Running Head: INJURY PREVENTION IN FEMALE YOUTH SOCCER

Injury Prevention in Female Youth Soccer: Comparing Injury Occurrence When Employing
Different Stretching Routines

Jock Mutschler
March 20, 2015
Ohio University
COED 6200: Research and Analysis Methods for Sport Coaches

Abstract

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The aim of this research paper is to better understand how coaches can reduce soccer
injuries. The following initial research question is posed: does stretching before and after
training as compared to stretching solely before training result in fewer injuries? Specifically,
does 15 minutes of coach directed dynamic stretching before, combined with 10 minutes of
coach directed static and dynamic stretching after training as compared to stretching solely
before training result in fewer lower extremity injuries among Midwestern female varsity high
school soccer players?
This papers research objectives are to collect accurate and clearly defined injury data
from selected local teams those that employ a pre stretching regimen only and those that utilize
both pre and post stretching. The injury data that is collected will be compared and analyzed to
ascertain whether there is a statistically significant difference between a pre stretching regimen
only and a pre and post stretching regimen.

Table of Contents

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Page
Abstract

Chapter 1: Introduction

Purpose of the Study

Theoretical Perspective

Research Objective

Chapter 2: Literature Review

10

Stretching
Neuromuscular Examination

10

Evidence Based Research

11

Compliance

12

Conflicting Views

13

Research Hypothesis

14

Chapter 3: Method

15

Participants

15

Research Design

15

Data Collection Procedures

16

FIFA 11+ Stretching Regimen

16

Data Analysis Procedures

17

Definition of Terms

17

Evaluation of the Methodology

18

Ethical Concerns

19

References

21
Chapter 1: Introduction

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Soccer is the worlds most popular sport with an estimated 300 million players
participating at the recreational level worldwide (Bizzini, Junge & Dvorak, 2013, p. 803).
Soccer is a team sport which provides enjoyment to many different people. Soccer inspires
passion it becomes part of the entire household. It encompasses weekday practices to weekend
tournaments; from school run discussions in the mini-van to dinner table lamentations on the
coaches critical nature; to bedtime exhaustion and dreams realized. There are a host of possible
benefits available from playing soccer, to include reduced blood pressure, reduced blood fats,
and weight loss (Kirkendall, 2011, p. 5). Kirkendall (2011) stated that to be successful in soccer,
a team must present a physical, technical, tactical, and psychological display which is superior to
the opponents. Soccer has been given the moniker the beautiful game. However, when one
aspect to the game is not in sync, it can be frustrating. In particular, the physical nature of soccer
can be vexing when injuries occur. Hammermeister (2010) stated that coaches can play a key
role in reducing injury. Ensuring a positive sport experience for athletes is a critical outcome for
successful coaches. A positive sport experience necessitates proper coach supervision, providing
a safe environment, and fulfilling a coaches responsibility to provide a coordinated sports health
care program that includes prevention of injuries (Hammermeister, 2010, p. 12).
Purpose of the Study
Team sports, such as soccer, require a range of complexity and intensity, which
differentiates it from individual sports (Kirkendall, 2011). Despite the perception that soccer is a
relatively safe sport, as compared to football, for example, it is one of the most common causes
of sport injuries among youths (Schiff, Mack, Polissar, Levy, Dow & OKane, 2010). There
have been numerous changes in the medical support and supervision soccer players in recent
years (Verheijen, 1998, p. 2). More attention is being paid to fitness tests, injury prevention,

