Neuromuscular conditioning strategies and their effectiveness in preventing injuries in soccer players: a systematic review

Introduction

Justification

The justification for this research focuses on the importance of establishing best practice strategies for preventing injuries in soccer with the different types and varieties of physical training currently used due to the high injury rate.

Sports medicine is the intersection of physical education and medicine. This branch of medicine focuses on the physiological, anatomical, and educational outcomes, as well as the management of sports-related pathologies. In soccer, an exercise program allows for proper neuromuscular control, establishing more efficient communication between muscles and the central nervous system, thus improving mobility.

Sports medicine deals with the prevention, diagnosis, and treatment of injuries related to physical activity. This requires a group of interventions that include physical education, neuromuscular training, educational sessions, biofeedback, and landing mechanics training. It also recognizes other biomechanical risk factors that can affect the practice of soccer.

Neuromuscular training, multicomponent neuromuscular warm-up programs, strength-focused interventions, balance training, proprioception, rehabilitation, educational participation, and technology-assisted or biofeedback interventions allow for improved neuromuscular control in players. These techniques promote communication between muscles and the central nervous system. In the field of soccer, these types of practices are applied to improve neuromuscular control and prevent injuries.

Neuromuscular control refers to the coordination of muscles that allows for joint stability. Adequate training improves neuromuscular control; Otherwise, it is a risk factor for knee and other injuries. Lack of neuromuscular control in soccer players is characterized by limb asymmetries, which increases the risk of injury, especially in young players who return to play without fully recovering. This is associated with overuse injuries and increased workloads. Certain positions on the sports field have a higher risk of damage to certain anatomical areas, and important factors such as lack of training can make them more susceptible to injury (1).

According to the International Federation of Associated Football (FIFA) programs have been developed to reduce injuries, being necessary to evaluate the usefulness of neuromuscular training through the use of FIFA 11+ program, playing an important role in the reduction of injuries, which has been designed by consensus of experts and contains running exercises, strength and balance exercises, helping to improve the position of the knee, however, its real role is subject to analysis (2). Serious injuries can be effectively reduced with an injury prevention protocol in players with good results (3).

Sports injuries continue to increase and are 87% more frequent in the lower extremities (IRR: 1.87; 95% CI: 1.29−2.74) mainly in soccer and volleyball players who have a history of concussion in the last 12 months, compared to those who have not had this history, this demonstrates a direct association between neurological injuries such as concussion and other types of limb injuries (4). Athletes who suffer a concussion consequently have prolonged or slow response times, a situation that is more significant in the female group, requiring a longer neurological recovery time than clinical recovery, placing it as a group at risk of suffering new injuries (5).

Soccer is the most widely practiced sport worldwide, and the increase in injuries is understandable given its unpredictable nature, making neuromuscular control a highly relevant topic. Plyometric training involves exercises such as explosive jumping and sprinting, which have been shown to evaluate ground contact time (GCT) in milliseconds and increase muscle strength and power. This produces positive effects on speed, agility, and coordination when performing exercises that range from eccentric contractions, such as stretching, to concentric contractions, such as shortening. The average age of injury is 18.29 years. Players with a history of trauma are most frequently affected by ligament injuries (42.9%), muscle injuries (21.4%), bone injuries (14.3%), and tendon injuries (7.1%) (6).

Physical education is a subject based on physical movement. This discipline allows for the comprehensive development of a person's physical, emotional, and cognitive abilities, with the goal of improving the quality of participation. The effectiveness of trauma prevention programs with incorporated exercises reduces susceptibility to hamstring injuries; for every 1,000 h of training, injuries are reduced by 57% (7).

There are few investigated risks following a concussion in sports. Neurological changes occur in the first 14 days, such as cognitive and sleep disturbances that do not improve even with complete medical rest. Furthermore, the ideal recovery time is unknown, which represents a risk for the athlete (8).

Sport alone has shown a positive effect on the heart, for example, in hypertensive premenopausal women randomly assigned to soccer training and control group, 15 weeks of training increased left ventricular mass and improved diastolic function indices with great cardiovascular effect, so much so that soccer increased the left ventricular mass index by 10% and increased the diameter of the left ventricular septum revealing a close relationship between training and the cardiovascular system (9). Soccer also improves diseases such as type 1 diabetes with practice for 12 weeks, combined with dietary intervention, which provided an improvement in glycemia in adolescent children with type 1 diabetes (10).

