How Effective are F-MARC Injury Prevention Programs for Soccer Players? A Systematic Review and Meta-Analysis.

BACKGROUND The FIFA Medical and Research Centre (F-MARC) has designed a comprehensive warm-up program targeting muscular strength, body kinaesthetic awareness, and neuromuscular control during static and dynamic movements to decrease injury risk for soccer players. Prior studies have investigated the effectiveness of the F-MARC programs, but have not consistently reported a statistically significant reduction in injury and reduction in time loss due to injury from utilizing the program. OBJECTIVE The purpose of this study was to conduct a systematic review and meta-analysis of randomized controlled trials and interventional studies that evaluated the efficacy of the F-MARC injury prevention programs in soccer. METHODS Two independent researchers searched the relevant article databases. The keyword domains used during the search were 'F-MARC', 'FIFA 11+', 'the 11+', 'injury prevention programs', 'soccer', and variations of these keywords. The initial search resulted in 4299 articles which were filtered to nine articles that met the inclusion criteria. Main inclusion criteria were randomized controlled trials or interventional studies, use of F-MARC injury prevention programs, and the primary outcome measuring overall and lower extremity injuries. Extracted data were entered and analyzed using Comprehensive Meta-Analysis software, version 2 (CMA.V2). RESULTS The pooled results based on total injuries per 1000 h of exposure showed that F-MARC injury prevention programs had a statistically significant reduction in the overall injury risk ratio of 0.771 (95% CI 0.647-0.918, p = 0.003) and the lower extremity injury risk ratio of 0.762 (95% CI 0.621-0.935, p = 0.009). Moreover, FIFA '11+' had a statistically significant reduction in the overall injury risk ratio to 0.654 (95% CI 0.537-0.798, p < 0.001) and the lower extremity injury risk ratio of 0.612 (95% CI 0.475-0.788, p < 0.001). However, FIFA '11' did not reach significance for the lower extremity and overall injury reduction. It can be suggested that teams involved in the FIFA '11+' warm-up program will reduce injury rates by between 20 and 50% in the long term compared with the teams that do not engage in F-MARC programs. CONCLUSIONS This systematic review and meta-analysis indicated that use of F-MARC injury prevention programs, particularly the '11+' program, decreases the risk of injuries among soccer players. These data also support the case for the development and introduction of sport-specific programs.