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stretching techniques, rehabilitation and physiotherapy. Emery and Meeuwisse (2010) stated that
there is growing concern regarding the public health significance of soccer-related injuries
because there is such a high youth participation rate. Soccer injuries account for 10% of all sport
injuries in Canadian youth aged 11-18 (McKay, Steffen, Romiti, Finch & Emery, 2014). Heidt,
Sweeterman, Carlonas, Traub, and Tekulve (2000) summarized although soccer injuries cannot
be prevented completely, it is possible to avoid some types and minimize the overall number and
severity (p. 622). Reducing the risk of injury to our student-athletes is everyones job - from the
coaches and trainers to athletes and parents.
There can be devastating economic costs associated with soccer injuries. The immediate
and long-term health care costs can be significant. FIFA estimates that the average treatment
cost is $150 per injury which results in an estimated $30B a year spent on injuries in soccer
worldwide (Mohib, Moser, Kim, Thillai & Gringmuth, 2014). Thus, injury prevention strategies,
such as stretching regimens play a necessary role in reducing costs associated with soccer
injuries (Junge, Lamprecht, Stamm, Hasler, Bizzini, Tschopp,& Dvork, 2010). Time loss
associated with injury can be considered a secondary cost. Dvorak, Junge, Derman, and
Schwellnus (2010) reported that the incidence of time loss injuries in matches were 50.7 injuries
per 1000 hours in the 2002 FIFA World Cup, 45.9 in the 2006 FIFA World Cup and 41.6 in
EURO 2008. The resulting primary and secondary costs associated with injury call for
prevention programs to be developed and implemented (Junge et al., 2010).
Hammermeister (2010) stated coaches can play a key role in reducing injury (p. 35). Coaches
play a crucial role in a sound risk management program by ensuring student-athletes have access
to safe facilities and equipment, organized training, sound instruction, proper supervision, and a
suitable coach style which is free of psychological and emotional stress. While not all teams are

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able to win the majority of their games, all athletes should have exposure to a well-crafted,
thoroughly researched risk management plan, that highlights supervision and planning. This will
afford them every chance to enjoy a healthy, injury-free, sport experience.
The purpose of this study is to examine whether a pre and post stretching regimen would
result in a lower injury occurrence as compared to a solely pre stretching regimen among female
high school soccer players in Wisconsin. The study intends to use the Federation Internationale
de Football Associations (FIFAs) 11+ stretching regimen as the model for the pre and post
stretching routine.
Theoretical Perspective
Langevin, Bouffard, Badger, Iatridis and Howe (2005) explored the effect of tissue
stretch on mouse subcutaneous tissue fibroblast morphology. The dynamic, cytoskeletondependent responses of fibroblasts to changes in tissue length demonstrated in this study have
important implications for our understanding of the importance of stretching prior to exertion.
Langevin et al. (2005) found that mouse subcutaneous tissue fibroblasts exhibited extreme
cytoskeleton-dependent changes in cell size and shape in response to tissue stretch. Their results
demonstrate that both dendritic and sheetlike fibroblast phenotypes occur regularly in response to
changes in tissue length. Langevin et al. (2005) determined that these changes are often
accompanied by important modification of cell signaling and may also produce variable
connective tissue tension. Loose connective tissue forms a continuous network throughout the
body. Subcutaneous and interstitial connective tissues surround the bodys muscles. Loose
connective tissue may become more or less loose in response to changes in tissue length.
Therapeutic mechanical deformation of loose connective tissue is commonly used in
physiotherapy, to include stretching.

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Coutinho, Gomes, Frana, Oishi & Salvini (2004) studied the effect of stretching applied
every three days to the soleus muscle immobilized in the shortened position on muscle fiber
morphology. Coutinho et al. (2004) reported that stretching applied every three days to
immobilized muscles reduced muscle atrophy, suggesting that muscle stretching differently
regulates the serial sarcomere number and cross-sectional area of muscle fiber. Stretching
sessions induced hypertrophic effects in the control muscles. Acknowledging that muscle
stretching is a stimulant of muscle longitudinal growth and muscle protein synthesis, the authors
argue that stretching is a valuable therapeutic tool that should be used in physical rehabilitation
and sports.
The high injury rate among female soccer players constitutes a serious societal issue for
the individual player and her club (Soligard, Myklebust, Steffen, Myklebust, Holme, Silvers,
&Andersen, 2008). Stretching programs can significantly influence the viscosity of the tendon
and make it significantly more compliant (Witvouw, Mahieu, Danneels & McNair, 2004). In
soccer, with its demand for high intensity strength shortening cycles, stretching is important for
injury prevention. Thacker, Gilchrist, Stroup, and Kimsey (2004) reported that an imbalance in
flexibility in individual athletes might predispose them to injury. Therefore, employing a
stretching regimen is a rational approach to take in endeavoring to reduce soccer injuries.
The Federation Internationale de Football Associations (FIFAs) 11+ stretching regimen
is the collection of stretches that this study has adopted as its baseline stretching standard. The
FIFA 11+ is a comprehensive exercise program that includes key exercises and variation that
improves the stretching compliance of coaches and players as well as yielding decreased injury
occurrence.