FIFA 11+ training improves performance in changing direction and limb asymmetries, compared to integrative neuromuscular training. Neuromuscular training clearly improves skills in changing direction during sprinting, reducing limb asymmetries that occur with leg changes in some soccer players (11).

Neuromuscular control and cardiovascular conditioning are essential for improving endurance in soccer. Some matches last more than 120 min, and training improves the player's internal homeostasis, highlighting its importance in improving physiological aspects such as red blood cell count, lipid metabolism, and aerobic capacity (12).

Injuries represent a limitation for soccer players worldwide, as in many cases they are associated with various factors, among which the lack of adequate training stands out (13).

In youth populations, injuries can begin early, affecting the development of soccer players. A systematic review of 27 articles with data from 1427 participants reported positive effects of skills improvement programs on outcomes (14).

A systematic review of controlled trials evaluating FIFA +11 in 7,939 male soccer players with 695,503 h of training, the risk of injury was reduced by 48% (15). The following risk factors for injury in female soccer players have been identified: higher game load, history of injuries, overuse injuries at an early age and anatomical factors (16).

It is important to adapt the intensity and duration of the exercises to the level of each player, data from a meta-analysis of retrospective studies in male soccer players evaluated soccer and its effect on health (n = 13,065; mortality rate = 0.55; 0.46−0.67; p < 0.001) presenting a lower rate of neurological problems in relation to the general population (17).

Excessive training frequency is associated with several symptoms that lead to overtraining, this is related to an increased risk of injury in soccer players. A study conducted on a population of 189 young soccer players aged 13 to 17 years, showed that symptoms such as fatigue, mood swings, poor performance, anorexia, susceptibility to muscle strains, arthralgia, depression and anxiety are problems to which soccer players are exposed, so it is necessary to apply a test such as routine questionnaires to evaluate overtraining such as the one granted by the Société Françoise de Medicine du Sport (18).

Overuse knee injuries are common and are characterized by cartilage wear, which causes pain and impairs the quality of life of athletes. Lack of sleep is a factor that influences the development of overtraining syndrome in soccer players. Treatment sometimes requires advanced diagnostic and therapeutic techniques such as knee arthroscopy, knee surgery with the application of techniques such as microfracture and autologous transplantation to renew the cartilage and improve symptoms. Therefore, prevention of cartilage injury is of vital importance in sports (19).

Injuries are a growing problem for soccer players, and prevention through physical training is the subject of multiple studies that highlight its importance, given the kinematics of contact in soccer.

The practice exposes players to injuries in different parts of the body such as the head, neck, chest, abdomen, and extremities. Therefore, the training proposed to prevent injuries with advances in physical education, in addition to identifying the factors that may influence the risk of injury, is a scientific circumstance in which the importance of this research lies.

Aim

• Defines the advances in neuromuscular training and its effectiveness in preventing injuries in soccer.

Methods

A systematic review was conducted using articles published according to the PRISMA 2020 guidelines, obtained from databases such as PubMed, MEDLINE, Embase, CENTRAL, and Web of Science. The research design was guided by the following research question: What is the prevention, performance, and rehabilitation strategies for reducing injuries in soccer? The study population consisted of randomized controlled trials that included modifiable risk factors, advanced assessment, and training programs to prevent injuries in soccer players (20, 21).

Eligibility criteria

The eligible sport was soccer, and the participants were either professional or amateur soccer players. The study included randomized controlled trials that incorporated interventions such as sports medicine, neuromuscular training, and conditioning, with a population comprised of professional or amateur soccer players. The entire inclusion, extraction, and synthesis process was conducted collaboratively by the authors to prevent manipulation or bias in the research. Studies with randomly selected individuals or populations were used, ensuring equal chances of selection. The interventions consisted of injury prevention, performance, and rehabilitation strategies in sports medicine. The comparator was a control group that did not receive the intervention. The required follow-up period was a minimum of one month. The primary outcome was injury prevention, and the secondary outcome included training, conditioning, rehabilitation, and physical education programs focused on soccer.

