Four Months Training with the Football+ and 11+ Improves the Landing Quality of Female Players

Abstract

The effectiveness of the Football+- and 11+-programs in improving landing quality among players with a history of severe ankle or knee injury remains unexplored. This study examined (i) the efficacy of these programs in developing landing assessed via the Landing Error Scoring System (LESS) and (ii) the association between injury history and landing quality. Fifty-six amateur female players (24.12±5.37 y) reported their injury history and completed the LESS test before and after a 4-month intervention. Repeated-measures analysis of variance and independent t-tests analyzed the outcomes at p≤0.05. Players with a history of severe ankle (6.33±1.53; p = 0.019 and d = –0.76) or knee (5.92±0.74; p =0.041, d =–0.77) injury exhibited higher LESS scores compared to the non-injured counterparts (5.25±1.37). Analysis of variance revealed a significant time (p = 0.001 and η ²= 0.31) and time-group effects (p = 0.002 and η ²= 0.24) following the 11+ (5.59±1.35 vs. 5.04±1.47) and the Football+ (5.76±1.55 vs. 4.65±1.37). A history of severe knee or ankle injury reduces the landing quality. Both the Football+ and 11+ improved landing, with the Football+ demonstrating greater efficacy. Previously injured players benefited most, although their landing performance remained inferior to non-injured peers. While the injury history is traditionally regarded as a non-modifiable risk factor, targeted neuromuscular programs may partially mitigate its impact on movement quality.