Kirkendall (2011) stated that FIFAs Medical Assessment and Research Center

began an injury surveillance program in 1998 to determine the true incidence of injury. Prior to

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this time, most injury prevention reports were based on expert opinion, not research. The first
iteration of the FIFA stretching program was called the 11. It was a rigidly designed program,
consisting of ten exercises and a call for fair play (Kirkendall, 2011). Kirkendall (2011) stated
that it resulted in a reduction of injuries by about one-third, but was so cumbersome that many
clubs experienced compliance failure with the program. The FIFA 11+ program, which evolved
from the FIFA 11, combines strength, plyometric and balance exercises with jogging and running
elements. The FIFA 11+ stretching regimen has been researched extensively with numerous
associated injury prevention trials having been published in medical journals (Junge et al., 2010;
Soligard, Nilstad, Steffen, Myklebust, Holme, Dvorak & Andersen (2010); Soligard et al.,
2008; Steffen et al., 2013). Many of the FIFA 11+ exercises are challenging but not intense.
The FIFA 11+ stretching regimen distinguishes itself by its high compliance rate.
Adherence to the FIFA 11+ program is central to its success in reducing the soccer injury rate.
The FIFA 11+ stretching program is simple to execute, which is part of its appeal and contributes
to its high compliance rate (Soligard et al., 2010). It requires no equipment other than a ball.
Soligard et al. (2010) stated that when injury prevention measures are incorporated into club
training sessions, team compliance will be effected by the coaches motivation, choices and
actions. High player compliance to the FIFA 11+ program resulted in significant individual
improvements in functional balance as well as in reduced injury risk (Steffen et al., 2013).
Soligard et al. (2010) analyzed compliance rates with the FIFA 11+ and to examine whether high
compliance correlated with lower injury risk. The study was based on data from a controlled
randomized trial on 125 teams of Norwegian female youth soccer players. Compliance was
recorded among both individual players and teams, providing a detailed account of the
acceptance of the intervention. The risk of overall and acute injuries was reduced by more than

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one-third among players with high compliance. The study argues that it may be important to
increase the understanding of the benefits of injury prevention among coaches in both youth and
elite sports. Compliance is critical if an injury prevention stretching regimen is to be successful
in actually reducing the expected injury rate.
The combination of the efficacy of stretching in general, the proven injury reduction
results of the FIFA 11+ stretching regimen, and the high compliance rate associated with the
FIFA 11+ program, all support using the FIFA 11+ stretching regimen as the theoretical vehicle
through which to test this studys research question.
Research Objective
This studys research objective is to determine if 15 minutes of coach directed, FIFA 11+
based, dynamic stretching before, combined with 10 minutes of coach directed static and
dynamic stretching after training result in fewer lower extremity injuries as compared to 15
minutes of pre stretching only, among Midwestern female varsity high school soccer players.

Chapter 2: Literature Review

Stretching Neuromuscular Examination
Soccer, which has a high intensity of strength-shortening cycles, requires a muscletendon unit that is receptive enough to store and release enormous amounts of elastic energy that
benefits performance (Witvouw, Mahieu, Danneels & McNair, 2004). Witvouw et al. (2004)
stated that soccer injuries were more likely to occur if the muscle-tendon unit could not handle
the demands in energy absorption and release. Consequently, increasing the compliance of the
muscle-tendon unit is a common protocol to reduce soccer injury occurrence. It is critical that

