Sideline Sports Doc: Can you save your ACL?

Sideline Sports Doc: Can you save your ACL?

Editor’s Note: This article is written by Sideline Sports Doc president Dev Mishra, M.D. Bert Mandelbaum, MD DHL, also contributed to the article. Mandelbaum is a member of the FIFA and CONCACAF Medical Committees and F-MARC, assistant medical director of MLS and team physician to U.S. Soccer, LA Galaxy and Pepperdine University. Sideline Sports Doc is advancing the Players First pillar of Player Health & Safety. Stay tuned for important implementation of the program.

Injuries to the anterior cruciate ligament (ACL) are an unfortunate part of playing soccer. Some tears occur from direct contact through tough challenges, but the majority of ACL tears actually occur without any contact. Earlier this month, U.S. women’s national team star Megan Rapinoe sustained an ACL tear in a non-contact injury, and the quality of the field has been called into question as a possible causative factor.

There has been a considerable amount of research over the years about the exact reasons why ACL tears occur and possible ways we can reduce injury risk. One area of promise is in proper muscle training. The theory behind the muscle training is that improvements in body mechanics, hip and hamstring strength, and proper muscle firing patterns can reduce not just risk of ACL tears, but also reduce risk of general lower extremity injuries and improve player performance. The FIFA 11+ program looks like it does just that.


  • The FIFA 11+ warmup program results in reductions to all soccer related injuries by an incredible 30-70 percent
  • The program works for males and females across multiple age groups
  • You must consistently use the program all season for at least two times per week
  • The head coach is in an excellent position to improve player health by requiring this warm-up program

I listened to a presentation by Holly Silvers at the US Club Soccer Players First launch event in August. Silvers is one of the creators of the PEP warm-up program for soccer that ultimately evolved into the FIFA 11+ program (along with Dr. Bert Mandelbaum). I was astounded by what I heard: using the program consistently, at least two times per week, produced reductions in all soccer-related injuries by 30-70 percent.

For context, I’ve only seen those types of health-related reductions if a drug is involved, like using statins to reduce LDL cholesterol or using insulin for a diabetic to reduce blood sugar. But for a physical intervention to reduce injury rates by this amount is really unheard of. I think other than the FIFA 11+ program, you could only reduce injury rates this much by staying in bed all day.

The links at the bottom of this article will take you to FIFA’s F-MARC site where you can download the program, as well as see some supporting scientific information. Please review it critically yourself, and I believe you’ll come to the same conclusion: this program works.

At Sideline Sports Doc, we’ve been preaching the benefits of injury reduction for years now, so let’s review a few of these areas. Each of these can be achieved through use of FIFA 11+:

  • Reduce injuries to the groin, hamstrings, knees, legs, ankles by 30-70 percent for males and females, across multiple age groups
  • Reduced injuries means you keep players in your squad longer
  • The program also improves soccer specific performance
  • Fewer injuries means lower health related costs. In many parts of the United State,s a severe ankle sprain will cost in excess of $3,000 to diagnose and treat. These costs will often be borne by the parents through high-deductible insurance plans.

Like any safety and preventive measure, this program is only good if you actually use it consistently through the season, at least two times per week. The person in the best position to implement the program and positively influence player health is the head coach. US Club Soccer’s Players First program provides many resources for the coach to assume a leadership position in player health, safety and skill promotion. Take a stand for player health by letting your players know that you are going to be doing the program all year; let them know that you are doing it because you really care about their health, safety and performance.

Your players look up to you as their coach, and if you set the example, they will do the program. Save a hamstring; save an ACL. Use FIFA 11+.

Important links to review:

Join the conversation on social media by using the hashtag #P1soccer.