Selection criteria

• Participants:
• Interventions
• Types of Studies:

Research approach

• Sport analyzed: soccer.
• Common objective in these studies:

Inclusion criteria

• Randomized clinical trials concerning multicomponent neuromuscular warm-up programs to reduce injuries.
• Randomized clinical trials on preventive strategies used for joint injuries or disorders in soccer players.
• Randomized clinical trials related to injury prevention with strength, balance and proprioception training in soccer.
• Randomized clinical trials on performance and rehabilitation strategies to prevent injuries in soccer.
• Randomized clinical trials on biomechanical risk factors that may affect the practice of soccer.
• Randomized clinical trials regarding educational sessions, biofeedback focused on the management and prevention of injuries.

Exclusion criteria

• Non-randomized studies
• Studies on sports other than soccer
• Studies unrelated to sports medicine should be excluded
• Studies with unavailable results
• Ongoing studies with no published data

Any study that is not about soccer should be excluded.

Sources of information

Published articles on the usefulness of physical training in the prevention of injuries in soccer were reviewed using information from databases such as MEDLINE, Embase, CENTRAL and Web of Science.

Search strategy

The specific search terms were neuromuscular training, warm-up, balance, proprioception, strength, FIFA 11+, knee control, Nordic hamstring training, and injury prevention.

Controlled vocabulary used English descriptors (MeSH); soccer, training, sports injuries, athletic injuries, physical activity-related injuries.

Free text terms; neuromuscular training soccer preventing injuries, Advances in neuromuscular training and its effectiveness in preventing injuries in soccer, neuromuscular training and its effectiveness in preventing injuries in soccer.

Boolean operators; “neuromuscular training soccer” AND effectiveness AND “injury prevention” AND soccer, “neuromuscular training” AND “preventing injuries” AND soccer.

Truncation; neuromuscular training , soccer, injuries*.

Design filters; randomized clinical trials were used to find rigorous experimental and interventional evidence.

Language limitations; research published in English.

Date limits; The search was conducted between January 2025 and final search date July 2026, including studies published over a 10-year period. For field restrictions, only articles from the last 10 years were used due to the evolution of soccer in terms of physical preparation, training methods with technology, technological advances, match load, current regulations and updated injury care protocols.

These terms were used to connect the searches in the consulted databases to link physical education and the different types of strategies used for injury prevention in soccer.

Study selection process

The articles that responded to the objective and met the inclusion criteria were reviewed and selected jointly by all the authors of the research.

Data extraction process

For data extraction, manual stratified randomization was used based on the study date, study type, and intervention. To ensure transparency, the extracted results were analyzed in working groups to avoid selection bias.

List of data

The data and materials, including the sample design, instruments, hardware, software used, protocols, questionnaire, and instructions, are available from the corresponding author. Primary outcomes included injury prevention, recovery, and reduction with some form of fitness improvement training. Secondary outcomes included training load, injury incidence, injury rate, and injury risk reduction.

Participant characteristics or the primary variable for which data were collected were for professional or amateur soccer players who underwent physical training and neuromuscular control as part of their discipline in clinical studies.

Assessing the risk of bias of individual studies

Figure 1 shows the results of the ROB2 risk of bias assessment for a specific outcome. The assessment under the intention-to-treat or per-protocol criteria resulted in a low or intermediate risk.

Measures of effect

To measure the effect, the following were used: risk ratio (RR), odds ratio (OR), hazard ratio (HR), incidence rate ratio (IRR), relative risk (RR), confidence interval (CI), incidence ratio (IRR), absolute risk (AR), and p-value. The interventions consisted of advancements in physical training, neuromuscular training, and their impact on reducing injuries in soccer. A comparison was made between soccer players undergoing physical training research and those receiving regular injury-reduction training. These variables were used to estimate the protective effect, precision, and probability of the intervention.

The risk and frequency measures used, for which results were sought according to availability in the analyzed studies, were: The measures of precision and validity that were included in the variables to assess whether the effect was significant or reliable.