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10

any athlete warm up before exercising. Warming-up consists of movements that prepare the body
before the desired activity. The aerobic energy system works most efficiently at temperatures
above rest. The point at which the player breaks into a light sweat is great evidence that the
bodys core temperature has risen sufficient to be considered warmed up. Hammermeister (2010)
stated a pre-exercise warm-up helps to: a) warm your muscles by increasing the movement of
blood your tissues, b) make the muscles more supple; c) increase delivery of oxygen and
nutrients to your muscles by increasing the blood flow to them; d) prepare your muscles for
stretching, e) prepare your heart for an increase in activity; f) prepare you mentally for the
upcoming exercise; and g) prepare your nerve-to-muscle pathways to be ready for exercise (p.
49). The cool down period occurs after training session and matches. The aim of this period is to
gradually reduce the heart rate back to resting levels and eliminate waste products from the
muscles. The cool down period includes an easy jog for 3-5 minutes, as well as several dynamic
and static stretches. The focus of many of the stretches will be on the hamstrings, knees, ankle,
and groin but the whole body will be covered. Miller, Cheatham and Patel (2010) summarized,
stretching exercises after activity can increase flexibility while increasing performance and
reducing the risk of injury over the long term (p. 674). Anderson (2000) believes that
stretching helps prevent injuries such as muscle strains (p. 11). However, the literature review
has identified a gap in the research with regard to the combined benefit of a pre and post training
stretching regimen on lower extremity injury reduction.
Emery and Meeuwisse (2010) studied the effectiveness of a neuromuscular prevention
strategy in reducing injury in male and female youth soccer players. Players from sixty indoor
soccer teams in Calgary, Canada participated in the study. The study period was one year. A
coach-delivered warm-up routine was taught to the players and coaches in both the training

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11

group and the control group. A 15 minute warm-up routine, including aerobic, static stretching
and dynamic stretching was taught to the control group. The training group was taught a 15
minute warm-up including the same aerobic and dynamic stretch components condensed into 5
minutes, in addition to 10 minutes of neuromuscular training. This single-blinded, RCT study
revealed that a soccer-specific neuromuscular training program can reduce the risk of injury by
over one-third in youth soccer players.
Stretching Evidence Based Research
To the degree that flexibility might decrease the risk of injury, stretching might be
desirable (Thacker et al., 2004, p. 376). Additionally, Pollard (2006) found evidence that injury
prevention training is effective in reducing injuries in amateur, female soccer players. Pollard
(2006) conducted a study involving eighteen female soccer players between the ages of 14-17.
Following a season-long injury prevention regimen, the females demonstrated significantly less
hip internal rotation and significantly greater hip abduction. There is some existing evidencebased research that a structured regimen of stretching exercises results in decreased injury
occurrence (Kirkendall, 2011). Soligard et al. (2013) tested the FIFA 11+ stretching regimen
among 14-16 female soccer players. He reported injury reduction rates of 32%. The Federation
Internationale de Football Associations (FIFAs) 11+ stretching regimen has been tested on
female youths in Norway with statistically significant results, which showed that participants in
the warm-up had an expected injury reduction rate of one-third (Kirkendall, 2011). The evidence
demonstrates that stretching clearly increases flexibility. Heidt, Sweeterman, Carlonas, Traub,
and Tekulve (2000), showed that female soccer players that participated in the Frappier
Acceleration Training Program had less time-loss injuries than the control group. Jamtvedt et al.
(2010) reported that stretching reduced the risk of muscle, ligament and tendon injuries.
Stretching Compliance

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Bizzini, Junge and Dvorak (2013) found that understanding a soccer coaches
character and underscoring the value of the FIFA 11+ stretching program to the coach is
especially important as it relates to adherence to the program. Preventing injuries equates to
more players being available to play in matches. Switzerland and New Zealand have
successfully implemented countrywide injury prevention programs in youth soccer (Bizzini,
Junge & Dvorak, 2013). New Zealands Accident Compensation (ACC) Program invested
NZ$650,000 in their injury prevention program called Soccer Smart in 2004 (Bizzini, Junge &
Dvorak, 2013, p. 805). The ACC estimate that they have saved NZ$5,331,000 since that time in
injury compensation.
McKay, Steffen, Romiti, Finch, and Emery (2014) found that personal characteristics
such as injury history and prior exposure to an injury prevention program did not influence
female youth soccer players adherence to a stretching based injury prevention program.
Interestingly, they determined that greater playing experience leads to poorer program
compliance (McKay et al., 2014, p. 1285). Conversely, Soligard et al. (2010) stated that it may
be important to implement injury prevention training early in a players development to make it a
natural part of their training routine. Soligard et al. (2010) argued that it was necessary to
increase the understanding of the benefits of injury prevention programs among coaches and
players in youth soccer. Furthermore, McKay et al. (2014) determined that only a small
proportion of coaches believed that stretching would prevent injuries while players commonly
endorsed stretching as an injury prevention strategy.
Stretching - Conflicting Views
Stretching before participation in athletic competition is routine and commonly practiced
in all levels of sport. However, stretching, used as a prevention tool against injury, has been
based on intuition and unsystematic observation rather than scientific evidence (Thacker et al.,

