Efficacy of a new injury prevention programme (FUNBALL) in young male football (soccer) players

Key points

1. 01Overall injury incidence was 31% lower in the FUNBALL group (IRR 0.69, 95% CI 0.55 to 0.87, p=0.002)
2. 02Thigh injuries fell by 38% (IRR 0.62, 95% CI 0.39 to 0.98, p=0.042)
3. 03Severe injuries (>28 days absence) were halved (IRR 0.51, 95% CI 0.28 to 0.91, p=0.024)
4. 04Injury burden was 40 days lost per 1000 hours in the FUNBALL group versus 74 in controls
5. 05Both training and match injuries were significantly reduced separately

How it was conducted

Design

Two-arm cluster-randomised controlled trial with football clubs as the unit of randomisation

Participants

1027 male players aged 13-19 across 45 teams from Kosovo (under 15, under 17, under 19 age groups), followed August 2021 to May 2022

Groups

Intervention: 23 teams (524 players) performed FUNBALL after usual warm-up at least twice per week; Control: 22 teams (503 players) followed usual training routine

Primary outcome

Overall number of football-related injuries during one season

Secondary outcomes

Region-specific lower limb injuries and injury severity (minimal, mild, moderate, severe)

Analysis

Intention-to-treat Poisson regression with cluster adjustment; incidence rate ratios (IRRs) with 95% CIs

What they found

• Overall injury incidence: 132 injuries in intervention (IR 2.46 per 1000 hours, 95% CI 2.08 to 2.92) vs 187 in control (IR 3.53, 95% CI 3.06 to 4.07); IRR 0.69 (95% CI 0.55 to 0.87), p=0.002
• Thigh injuries: IRR 0.62 (95% CI 0.39 to 0.98), p=0.042
• Moderate injuries (8-28 days absence): IRR 0.65 (95% CI 0.44 to 0.97), p=0.035
• Severe injuries (>28 days absence): IRR 0.51 (95% CI 0.28 to 0.91), p=0.024
• Match injuries: IRR 0.68 (95% CI 0.49 to 0.94), p=0.021
• Training injuries: IRR 0.69 (95% CI 0.50 to 0.94), p=0.022
• Traumatic injuries: IRR 0.68 (95% CI 0.53 to 0.86), p=0.002
• Under 15 subgroup: IRR 0.51 (95% CI 0.32 to 0.82), p=0.005; under 17 and under 19 subgroups did not reach significance (IRR 0.77 and 0.78 respectively)
• Knee injuries: IRR 0.71 (95% CI 0.43 to 1.18), p=0.193 (non-significant)
• Ankle injuries: IRR 0.66 (95% CI 0.39 to 1.13), p=0.138 (non-significant)
• Injury burden: 40 days lost per 1000 hours in intervention vs 74 in control
• Programme compliance: FUNBALL used in 72.2% of training sessions, average 2.2 times per week

Limitations

• Female players were excluded, limiting generalisability to girls and women
• Team rather than individual exposure hours were collected, which may mask variation in playing and training time between players
• Some coaches in the older age groups reported using exercises similar to FUNBALL components already, potentially diluting the measured effect
• No player input was gathered during programme development, and the decision on when to progress exercise levels was left to coaches without standardised guidance

Why it matters

For patients

Young male football players who do FUNBALL twice a week after warm-up can expect roughly one-third fewer injuries overall and significantly fewer serious injuries that would keep them off the pitch for weeks.

For clinicians

FUNBALL is a structured, football-specific warm-up addition of 15 to 20 minutes that demonstrated significant reductions in overall, thigh, moderate, and severe injuries in a well-conducted cluster-RCT, making it a practical evidence-based addition to adolescent football programmes.

For readers

This cluster-RCT provides moderate-strength evidence that the FUNBALL programme, designed with football-specific elements to improve compliance, reduces injury incidence and burden in male adolescent football players over a full competitive season.