10 minutes; these exercises are performed to increase local muscular endurance. Program compliance will be evaluated according to the players’ rate of participation using an attendance log. The investigator will randomly visit one team selected from each group each week throughout the study period to motivate the teams and to ensure that the program is being followed conscientiously and correctly.