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2004). Anderson (2005) found that pre-exercise stretching of the major lower extremity
musculature using a specific stretching protocol does not result in meaningful reduction of lower
extremity injury risk. Gremion (2005) related that the scientific evidence of injury prevention by
a routine stretching regimen seems unclear. Steffen, Emery, Romiti, Kang, Bizzini, Dvorak, and
Meeuwiss (2013) stated that there are contradictory findings regarding the effect of
neuromuscular stretching programs in improving physical performance in soccer players. There
is a lack of information regarding the quantity and quality of coach-led injury prevention
programs and its impact on physical performance of players (Steffen et al., 2013).
Gro et al. (2010) studied the effects of stretching before and after physical activity on
risks of injury and soreness in a community population. The study was conducted through the
Internet with 2,377 adults who regularly participated in physical activity. Potential participants
visited the trial website and were screened for eligibility. Outcomes were self-reported and the
participants were not blind. Gro et al. (2010) concluded that stretching before and after physical
activity does not appreciably reduce all-injury risk but probably reduces the risk of some injuries,
and does reduce the risk of bothersome soreness.
Research Hypothesis
Midwestern, female youth soccer players that participate in a pre and post training
stretching regimen will incur fewer injuries than those that only engage in a pre-training
stretching regimen.

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Chapter 3: Method
Participants
This is intended to be a season long study of female, high school varsity soccer teams
participating in the WIAAs Midwest Classic Conference (MCC). Using teams from the same
conference will alleviate moderating variables to include varying degrees of difficulty in the
schedule, different field surfaces and refereeing consistency. The MCC is comprised of eight
teams. The conference is designated as Division 4 the smallest classification of schools in the
WIAA. The conference is composed of seven private schools and one public school. The teams
have players ranging from 9th grade through 12th grade. The WIAA regulations dictate a
maximum of twenty-two players on the roster. Thus, the sample population will be
approximately 220 female youth soccer players between the ages 15-18.
Research Design
This section provides a description of the research design utilized in this study. This
study intends to examine the effect of a structured pre and post training stretching regimen as
compared to a solely pre training stretching regimen as it relates to soccer injury occurrence.
This study can be characterized as an experiment. The independent variable in this study is the

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FIFA 11+ stretching regimen. The dependent variable is the number of injuries incurred. The
study will employ two groups of teams. The control group will be comprised of teams that
employ the FIFA 11+ stretching regimen solely before commencing training. The intervention
group will be comprised of teams that employ the FIFA 11+ stretching regimen both before and
after training.
The nature of this research design is more closely associated with natural science and
should be thought of as positivist paradigm (Gratton & Jones, 2010). This is intended to be a
season long study of female, high school soccer players in the Midwest. The girls varsity soccer
teams within the Midwest Classic Conference (MCC) of the Wisconsin Interscholastic Athletic
Association (WIAA) will be the unit of randomization. This experimental research design is a
good choice for this study as it will result in increased administrative efficiency, lessened risk of
experimental contamination, and likely enhance participant compliance.
Data Collection Procedures
All ten MCC teams have a dedicated athletic trainer on campus. This reduces the
instance of inconsistent medical supervision, a moderating variable. The athletic trainers will be
responsible for submitting weekly injury reports to the research team every Friday. This will
provide uniformity in the reporting process. They will record lower extremity injuries,
differentiating between acute and overuse. Schiff, Mack, Polissar, Levy, Dow, and OKane
(2010) tested different surveillance system methods for injury reporting. They found no
difference in reporting acute and overuse injuries between parents and athletic trainers in a study
involving 92 female soccer players. Emery and Meeuwisse (2010) found that athletic trainers
tend to report a greater number of injuries than do parents.
FIFA 11+ Stretching Regimen
Athletic trainers, in the intervention group, will be given written materials, a video and
provided with a group session block of instruction on the FIFA 11+ stretching regimen prior to
the season. A block of instruction, written materials and a video on a conventional stretching

