BJSM form by the coaches. In case of any inconsistencies between the two recordings about the absence of a player due to injury, a member of the research staff contacted the coach and/or paramedic to verify the absence. Given these procedures, reporting bias and underreporting should have been minimal. If any under-reporting exists, it will be restricted to minor injuries because more than 70% of the injuries reported resulted in absence of more than 1 week. In conclusion, there are serious doubts that a general, multicomponent training programme such as The11 is effective in this particular population of adult male amateur soccer players. The nonspecifi c content of the programme, an ineffective intensity, and possibly also the limited number of two training sessions per week available to perform the programme may have caused the programme to become ineffective. Unfortunately, the programme was tested as a single intervention, making it impossible to determine which exercises failed to have an impact on the injury risk. New research should focus on the correct type and dose–response relationship of exercises, specifi cally addressing risk factors for injuries in adult male amateur soccer players. Such research should at least cover the most frequently reported injuries being ankle, knee, upper leg and groin injuries. What are the new fi ndings? Although in some studies The11 was used to reduce injury rates in various populations, its effectiveness has not yet been studied in the largest group of active participants in soccer worldwide: male adult soccer players. In our study among adult male amateur soccer players, The11 did not signifi cantly reduce injury incidence or injury severity. Funding This study was funded by the Netherlands Organization for Health Research and Development (ZonMw), reference number 5050110-96-554, and the Royal Netherlands Football Association (KNVB). The Open Access fee was funded by the Netherlands Organisation for Scientifi c Research (NWO). Competing interests None. Ethics approval The study protocol was approved by the Medical Ethics Committee of the University Medical Centre Utrecht, reference number 08/263. Provenance and peer review Not commissioned; externally peer reviewed. References 1. Inklaar H. Soccer injuries. I: Incidence and severity. Sports Med 1994;18:55–73. 2. Schmikli SL, de Vries WR, Inklaar H, et al. Injury prevention target groups in soccer: injury characteristics and incidence rates in male junior and senior players. J Sci Med Sport 2011;14:199–203. 3. Consumer Safety Institute. Factsheet Blessures door veldvoetbal (in Dutch) [Factsheet on outdoor soccer injuries]. Amsterdam: Consumer Safety Institute, 2011. 4. Ekstrand J, Hagglund M, Walden M. Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med 2011;39:1226–32. 5. Ekstrand J, Hagglund M, Walden M. Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med 2011;45:553–8. 6. Emery CA, Meeuwisse WH, Hartmann SE. Evaluation of risk factors for injury in adolescent soccer: implementation and validation of an injury surveillance system. Am J Sports Med 2005;33:1882–91. 7. Aaltonen S, Karjalainen H, Heinonen A, et al. Prevention of sports injuries: systematic review of randomized controlled trials. Arch Intern Med 2007;167:1585–92. Correction notice This paper has been corrected since it was published Online First. The fi rst author’s fi rst name has been corrected to Anna. Also in table three, in the row named ‘Injury severity’ the numbers in the Intervention and Control groups were wrong and these have been corrected. Acknowledgements We are grateful to the district managements of the Royal Netherlands Football Association (KNVB), representatives of the participating soccer clubs (board members, coaches, and medical staff ) and the soccer players involved. Contributors In accordance with the Vancouver Protocol, all seven authors have substantially contributed to conception and design, acquisition of data or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; and fi nal approval of the version to be published. 8. Emery CA, Meeuwisse WH. The effectiveness of a neuromuscular prevention strategy to reduce injuries in youth soccer: a cluster-randomised controlled trial. Br J Sports Med 2010;44:555–62. 9. Junge A, Dvorak J. Soccer injuries: a review on incidence and prevention. Sports Med 2004;34:929–38. 10. Arnason A, Andersen TE, Holme I, et al. Prevention of hamstring strains in elite soccer: an intervention study. Scand J Med Sci Sports 2008;18:40–8. 11. Askling C, Karlsson J, Thorstensson A. Hamstring injury occurrence in elite soccer players after preseason strength training with eccentric overload. Scand J Med Sci Sports 2003;13:244–50. 12. Petersen J, Thorborg K, Nielsen MB, et al. Preventive effect of eccentric training on acute hamstring injuries in men’s soccer: a cluster-randomized controlled trial. Am J Sports Med 2011;39:2296–303. 12 Sport & Geneeskunde | december 2012 | nummer 5 Pagina 11
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