The 11+ of the future: a primary injury prevention framework for sub-elite football.

Originally developed as a way to integrate injury risk mitigating exercises into the warm-up,1 the 11+ importantly reduces injury incidence and burden by ~40% in men’s sub-elite football.2 Despite its efficacy as a primary injury mitigation strategy, challenges remain regarding 11+ compliance and adoption.3 This editorial presents a new framework that modernises the programme and tackles issues related to 11+ adoption. A lack of coach/player buy-in, complaints regarding its prolonged duration, and concerns that some exercises (part 2: strength exercises and plyometrics) induce fatigue, are established barriers to 11+adoption.3 Although recent research has identified strategies to improve the efficacy and adoption of the 11+, it has not been updated since its 2009 launch.2 The challenge, thus, remains to develop a framework that facilitates implementation of risk reduction strategies, while maintaining the initial philosophy of the original 11+, that is, deliverable by a coach with minimal experience or equipment. The proposed new framework is outlined in figure 1. Figure 1 New framework incorporating the key elements of education, risk reduction …