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regimen will similarly be provided to the athletic trainers in the control group. The block of
instruction will be delivered by the research team. Athletic trainers will observe training a
minimum of once per week. They will be in communication with the coach a minimum of three
times per week. Athletic trainers will complete and submit injury surveys for their individual
teams, designed specifically for this study, to researchers on a weekly basis via the Internet.
Data Analysis Procedures
The research team will be solely responsible for analyzing the injury data as it is received
from the control and intervention groups athletic trainers. The injury data will be categorized in
the following way for comparison; acute injuries, overuse injuries, and lower extremity injuries.
This study is not concerned with upper extremity injuries. Time loss can be analyzed to compare
total time lost and time lost by injury category between the control and intervention groups. The
data can be analyzed to compare percentage of athletes in each group that incurred an injury
during the season.
Definition of Terms
A lower extremity injury refers to the part of the body from the hip to the toes. The lower
extremity includes the hip, knee, ankle joints and the bones of the thigh, leg and foot.
An acute injury is defined as a new, sudden-onset injury resulting from participation in a
soccer match or training that results in time loss.
An overuse injury is defined as the development of new onset of pain in a specific body
region that persisted for two weeks or more that did not result from an acute injury. Time loss is
not associated with overuse injuries.
Time loss is defined as missing a subsequent match or training after the injury.
FIFA 11+ Stretching Regimen is a 10-15 minute stretching program developed by the
FIFA medical Assessment and Research Center (F-MARC) to prevent lower extremity injuries

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among soccer players. The program consists of 15 single exercises with focus on cutting,
jumping, and landing technique, and on strength, plyometrics, agility and field balance
components (McKay et al., 2014).
Evaluation of the Methodology
In an attempt to ensure study reliability and validity, it is necessary to strive for
consistency between the control group and the intervention group. Slade, Dionne, Underwood
and Buchbinder (2014) stated evaluation and implementation of research would be greatly
facilitated if the exercise programs and their components were comprehensively reported in a
standardized fashion. This study will measure only the injuries incurred during each teams
regular season. As the WIAA mandates an opening day of training and the conclusion of the
regular season, this will ensure that each team in the study will train a relatively equal number of
days. Of course, there may be variability due to inclement weather and an unequal number of
matches scheduled during the regular season. The number of total hours trained during the
season is a variable that must be considered during the analysis of data. Typically, teams within
the MCC train 1 - 2 hours per day. There may be some variability with some teams opting for
two a day training sessions in the first couple weeks of the season and others not. Coach
adherence to the implementation of the FIFA 11+ stretching regimen will be another factor that
warrants scrutiny. The study asks each control group team to employ the stretching regimen
before every training session. Each intervention team is directed to employ the stretching
regimen before and after every training session. Coach compliance will need to be scrutinized as
part of the study evaluation. There is a significant financial cost associated with this study as the
FIFA 11+ stretching program must be introduced to the control and intervention groups through a
block of instruction tapes and handouts. This cost could have been alleviated had the study been

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designed in a different manner. For example, Jamtveldt, Herbert, Flottorp, Odgaard-Jensen,