Keywords

Injury history - women’s football - landing technique - injury prevention - LESS

Publication History

Received: 07 May 2025

Accepted after revision: 22 January 2026

Article published online:
19 February 2026

• References

• 1 Del Coso J, Herrero H, Salinero JJ. Injuries in Spanish female soccer players. J Sport Health Sci 2018; 7: 183-190
• 2 Geertsema C, Geertsema L, Farooq A. et al. Injury prevention knowledge, beliefs and strategies in elite female footballers at the FIFA Women’s World Cup France 2019. Br J Sports Med 2021; 55: 801-806
• 3 Hartmut G, Becker A, Walther M. et al. Injuries in women's soccer: a 1-year all players prospective field study of the womenʼs Bundesliga (German premier league). Clin J Sport Med 2010; 20: 264-271
• 4 Ibikunle PO, Efobi KC, Nwankwo MJ. et al. UEFA model in identification of types, severity and mechanism of injuries among footballers in the Nigerian Women’s Premier League. BMJ Open Sport Exerc Med 2019; 5: e000386
• 5 Jacobson I, Tegner Y. Injuries among Swedish female elite football players: a prospective population study. Scand J Med Sci Sports 2007; 17: 84-91
• 6 Ekstrand J, Hägglund M, Fuller C. Comparison of injuries sustained on artificial turf and grass by male and female elite football players. Scand J Med Sci Sports 2011; 21: 824-832
• 7 Babwah TJ. The incidence of injury in a Caribbean amateur women’s football league. Res Sports Med 2014; 22: 327-333
• 8 Horan D, Blake C, Hägglund M. et al. Injuries in elite‐level women’s football—a two‐year prospective study in the Irish Women’s National League. Scand J Med Sci Sports 2022; 32: 177-190
• 9 Kirkendall DT, Krustrup P. Studying professional and recreational female footballers: A bibliometric exercise. Scand J Med Sci Sports 2022; 32: 12-26
• 10 Asgari M, Alizadeh S, Sendt A. et al. Evaluation of the Functional Movement Screen (FMS) in Identifying Active Females Who are Prone to Injury. A Systematic Review. Sports Med Open 2021; 7: 85
• 11 Hanzlíková I, Hébert-Losier K. Is the Landing Error Scoring System Reliable and Valid? A Systematic Review. Sports Health 2020; 12: 181-188
• 12 Padua DA, DiStefano LJ, Beutler AI. et al. The Landing Error Scoring System as a Screening Tool for an Anterior Cruciate Ligament Injury–Prevention Program in Elite-Youth Soccer Athletes. J Athl Train 2015; 50: 589-595
• 13 Padua DA, Marshall SW, Boling MC. et al. The Landing Error Scoring System (LESS) Is a Valid and Reliable Clinical Assessment Tool of Jump-Landing Biomechanics: The JUMP-ACL Study. Am J Sports Med 2009; 37: 1996-2002
• 14 Hanzlíková I, Athens J, Hébert-Losier K. Factors influencing the Landing Error Scoring System: Systematic review with meta-analysis. J Sci Med Sport 2021; 24: 269-280
• 15 Tegnander A, Olsen OE, Moholdt TT. et al. Injuries in Norwegian female elite soccer: a prospective one-season cohort study. Knee Surg Sports Traumatol Arthrosc 2008; 16: 194-198
• 16 John C, Stotz A, Gmachowski J. Is an elastic ankle support effective in improving jump landing performance, static and dynamic balance in young adults with and without chronic ankle instability?. J Sport Rehabil 2019; 29: 789-794
• 17 van Rijn RM, Van Os AG, Bernsen RM. et al. What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med 2008; 121: 324-331 .e6
• 18 Verhagen E, Bay K. Optimising ankle sprain prevention: a critical review and practical appraisal of the literature. Br J Sports Med 2010; 44: 1082-1088
• 19 Hoch MC, McKeon PO. Peroneal reaction time after ankle sprain: a systematic review and meta-analysis. Med Sci Sports Exerc 2014; 46: 546-556
• 20 Akbari H, Sahebozamani M, Daneshjoo A. et al. Effect of the FIFA 11+ on Landing Patterns and Baseline Movement Errors in Elite Male Youth Soccer Players. J Sport Rehabil 2020; 29: 730-737
• 21 Parsons JL, Carswell J, Nwoba IM. et al. Athlete perceptions and physical performance effects of the fifa 11+ program in 9-11 year-old female soccer players: a cluster randomized trial. Int J Sports Phys Ther 2019; 14: 740
• 22 Winstanley C, Reid D, Fulcher ML. Suggested improvements to the 11+ as identified by coaches, players, strength and conditioning staff and medical staff in New Zealand Football. BMJ Open Sport Exerc Med 2023; 9: e001463
• 23 Asgari M, Alizadeh MH, Shahrbanian S. et al. Effects of the FIFA 11+ and a modified warm-up programme on injury prevention and performance improvement among youth male football players. PLoS One 2022; 17: e0275545
• 24 Asgari M, Nazari B, Bizzini M. et al. Effects of the FIFA 11+ program on performance, biomechanical measures, and physiological responses: A systematic review. J Sport Health Sci 2023; 12: 226-235
• 25 O'Brien J, Finch CF. Injury prevention exercise programmes in professional youth soccer: understanding the perceptions of programme deliverers. BMJ Open Sport Exerc Med 2016; 2: e000075
• 26 O'Brien J, Young W, Finch C. The use and modification of injury prevention exercises by professional youth soccer teams. Scand J Med Sci Sports 2017; 27: 1337-1346
• 27 O’Brien J, Young W, Finch CF. The delivery of injury prevention exercise programmes in professional youth soccer: Comparison to the FIFA 11+. J Sci Med Sport 2017; 20: 26-31
• 28 Asgari M, Schmidt M, Terschluse B. et al. Acute effects of the FIFA11+ and Football+ warm-ups on motor performance. A crossover randomized controlled trial. PLoS One 2023; 18: e0284702
• 29 Faul F, Erdfelder E, Buchner A. et al. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav Res Methods 2009; 41: 1149-1160
• 30 Hirschmüller A, Steffen K, Fassbender K. et al. German translation and content validation of the OSTRC Questionnaire on overuse injuries and health problems. Br J Sports Med 2017; 51: 260-263
• 31 Gribble PA, Delahunt E, Bleakley C. et al. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. J Orthop Sports Phys Ther 2013; 43: 585-591
• 32 Fuller CW, Ekstrand J, Junge A. et al. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Scand J Med Sci Sports 2006; 16: 83-92
• 33 Soligard T, Myklebust G, Steffen K. et al. Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ 2008; 337: a2469
• 34 Rhea MR. Determining the magnitude of treatment effects in strength training research through the use of the effect size. J Strength Cond Res 2004; 18: 918-920
• 35 Scarneo SE, Root HJ, Martinez JC. et al. Landing Technique Improvements After an Aquatic-Based Neuromuscular Training Program in Physically Active Women. J Sport Rehabil 2017; 26: 8-14
• 36 Parsons JL, Sylvester R, Porter MM. The effect of strength training on the jump-landing biomechanics of young female athletes: results of a randomized controlled trial. Clin J Sport Med 2017; 27: 127-132
• 37 Glasgow P, Bleakley CM, Phillips N. Being able to adapt to variable stimuli: the key driver in injury and illness prevention?. Br J Sports Med . 47 2013; 64-65
• 38 Theisen A, Day J. Chronic ankle instability leads to lower extremity kinematic changes during landing tasks: a systematic review. Int J Exerc Sci 2019; 12: 24
• 39 Gribble PA, Bleakley CM, Caulfield BM. et al. Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med 2016; 50: 1496-1505
• 40 Anandacoomarasamy A, Barnsley L. Long term outcomes of inversion ankle injuries. Br J Sports Med 2005; 39: e14
• 41 Bell DR, Smith MD, Pennuto AP. et al. Jump-Landing Mechanics After Anterior Cruciate Ligament Reconstruction: A Landing Error Scoring System Study. J Athl Train 2014; 49: 435-441
• 42 Kuenze CM, Foot N, Saliba SA. et al. Drop-Landing Performance and Knee-Extension Strength After Anterior Cruciate Ligament Reconstruction. J Athl Train 2015; 50: 596-602
• 43 Gokeler A, Eppinga P, Dijkstra P. et al. Effect of fatigue on landing performance assessed with the landing error scoring system (less) in patients after ACL reconstruction. A pilot study. Int J Sports Phys Ther 2014; 9: 302
• 44 Han YH, Li B, Wen Y. Distribution, quantity and gene expression of mechanoreceptors in ligaments and tendons of knee joint in rabbits. J Mol Histol 2020; 51: 233-240
• 45 Lam KC, Valovich McLeod TC. The Impact of Sex and Knee Injury History on Jump-Landing Patterns in Collegiate Athletes: A Clinical Evaluation. Clin J Sport Med 2014; 24: 373-379
• 46 O'Malley E, Murphy JC, Persson UM. et al. The effects of the gaelic athletic association 15 training program on neuromuscular outcomes in gaelic football and hurling players: a randomized cluster trial. J Strength Cond Res 2017; 31: 2119-2130