• Risk Ratio (RR)/Relative Risk (RR): Compares the risk of injury in the advanced training group vs. the regular group.
• Odds ratio (OR): Estimates the likelihood of an injury occurring in one intervention compared to another.
• Instantaneous Hazard Ratio (HR): to measure the speed or rate of injuries over time between groups.
• Incidence rate ratio (IRR)/IRR: to compare the number of new injuries per exposure time between the two types of training.
• Absolute Risk (AR): demonstrates the actual risk or direct probability of suffering an injury in a specific group.

Confidence interval (CI): with a 95% certainty level.

P-value: to measure whether the result is statistically significant or is a coincidence, if the value is < 0.05 with statistical value or >0.05 without statistical value.

Synthesis methods

The studies selected for inclusion were synthesized using descriptive analysis and Excel result tables, as well as graphs, through a methodological filtering strategy. For the results, randomized clinical trials were considered to improve methodological rigor.

The types of training and their effect on injuries, and the participants included in Table 1, were used.

Table 1. Strategies for injury prevention with neuromuscular conditioning and training in soccer.

Randomized clinical trials investigating the impact of training on injury prevention. The studies found that neuromuscular training significantly reduced injuries compared to the control group.

To visually tabulate the results of the individual studies, PICO was used and its synthesis in an Excel table.

To reduce the statistical heterogeneity of the studies, confidence intervals and statistical significance in injuries in soccer players were primarily evaluated.

Assessment of publication bias

A critical analysis of the evidence was performed using only randomized controlled trials to eliminate randomization bias. Using the ROB2 program, trial bias was assessed as intermediate or low (see Figure 1).

Evaluating the certainty of the evidence

The certainty of the evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology to evaluate the certainty and strength of the recommendations.

The review findings come from both amateur and professional soccer players who practiced some type of training, warm-up, or conditioning strategy. To improve the certainty of the evidence, the research focused solely on randomized controlled trials. The populations studied included high-level evidence clinical trials conducted on children, adolescents, women, and men who were professional and amateur soccer players, with and without a history of injuries. These trials reached statistical significance for or against injury prevention through physical training.

Results

Selection of studies

For the development of the research, 14 randomized clinical trials that assessed the effect of training on injury prevention were identified and selected for analysis (Table 1). The studies obtained from the search were manually selected in a stratified manner among all authors according to the results to issue clear recommendations of a high level of evidence and were expressed in the flow diagram that represents the direction of the research (Figure 2) (22).

Studies that apparently met the inclusion criteria, but with a focus on other interventions that were not injury prevention, were excluded (23–36, 49); other strategies that included conditioning for soccer were taken into consideration (Figure 2, and Table 2).

Table 2. Strategies focused on improving skills, performance and conditioning in soccer.

Randomized clinical trials on strategies to improve skills, knowledge, and landing patterns in soccer.

There are other variables such as the application of FIFA 11+ neuromuscular training to reduce asymmetries during leg changes or changes in speed rhythm during the training run that provide improvements in leg asymmetries and changes of direction during the run, although the study did not assess the effect on injuries, it only evidently improved skills (11).

The intervention program for injury risk factors such as functional instability consisted of: first, strengthening the ankle in three directions, second, single-leg heel raises, and third, balance training for 6 weeks in players >14 years old with a history of functional ankle instability, who were assessed using the Tampa scale to measure the fear of re-injury, in addition to quantifying and evaluating the degree of kinesiophobia of the participants, which showed significant improvement by decreasing kinesiophobia, instability, and improving performance after the program. For soccer players with a history of ankle injuries, individualized training significantly reduced ankle instability (38).

Educational intervention in amateur soccer players with a median age of 22 years improves educational knowledge and performance of soccer players, as well as their technical skills, although it does not directly reduce injuries. An educational session taught Saudi soccer players cognitively about the role of physical training and its relationship to injuries and disseminated educational content in the research group for 90 min, which included teaching the causes of injuries, injury mechanisms, types of injuries, symptoms, prevention measures and treatment. It did not decrease the incidence of injuries, only affected the knowledge of these in the sports medicine training group (40).