Havelsrud, Barratt, andOxman (2010) conducted a study on stretching before and after
physical activity to prevent injury and soreness. Their trials were conducted entirely through the
Internet, which saved considerable resources.
Ethical Concerns
The commissioner of the MCC and all participating school athletic directors will sanction
the study. All parents and student athletes participating in this study will be contacted via the
Internet. Informed consent will be sought from all participants. Participants will be informed as
to the nature of the study and how the data is to be used. The quantitative value of the data
ensures that participants will remain anonymous when the study is published. Athletic trainers
will safeguard injury statistics during the study just as they do in the course of routine high
school sport management.
There are a plethora of agreements and understandings that must be documented as part
of a sound ethical, risk management plan. The following documents will both serve to educate
student-athletes and parents as well as fulfill researcher obligations as they relate to ethical
considerations and negligence litigation.
Research Participation Agreement Parent permission authoring participation in
the research study should be certified in writing. Participation agreements are helpful in
that they are a useful tool to mitigate the risk of litigation. Parents that have children
participating in this study will be provided handouts with an overview of the studys
intention. This studys participation agreement will be clear and explicit. It will state that
the material collected will be kept confidential. It will underscore that the research study
is limited in nature. It will It will articulate the research question and objectives. The

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participation agreements may not be legally binding, however, it will establish the
researchers fulfilled their duty to warn of inherent risks. Participants will be advised that
they can withdraw from the study at any time.
Soccer Specific Warnings The soccer coaching staff should provide a written
statement identifying particular dangers inherent to soccer. This should be signed by
students and parents. Verbal warnings should be administered by the coach to studentathletes at various times throughout the season.
Medical History Questionnaire/Past Injury Reports - This particular
documentation, of a players past medical history, will be helpful to the research team
after the injury information has been collected and analyzed. It would be interesting for
future studies to examine the extent of past player injuries and the rate of reoccurrence as
it relates to their experience with the FIFA 11+ stretching regimen.
Field and Grounds and Equipment Inspection Report The soccer coach, the
school athletic trainer and the fields and grounds maintenance crew at each school must
conduct an inspection of the facility and the equipment and training aids to be utilized
prior to the commencement of the study. It is important to ensure that hazards be
identified, and then subsequently reduced or eliminated. A detailed field inspection
safety checklist will be provided to each participating school. These will be completed
and returned to the research team prior to the study. Deficiencies will be addressed.
Schools will be eliminated from the study if a standard of safety cannot be achieved.
This speaks to the desire to ensure that the research environments at each school are
relatively comparable from a health and safety perspective.
References

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Anderson, J. (2005) Stretching before and after exercise: Effect on muscle soreness and injury
risk. Journal of Athletic Training, 40(3), 218-220.
Anderson, R.A., (2000) Stretching. Bolinas, CA: Shelter Publications, Inc.
Bizzini, M., Junge, A., & Dvorak, J. (2013). Implementation of the FIFA 11+ football warm up
program: How to approach and convince the football associations to invest in prevention.
British Journal of Sports Medicine, 47, 803-806.
Clark, R. (2008). Hamstring injuries: Risk assessment and injury prevention. Annals Academy
of Medicine, 37, 341-346.
Coutinho, E., Gomes, A., Frana, C., Oishi, J. & Salvini, T. (2004). Effect of passive stretching
on the immobilized soleus muscle fiber morphology. Brazilian Journal of Medicine,
37(12), 1853-1861.
Dvorak, J., Junge, A., Derman, W., & Schwellnus, M. (2010). Injuries and illnesses of football
players during the 2010 FIFA world cup. British Journal of Sports Medicine.
doi:10.1136/bjsm.2010.079905.
Emery, C. & Meeuwisse, W. (2010). The effectiveness of a neuromuscular prevention strategy to
reduce injuries in youth soccer: A cluster-randomized controlled trial. British Journal of
Sports Medicine, 44, 555-562.
Gratton, C. & Jones, I. (2010). Research Methods for Sports Studies (2nd ed.). New York:
Routledge.
Gremion, G. (2005). The effect of stretching on sports performance and the risk of sports injury:
A review of the literature. Sportmedizin und Sporttraumatologie, 53(1), 6-10.

