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Football Medicine

Protecting the female player from serious knee injuries

Germany's injured player Sandra Smisek reacts during a training session

The risk of potentially devastating tears to the anterior cruciate ligament of the knee, a common injury in female players, can be reduced by a specific warm-up programme that can easily be incorporated into every team's training routine.

The 'Prevent Injury and Enhance Performance - PEP' programme is designed to help teams prevent non-contact anterior cruciate ligament (ACL) injuries without a significant investment in equipment and time. Female football players are at considerable greater risk for ACL injuries as compared to males. The gender difference becomes even greater for non-contact ACL injuries, which occur usually in stopping, turning, or landing from a jump as opposed to colliding with another player.

A study of the renowned Center for Disease Control and Prevention in first division American college players has now once more confirmed the effectiveness of PEP in preventing ALC injuries in women's football. In total, 1,435 players were followed for one season. The study compared 26 women's teams using the PEP programme with 35 teams not using PEP.

While the number of injuries in the study was small, PEP was however effective in reducing ACL injuries. Players in the PEP teams suffered no ACL injuries, compared to six injuries among the other teams. Also, of the players with a history of ACL injury, those practising PEP did not experience non-contact ACL injuries, as compared to four injuries among players not using PEP.

PEP includes warm-up, stretching, strengthening. Football-specific agility exercises aim to improve jumping, stopping and turning techniques. The programme provides an excellent start for training sessions.

PEP was developed by the Santa Monica Orthopaedic and Sports Medicine Research Foundation, Santa Monica, USA, in collaboration with the FIFA Medical Assessment and Research Centre F-MARC. The Santa Monica group is one of currently six established FIFA Medical Centres of Excellence worldwide.

"PEP was designed specifically to prevent serious knee injuries", said Dr Bert Mandelbaum, director of the Santa Monica group and member of the FIFA Medical Committee. "We recommend to teams to use it as an alternative warm-up before training sessions. Putting PEP widely into practice, we hope, will continue to show reduced risk of ACL injury among football players."

Within their 'Football for Health' programme, F-MARC promotes playing football as an ideal leisure activity for everyone to stay healthy and prevent common diseases. "However, in order to tap the full potential of the game in enhancing the physical well-being, negative effects such as injuries need to be minimised," explained Prof. Jiri Dvorak, Chairman F-MARC and FIFA Chief Medical Officer. "Therefore prevention of injuries is one of F-MARC's primary objectives."

The principles of PEP have recently been combined with the exercises of 'The 11', F-MARC's well-known prevention programme, to create a new and even more effective version.

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