Myofascial Release Combined With FIFA 11+: Effects on Hamstring Flexibility and Injury Risk

Effect of Myofascial Release Combined With the FIFA 11+ Program on Hamstring Flexibility and Injury Risk in Football Players

Football is a physically demanding sport that involves frequent jumping, cutting, and sudden changes in direction, making players vulnerable to various musculoskeletal injuries especially around the knee(1, 2). If not properly addressed, such mechanical demands can place excessive stress on key structures like the Hamstring, ACL and MCL, increasing the risk of injury during high-impact movement(1). Hamstring strains are one of the most common injuries among football players, with significant impact on their performance and career longevity(1). These injuries are especially prevalent due to the high-intensity nature of football, involving rapid sprinting, cutting, and changes of direction. Studies have shown that hamstring strains account for a substantial proportion of all injuries in football, ranging from 12% to 20% of total injuries in professional and amateur levels. Given the high rate of recurrence and the long recovery times associated with hamstring injuries, there has been growing interest in injury prevention programs aimed at reducing the risk of these injuries. Many of these injuries stem from deficits in dynamic balance, inadequate landing strategies, and reduced strength in the lower limbs(3). When such deficits persist, they increase biomechanical load on the knee joint, raising the likelihood of ligament injuries during explosive actions(4). By addressing these movement impairments, programs like FIFA 11+ aim to improve neuromuscular coordination and reduce injury rates among football players

Study Overview

• Status: Recruiting
• Conditions: Hamstring Injury
• Intervention / Treatment: Other: FIFA 11+ COMBINE WITH MYOFACICAL RELEASE TECHNIQUE; Other: Routine warm up session

Detailed Description

Although the FIFA 11+ program has been widely studied, there is limited evidence on its effectiveness in addressing hamstring injury-related factors combined with myofascial release among academy-level male football players in Pakistan. Most existing research focuses on professional athletes from developed countries and often lacks detailed assessments of neuromuscular and biomechanical components. Additionally, few studies have employed a randomized control design. This study will address these gaps by evaluating the FIFA 11+ program using validated assessment tools within a local youth football population.

This study will be significant, as it focuses on an underrepresented group, academy-level male football players in Pakistan, where data on injury prevention remains scarce. By examining the effects of the FIFA 11+ program on hamstring-related biomechanical and neuromuscular outcomes, the study will provide insights beyond basic injury incidence. The results will help inform effective, evidence-based warm-up strategies adapted to the local football environment.

Hamstring injuries are a frequent concern in football, often impairing player performance and longevity. A survey of male footballers from Peshawar clubs found a 53.3% prevalence of lower limb injuries, highlighting high injury risk at the grassroots level in Pakistan.

While FIFA 11+ has demonstrated strong preventive outcomes, its direct impact on flexibility is limited. Myofascial release offers an evidence-based method for improving hamstring extensibility, which could reduce strain risk. By combining MFR with FIFA 11+, this study addresses two major modifiable risk factors, flexibility deficits and poor neuromuscular control, thereby potentially reducing injuries more effectively than either approach alone.

• Study Type: Interventional
• Enrollment (Estimated): 28
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Zavata Afnan, MS NMPT; Phone Number: 03434411214; Email: Zavata.afnan@riphah.edu.pk

Study Locations

• Pakistan
  • KPK
    • Chakdara, KPK, Pakistan, 18800
      • Recruiting
      • Riphah international University Malakand Campus
      • Contact: Zavata Afnan, MS NMPT; Phone Number: 03434411214; Email: Zavata.afnan@riphah.edu.pk
      • Principal Investigator: Muhammad idrees, MS OMPT

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Male football players aged 16-30 years.
• Able to comply with a 6-week FIFA 11+ program.
• Provide informed consent.

Exclusion Criteria:

• Acute or chronic hamstring injury.
• Recent major surgery of the lower limb or ongoing rehab plan.
• Inability to safely perform exercises included in the FIFA 11+ program.
• Non-compliance with baseline assessments or the training schedule.
• Current musculoskeletal injuries affecting lower limb function.
• Unable to achieve ≥65% limb symmetry index (LSI) in any hop test.
• Undergoing physiotherapy or post-rehabilitation care.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: intervention group; The intervention group will participate in the FIFA 11+ injury prevention program, which includes a structured series of exercises designed to improve strength, balance, and neuromuscular control. The program will be conducted three times per week for Six weeks as part of their regular training schedule. Myofascial Release: Manual therapist will perform standardized MFR techniques on hamstring fascia prior to FIFA 11+ sessions, lasting 10-15 minutes.	Other: FIFA 11+ COMBINE WITH MYOFACICAL RELEASE TECHNIQUE; The intervention group will participate in the FIFA 11+ injury prevention program, which includes a structured series of exercises designed to improve strength, balance, and neuromuscular control. The program will be conducted three times per week for Six weeks as part of their regular training schedule. Myofascial Release: Manual therapist will perform standardized MFR techniques on hamstring fascia prior to FIFA 11+ sessions, lasting 10-15 minutes.
Experimental: Control group; the control group will continue their standard warm-up routines without incorporating the FIFA 11+ exercises. Frequency: 3 sessions per week for 6 weeks (same as the intervention group). Consistency: Participants will continue their usual warm-up routine without modifications.	Other: Routine warm up session; the control group will continue their standard warm-up routines without incorporating the FIFA 11+ exercises

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Injury Surveillance Form	Players' baseline information form, Injury report form, exposure report form.	six weeks
Manual Muscle Testing (MMT) for strength	to assess the muscles' strength on a scale of 5	Six weeks
Passive Straight Leg Raise (SLR) with Goniometer	to assess hamstring flexibility	Six weeks
Single-Leg Hop Test for Distance	(To assess functional outcome)	Six weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Zavata Afnan, MS NMPT, Riphah International University

Study record dates

Study Major Dates

• Study Start (Actual): November 15, 2025
• Primary Completion (Estimated): May 30, 2026
• Study Completion (Estimated): July 31, 2026

Study Registration Dates

• First Submitted: March 16, 2026
• First Submitted That Met QC Criteria: March 16, 2026
• First Posted (Actual): March 20, 2026

Study Record Updates

• Last Update Posted (Actual): March 20, 2026
• Last Update Submitted That Met QC Criteria: March 16, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: REC-01025 Muhammand Idrees

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No