Characteristics of the studies

The GRADE methodology was used to classify the quality of the scientific evidence from the selected studies. This research used a high level of evidence, including randomized trials.

Risk of bias of individual studies

An individual analysis was performed for each study selected in Table 1 with the respective risk of bias dependent on participant dropouts.

Results of individual studies

The results of each study included in the selection were summarized individually in Table 1, and are described according to population, intervention, comparison, and outcomes (PICO).

Results of the synthesis

The probability of injury occurring in children < 14 years was lower in the FIFA 11+ exercise group applied for 6 months. The FIFA 11+ kids consisted of 7 exercises with 5 levels of difficulty performed as a warm-up before training sessions, which significantly reduced injuries in relation to the control group (15).

FIFA 11+ exercises as an intervention applied in the warm-up showed a protective effect for players who performed the training for 7 in relation to the control group that did not perform FIFA 11+ (37).

Although the Nordic hamstring exercise had a protective effect on injuries by reducing them, the probability of the event was lower in the group exposed to the program in relation to the unexposed control group, the prevention of hamstring injuries in adult male soccer players did not reach statistically significant value (39).

The probability of suffering an injury with exercises in male players with the FIFA 11+ program applied for 6 months before and after training was significantly lower in the intervention group compared to the control group that only applied warm-up exercises before training (41).

The implementation of the FUNBALL program after the usual warm-up of soccer players between 15 and 19 years old twice a week resulted in the exposed group obtaining injury occurrence rates 31% lower compared to the non-exposed group with statistical significance (42).

Biofeedback was used in female soccer players with a mean age of 13.3 ± 2.1 years, employing sensors to measure involuntary bodily functions. This biofeedback indicated the amount of load or force exerted on the inner part of the knee. Real-time biofeedback training reduced knee adduction moment, improving performance in landing and jumping tests. No anterior cruciate ligament injuries were recorded in any of the three groups that underwent biofeedback. One limitation of the study was the lack of a control group without intervention; the effect of this control group was not measured (43).

The results demonstrate a protective effect was observed with the neuromuscular warm-up program in male and female soccer players with a mean age of 12 years who performed 2 to 3 weekly sessions for 20 min for 20 weeks as an intervention. An Incidence Rate Ratio (IRR) of 0.77 (95% CI: 0.61 to 0.96) was obtained, indicating a 23% decrease in the event rate in the exposed group compared to the control group. Non-contact lower extremity injuries were reduced in the teams with high adherence. The study found no statistically significant difference in the incidence of acute injuries, nor in the prevalence of injuries. The warm-up had no statistically significant effect on overuse injuries of the lower extremities. In the high-adherence group, the incidence was 12.5% (95% CI: 11.6 to 13.5) compared to 11.3% (95% CI: 10.7 to 11.9) in the control group (44).

Soccer players aged 16 to 19 were compared across two training programs: FIFA 11+ and M11+. The latter is a modified version of the M11+ program that includes: first, core exercises (prone, supine, and dynamic plank), balance exercises, and iliopsoas muscle strengthening. The second phase consists of straight-line running, controlled contact drills, hip inward and outward tilts, dynamic hamstring stretching, and rotational and cutting movements. The third phase comprises Nordic hamstring exercises, single-leg balance with a heel-to-toe movement cycle, ball throwing, and squats. The final part, agility and plyometric exercises, including drop jumps and countermovement jumps, injury prevention, and performance enhancements, practiced three times a week with warm-ups before training sessions for four months, reduced lower limb injuries. The M 11+ resulted in 2.00 injuries per 1,000 hours of training vs. 5.79 injuries per 1,000 hours for FIFA 11+ and 7.55 injuries per 1,000 hours with regular training. The magnitude of the effect on injuries was not evaluated; a protective effect was only observed on skill, time, and speed (45).

Another variant of FIFA 11+ is FIFA 11+ S (or FIFA 11+ Shoulder) which is an official variant of the system for preventing upper limb injuries to the shoulder, elbow, wrist and fingers in goalkeepers in a statistically significant way (46).

