Neuromuscular warm-ups

What it is

How research describes the 11+

A systematic review (a study that sums up the research on a question) describes the FIFA 11+ as a complete warm-up of 15 exercises¹. They cover core stability, eccentric (lengthening) thigh work, dynamic stability and jumping¹. They also include proprioceptive training (training the body’s sense of where its joints are)¹.

A trial of the 11+ studied 1,892 female football players aged 13 to 17⁵. There the programme had three parts:

• slow running mixed with active stretching and controlled contact with a partner⁵;
• six sets of strength, balance and jumping exercises, each at three levels of difficulty⁵;
• faster running with football moves and sudden changes of direction⁵.

In that version the parts took 8, 10 and 2 minutes, about 20 minutes once players knew the routine⁵. The middle part included the plank, the side plank and the Nordic hamstring lower⁵. It also had single-leg balance, squats building to lunges and one-leg squats, and jumps building to box jumps⁵.

The trial introduced the programme with a focus on control while running, cutting, jumping and landing⁵. The focus was on core stability, hip control and keeping the knee out of excess valgus (a knock-kneed angle)⁵. Players were asked to watch each other and give feedback⁵.

Other programmes and broader labels

Two other studied programmes mix similar drills^6,7:

Programme	Content	Time
Knäkontroll, players aged 12 to 17 at Swedish clubs	Six exercises, including knee squats, the lunge and jump-landing technique, each in four steps6	About 15 minutes, twice a week6
11+ Kids, children’s football teams	Seven exercises: hopping and landing, trunk and whole-body strength, and falling technique7	About 15 to 20 minutes7

A 2025 review looked at strategies for lower-limb injuries in female athletes³. It called this kind of programme neuromuscular training (exercise aimed at how nerves and muscles work together to control movement)³. They were the most studied approach to lower-limb injuries, in 60 of the 82 studies³.

What it loads

The load measures here come from two small studies of men^8,9. An imaging study of 10 healthy men looked at 20 minutes of the 11+‘s middle part⁸. Afterwards, some muscles took up more glucose (sugar) than in a seated control group⁸. They were the rectus abdominis (a long, flat muscle down the front of the abdomen) and two buttock muscles, gluteus medius and minimus⁸.

In 20 amateur male footballers, the 11+ raised oxygen use at rest from 325 to 379 mL a minute⁹. Core temperature rose from 37.3 to 37.7 °C, and blood lactate from 1.0 to 2.6 mmol/L⁹. After it, sprint, agility, jump, stiffness and balance results improved by 1.0 to 6.2%⁹. Maximal isometric (holding) strength and rate of force development did not change significantly⁹. The authors judged the gains comparable with other warm-ups⁹.

A review of 33 studies drew a different picture of the 11+ done right before activity¹⁰. Against dynamic warm-ups, it had negative effects on physical performance and no significant effects on technical skills¹⁰. The review notes that the research on this is contradictory¹⁰.

How the body adapts

Balance, strength and speed

A 2026 meta-analysis pooled 17 studies of 611 football players aged 9 to 29¹¹. Compared with conventional warm-ups, the 11+ gave small-to-moderate gains in dynamic balance, change-of-direction speed and vertical jump height¹¹. It made no statistically significant difference to 10-metre or 20-metre sprint speed¹¹. Gains in change-of-direction speed and jump height were larger in players aged 18 and over, and in males¹¹. Most studies were in males, which the authors say limits how far this applies to female players¹¹.

A randomised trial (a study that assigns people to groups by chance) studied 81 male amateur players¹². They did the 11+ three times a week for 9 weeks¹². Compared with a usual warm-up, it improved time-to-stabilisation by 2.8% and a core-stability test by 8.9%¹². Strength of the muscles that bend the knee rose slightly, and jump, sprint and agility showed no substantial differences¹².

The review of 33 studies found that mid-to-long-term use improved most biomechanical (to do with the forces and movements in the body) measures¹⁰. Included studies consistently found gains in hamstring and quadriceps strength and less knee valgus collapse during a 90° cut¹⁰.

A separate meta-analysis pooled 16 trials of programmes aimed at reducing injury, in 976 female team-sport athletes¹³. It found very low certainty evidence of about 3 degrees more knee bend in tasks linked to ACL injury¹³. It found very low to low certainty evidence of no effect on hip and knee moments (turning effects of a force around a joint)¹³. The same held for ground reaction forces (the push of the ground back up on the body)¹³.

A review of 8 studies in young athletes, mostly footballers, looked at programmes aimed at reducing injury, most often the FIFA 11+ series¹⁴. It found no significant effect on endurance¹⁴.

Measure (8 studies in young athletes)	Average improvement (%)
Force generation	11.314
Coordination	5.714
Balance	5.214
Posture	5.214
Speed	2.214

Injuries in football trials of the 11+

A meta-analysis of four football trials found about 39% fewer injuries in teams that used the 11+². Its rate ratio (one group’s rate divided by the other group’s) was 0.61². The earlier FIFA 11 programme, in two trials, showed no fall in injuries (0.99)². Another meta-analysis of six trials found 24% of players injured in 11+ groups, against 40% in control groups¹. Its results were not consistent across studies, because of clinical and method differences¹.