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Hammermeister, J.J. (2010). Cornerstones of coaching: The building blocks of success for sport
coaches and teams. Traverse City, MI: Cooper Publishing Group, LLC.
Heidt Jr., R. S., Sweeterman, L. M., Carlonas, R. L., Traub, J. A., & Tekulve, F. X. (2000).
Avoidance of soccer injuries with preseason conditioning. American Journal of Sports
Medicine, 28(5), 659-662.
Jamtveldt, G., Herbert, R., Flottorp, S., Odgaard-Jensen, J., Havelsrud, K., Barratt,
A.,Oxman, A. (2010). A pragmatic randomized trial of stretching before and after
physical activity to prevent injury and soreness. British Journal of Sports Medicine, 44,
1002-1009.
Junge, A., Lamprecht, M., Stamm, H., Hasler, H., Bizzini, M., Tschopp, M.,& Dvork, J.
(2010). Countrywide campaign to prevent soccer injuries in Swiss amateur players. The
American Journal of Sports Medicine, Vol XX, No. X.
Kirkendall, D. T. (2011). Soccer anatomy. Champaign, IL: Human Kinetics.
Langevin, H., Bouffard, N., Badger, G., Iatridis, J. & Howe, A. (2005). Dynamic fibroblast
cytoskeletal response to subcutaneous tissue stretch ex vivo and in vivo. American Journal of
Physiology, 288 (3), 747-756.
McKay, C., Steffen, K., Romiti, M., Finch, C., & Emery, C. (2014). The effect of coach and
player injury knowledge, attitudes and beliefs on adherence to the FIFA 11 + programme
in female youth soccer. British Journal of Sports Medicine, 48, 1281-1286.

Running Head: INJURY PREVENTION IN FEMALE YOUTH SOCCER

22

Miller, M., Cheatham, C. & Patel, N. (2010). Resistance training for adolescents. Pediatric
Clinics of North America, 57(3), 671-682. doi:10.1016/j.pcl.2010.02.009
Mohib, M., Moser, N., Kim, R., Thillai, M., & Gringmuth, R. (2014). A four year prospective
study of injuries in elite Ontario youth provincial and national soccer players during
training and match play. Journal Canada Chiropractic Association, 58(4), 369-376.
Pollard, C. 2006). The influence of in-season injury prevention training on lower-extremity
kinetics during landing in female soccer players. Clinical Journal of Sports Medicine,
16(3), 223-227.
Schiff, M., Mack, C., Polissar, N., Levy, M., Dow, S., & OKane, J. (2010). Soccer injuries in
female youth soccer players: Comparison of injury surveillance by certified athletic
trainers and internet. Journal of Athletic Training, 45, 238-242.
Slade, S., Dionne, C., Underwood, M., & Buchbinder, R. (2014). Standardized method for
reporting exercise programmes: Protocol for a modified Delphi study. British Journal of
Sports Medicine, 4, e006682. doi: 10.1136/bmjopen-2014-006682.
Soligard, T., Myklebust, G., Steffen, K., Myklebust, G., Holme, I, Silvers, H.,Andersen, T.
(2008). Comprehensive warm-up programme to prevent injuries in young female
footballers: cluster randomized controlled trial. British Journal of Sports Medicine,
337;a2469. doi:10.1136/bmja2469.
Soligard, T., Nilstad, A., Steffen, K., Myklebust, G., Holme, I, Dvorak, J.,Andersen, T. (2010).
Compliance with a comprehensive warm-up programme to prevent injuries in youth
football. British Journal of Sports Medicine, 44, 787-793.

Running Head: INJURY PREVENTION IN FEMALE YOUTH SOCCER

23

Steffen, K., Emery, C., Romiti, M., Kang, J., Bizzini, M., Dvorak, J.,& Meeuwisse, W.
(2013). High adherence to a neuromuscular injury prevention programme improves
functional balance and reduces injury risk in Canadian youth female football players: A
cluster randomized trial. British Journal of Sports Medicine, 47, 794-802.
Thacker, S., Gilchrist, J., Stroup, D. & Kimsey, C. (2004). The impact of stretching on sports
injury risk: A systematic review of the literature. Medicine and Science in Sports and
Exercise, 2003. doi:10.1249/01.MSS.0000117134.83018.F7.
Verheijen, R. (1998). Conditioning for Soccer. Spring City, PA: Reedswain Videos and Books.
Witvouw, E., Mahieu, N., Danneels, L., & McNair, P. (2004). Stretching and injury prevention:
An obscure relationship. Sports Medicine, 34(7), 443-449.