Regarding the FIFA 11+ program as a conditioning exercise practiced 3 times a week for 8 weeks in elite soccer players under 19 years of age (mean ±: age = 16.79 ± 1.18 years) with risk factors for cruciate ligament injury, it improves the ability in terms of landing mechanics in relation to the control group, although no cruciate ligament injuries were observed in either group (47).

Extended Knee Control as a program to prevent hamstring, knee and ankle injuries, knee injuries in the research group decreased in relation to the control and there was no effect of extended adductor training on injuries in this area (48).

The ProSAS training with a mean age of 25.2 ± 3.1 years, achieved a statistically significant reduction in injuries with 8 weeks of training (50).

The overall injury rate in high-performance male players aged 17-18 years was significantly lower in neuromuscular training (8.00 injuries per 1,000 hours of exposure) compared to traditional training (13.33 injuries per 1,000 hours of exposure) (p = 0.049) (51).

The injury rate was significantly lower in the neuromuscular training group (5.1/1,000 h of exposure) compared to the endurance training group using running and sprinting, fartlek and high-intensity interval training (11.8/1,000 h of exposure) (p = 0.014) (52).

Studies based on Nordic exercises in the context of soccer were accompanied by an injury burden in favor of the experimental group (27.87 days of absence in the control group vs. 3.82 days of absence in the intervention group per 1,000 hours of exposure, rate ratio = 7.30, 95% CI: 3.34-15.99) (53).

Publication biases

A high percentage of attrition bias was observed, with high rates of participant dropout, both selectively and systematically, due to the long-term nature of the studies, which reduced precision because the data did not represent the original group that was initially randomized. The ROB2 program was used to assess bias, which individually revealed intermediate and low risk in most studies.

The statistical heterogeneity dependent on the different statistical measures evaluated was reduced by using the P value as the main variable to measure significance, using a cutoff point of P < 0.05 or P > 0.05 as significant or insignificant, improving the synthesis with results for and against training in relation to injuries.

Certainty of the evidence

The certainty of the evidence was assessed using the GRADE system. The final analysis used 15 randomized controlled clinical trials with a high level of evidence to evaluate the types of training, physical conditioning, and their direct effect on injuries in soccer.

A lower incidence of injuries was observed in the training group compared to the control group, which did not perform regular training not focused on a multi-skills strategy plan. Some studies revealed a protective effect of training; the p-value was influenced by a high dropout rate and a smaller sample size than in the intervention group (37). The incidence of injuries was lower in the experimental group with neuromuscular training compared to the control group, although the control group trained fewer hours. Dropouts occurred in both groups, introducing attrition bias (15). Hamstring injuries are common in both groups of soccer players, with an incidence of 1.12 per 1,000 hours in the jump training group and 1.39 per 1,000 hours compared to the regular control group, although the results did not reach statistical significance. When analyzing surgical procedures, a protective effect of jump training was observed (39).

A 10 min FIFA 11+ exercise after training was accompanied by a significant reduction in injuries; at the start of the study there was a smaller population in the training group compared to the control group (41).

Dropout rates were high in both groups. In the intention-to-treat analysis, a significant difference was observed between the two groups, with fewer injuries in the FUNBALL training group (42).

The implementation of feedback using technology such as biofeedback for 10 min was accompanied by good results due to the absence of injuries in all study groups (43). An important factor in neuromuscular training is adherence to training; the study showed that high adherence is associated with a lower injury rate (44).

The modified program called M11+, which includes specific exercises, yielded better results, significantly reducing injuries compared to FIFA 11+ (45). Although FIFA 11+ youth training was associated with a notable reduction in the percentage of injuries, the analysis of the results did not account for players who dropped out of the study after randomization, so the results may have been influenced by the likelihood of dropping out (46). Nevertheless, FIFA 11+ reduces the incidence of injuries with statistical significance, supporting the program's effectiveness in reducing anterior cruciate ligament injuries (47).

In a population where knee injuries were evaluated, training was associated with a lower incidence of injuries compared to the control group (48).

ProSAS training was associated with fewer joint injuries compared to the control group (50). The neuromuscular training group achieved statistical significance in injury reduction, with no dropouts observed during the 4 weeks of training (51, 52). A longer time off after injury was observed, but no statistical significance was observed in the incidence of injuries; both groups had an equal number of injuries (53).