Single trials show the range^5,15:

• Teenage girls. The trial in 1,892 players missed its main target: lower-limb injuries were not significantly reduced⁵. Injuries overall, overuse injuries and severe injuries were significantly lower in the warm-up group⁵.
• College men. In a randomised trial in US college men’s soccer, 11+ teams had 8.09 injuries per 1,000 athlete-exposures against 15.04 in control teams¹⁵. An athlete-exposure is one athlete taking part in one practice or game.
• Children. A trial had 3,895 players, average age 10.8⁷. The group that replaced its usual warm-up with 11+ Kids had a 48% lower injury rate⁷.
• Men over 40. A narrative review reports that a trial in veteran male footballers found little effect, with low, once-a-week use a limiting factor¹⁶.

Injuries in youth sport more widely

A meta-analysis of 21 trials in 27,561 athletes under 19 found an injury rate ratio of 0.54 with exercise-based programmes¹⁷. Results were similar for programmes run before and during the season¹⁷. Programmes with jumping exercises showed a larger fall (0.45) than those without (0.74)¹⁷. In the same analysis, girls benefited more than boys¹⁷.

A youth-sport meta-analysis found a lower rate of lower-limb injury in groups that trained (0.64)¹⁸. Its estimate for knee injury (0.74) was not statistically significant¹⁸. A review of training to prevent sports injuries drew on 7 well-conducted studies¹⁹. It linked training with several components to fewer lower-limb injuries, acute knee injuries and ankle sprains¹⁹. Balance training alone was linked with fewer ankle sprains, but not significantly fewer injuries overall¹⁹.

ACL injuries in female athletes

Several reviews looked at the ACL (anterior cruciate ligament)^3,4. A 2025 review for the FAIR consensus defined the programmes as lower-limb balance, strength, agility and change-of-direction exercises³. They ran at least 10 minutes twice a week³. The table gives its results with 95% confidence intervals (a range showing how precise a result is):

Outcome in female athletes	Estimate	Certainty
ACL injuries	61% fewer (0.39; 0.25 to 0.60)3	High3
Ankle sprains	An estimated 39% fewer (0.61; 0.36 to 1.03)3	Moderate3
Lower-limb injuries	An estimated 19% fewer (0.81; 0.61 to 1.08)3	Low3

A summary of eight meta-analyses found about 50% lower odds of any ACL injury with ACL-focused training programmes⁴. Six of the eight studied female athletes alone⁴. In women’s football, a meta-analysis of 11,773 players linked multicomponent programmes with 27% fewer injuries overall²⁰. It found 45% fewer ACL injuries, but rated the evidence low-level²⁰. All but one of its studies had a high risk of bias (a rating of how likely flaws skewed the result)²⁰.

A trial at Swedish clubs studied 4,564 female players aged 12 to 17⁶. Seven in the warm-up group had an ACL injury, against 14 controls⁶. The rate ratio was 0.36, but the difference in absolute rates was not statistically significant⁶. Severe knee injuries and sudden knee injuries of any kind were not significantly reduced⁶.

A meta-analysis of 14 trials in female athletes compared ages²¹. The odds ratio (how many times higher the odds are in one group than another) was lowest in mid-teens, at 0.28²¹. It was 0.48 in late teens, which was not statistically significant, and 1.01 in early adults²¹.

Dose and how often players took part

A meta-analysis of 14 trials in female athletes found larger ACL reductions with longer programmes (0.35 against 0.61)²². Reductions were also larger with more frequent sessions (0.35 against 0.62)²². They grew from low to moderate to high training volume (0.66, 0.46 and 0.32), though the moderate figure was not statistically significant²².

Among 1,055 female players aged 13 to 17, those who did the 11+ most had a 35% lower injury risk than the middle group²³. In another cohort of female players aged 12 to 17, the top third for use had an 88% lower ACL injury rate²⁴. That was against the bottom third²⁴. In adolescent female teams, use fell over the season, by about 3% a month for teams and 5% for players²⁴.

In 301 youth floorball players, boys doing Knee Control at least twice a week had fewer injuries than those doing it less than weekly²⁵. Girls showed no difference by how often they did it²⁵.

Connections

The middle part of the 11+ includes the plank, the side plank, the Nordic hamstring curl and one-leg squats⁵. Knäkontroll includes jump-landing technique, the subject of the drop landing page⁶. In a trial of 45 elite male players under 19, one group did the 11+ with the Copenhagen adductor plank in place of the Nordic²⁶. After 8 weeks, their eccentric hip adduction (moving the thigh toward the body’s midline) strength rose 8.9% more²⁶. The standard 11+ produced no change²⁶.

The 11+ includes balance, jumping and eccentric work, and each has its own method page: balance training, plyometric training and eccentric training¹. An analysis of 25 trials of sports injuries compared resistance training, proprioception training, mixed programmes and stretching²⁷.

The imaging study measured muscle, and the ACL findings concern ligament tissue^3,8. For the injuries studied, see the ACL, ACL tear and ankle sprain pages³.

Sources

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Every source the library cites

Changes

• September 30, 2026 First published.