Don't Peak Too Early: Evidence for an ACL Injury Prevention Mechanism of the 11+ Program.
Haraldur B Sigurðsson, Kristín Briem, Karin Grävare Silbernagel and 1 others
PMID 35949375WHAT IT FOUND
The 11+ warm-up reduced early knee valgus peaks in one female soccer team but not the other, and had no effect on very early peaks.
Adherence differences may explain the inconsistency, so the mechanism is not clearly proven.
Key findings
01The 11+ intervention significantly reduced the frequency of Early Peaks (40-60ms) in one intervention team but not the other.
02There was no significant effect of the intervention on Very Early Peaks (within 40ms).
03Early Peaks were most common during lateral shuffles, a movement not specifically trained in The 11+.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Teams were not randomized, so baseline differences between intervention and control groups cannot be ruled out. Only one of two intervention teams showed a significant effect, suggesting high variability in response or adherence. Compliance was self-reported and not objectively measured beyond frequency of sessions. Only three trials per movement were collected, which may underestimate the true frequency of rare Early Peak events. The study was not powered to detect interactions between specific movement tasks and the intervention. No direct link was established between changes in Early Peak frequency and actual ACL injury rates.
Declared interests
The authors declared no conflicts of interest. The study was funded by the National Institutes of Health and the Icelandic Research Fund.
The easy way to misread this
Do not assume The 11+ consistently alters knee valgus mechanics in all athletes. The effect was seen in only one of two intervention teams, and the lack of randomization means other factors could explain the difference.