In 76.47% of the studies analyzed, a reduction in injuries or improvements in conditioning, adherence, jump mechanics, and joint stability were achieved with a statistically significant value (P < 0.0134). Studies in which no improvements in injury rate or conditioning were observed represented 23.52%, therefore, future research should focus on providing additional data on this topic.

The research provides precise data on the types of training that did or did not demonstrate a protective effect, which is repeated with neuromuscular training, obtaining statistical significance when applied as a warm-up, conditioning before and after soccer. With programs such as FIFA 11+ compared to the usual warm-up, FIFA 11+ Kids showed a significant reduction when applied before and after practice, presenting a greater protective effect than when applied only before practice. This indicates that the primary outcome improved with this type of training. FIFA 11+ S is a variant of the FIFA 11+ warm-up protocol, developed for the prevention of shoulder injuries in soccer goalkeepers also showed a significant protective result.

The extended FIFA 11+ Kids program stands out as the most used training program among young people; other additional programs also obtained good results, FIFA 11 + S, M11+, ProSAS and FUNBALL, Extended Knee Control, although they need more studies to replicate the primary result.

Discussion

Neuromuscular training, the application of technology, and teaching can significantly reduce injuries despite limitations in studies (54).

Other evidence, such as a systematic review of non-randomized studies in the context of training, revealed a 10-fold reduction in injuries, reporting 36 injuries per 1,000 hours of exposure, reduced to 3.7 injuries per 1,000 hours of training (54).

A meta-analysis of randomized clinical trials investigated the best soccer training to reduce anterior cruciate ligament injuries, and the highest scoring were FIFA 11+ and Knee Control, observing a significant impact of training (55). Other injuries are common in populations such as women, where training is highly relevant in prevention, due to the evidence of current results (56).

Evidence shows poor program adherence and limited research on the causes of dropouts and their relationship to injuries. Data are based on heterogeneous populations to integrate results on a large scale; However, more high-quality research in specific populations is needed.

Future research should be directed towards improving current programs with strategies based on improvements in physical exercise and policies of follow-up and intervention aimed at injuries (57).

To assess the real effect of training, specific injury prevention programs are needed, focused on the most common areas of the group of soccer players who do not perform training focused on a clear objective (58).

Conclusions

The review demonstrates the importance of conditioning studies with neuromuscular training and the programs currently used, including: FIFA 11+, FIFA 11+ Kids, FIFA 11+ S, FUNBALL, ProSAS, M11+, FUNBALL, and Extended Knee Control before or after training, which prevent injuries in professional and amateur soccer players, with a protective effect and statistically significant effect in participants who developed this practice for 2 to 7 continuous months for a minimum of 10 min between 2 and 3 times per week compared to the control group that did not perform focused training.

Other types of conditioning included improvements in physical performance through preventative programs with no statistically significant effect on injury rate, for example: extended adductor program, neuromuscular training alone, Nordic training in injury load, biofeedback, adherence to training and landing mechanics improve neuromuscular control and favorably influence conditioning.

The review acknowledges interventions in sports medicine that can influence the mechanism of injury, for example, interruption of conditioning, kinesiophobia as a factor in ankle injury recovery with specialized ankle strength and balance training focused on improving skills, as well as implementation of technology in soccer to recognize patterns associated with injuries, they also did not have a significant effect on injury prevention.

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Footnotes

Edited by: Yinghui Hua, Fudan University, China

Reviewed by: Mohibullah Khan, The University of Lahore—New Campus, Pakistan

Zhikai Qin, Fujian Normal University, China

Abbreviations FIFA, international federation of association football; FIFA 11+, F11+, injury prevention program developed by FIFA for young players >14 years old; FIFA 11+ Kids) < 14 years old, injury prevention program in children; PICO, population intervention comparison outcomes; GRADE, grading of recommendations assessment, development and evaluation; RoB 2, risk of bias 2; M11+, FIFA 11+ modified; FUNBALL, fundamental exercises to prevent football-related injuries; ProSAS, multi-component training program; NMT, neuromuscular control; PROSPERO, international prospective register of systematic reviews.