Back to News Combating an injury epidemic and more on FIFA 11+ with Dr. Bert Mandelbaum Interview by Mike Woitalla, Soccer America, Oct. 30, 2012 Dr. Bert Mandelbaum, the team physician for U.S. Soccer national teams, has been a pioneer in researching ACL injury trends among female athletes and creating injury prevention methods for soccer players. We talked to him about what youth coaches can do to decrease the chances of injuries and the FIFA 11+ warmup procedure that he's promoting through the Sports Injury Prevention Program. SOCCER AMERICA: I had a couple of USSF-nationally licensed coaches when I played youth soccer in the 1970s and 80s. Now I coach U-13 girls. If I warm up my players the same way my coaches warmed up us back then, might I be doing it incorrectly? BERT MANDELBAUM: You would not be doing it right. We spent the late 1990s studying youth soccer – here in Southern California where unfortunately it is so competitive and it is a 12-month season for most young, competitive girls – and we saw many injuries in the anterior cruciate ligament (ACL). ACL injuries had become a tremendous epidemic problem in 14- to 18-year-old girls. We began to ask ourselves, "How the hell is this happening?" We [watched] hundreds of videos. We observed how they land, jump and accelerate. We came up with a consensus based on neuromuscular control and the position and the biomechanics of landing. We created the PEP (Prevent injury, Enhance Performance Program), which were basically five exercises that took 20 minutes … that would be the warm-up that would get these young girls to do the things that they weren’t doing naturally, that they weren’t pre-programmed for. SA: You noticed a difference between the boys and girls … BERT MANDELBAUM: If you compare young boys and young girls at the same age – the boys would be down low like Cobi Jones. Everything is very low to the ground. And the young girls would be like giraffes. Where their hips, their knees would be located in the wrong position when they land and jump. It was so consistently scientific that the Program made a huge difference. That it finally taught them how to do these things. SA: When one talks about today’s children playing too much organized soccer -- such as in tournament formats with several games in a weekend -- some will point out that previous generations played pickup soccer all day and it wasn’t a problem. Is that a fair comparison? BERT MANDELBAUM: There’s a big difference. If you’re playing a pickup game and it’s 104 degrees, maybe you play for 45 minutes, sit under a tree for 45 minutes, then you may go play for another 20 minutes. Then you maybe you say, OK I’m just gonna watch the baseball game in the afternoon because it’s too hot. Then come out in the evening. You control yourself. When you’re playing these tournaments when it’s 98 degrees and you’re also playing midweek games -- 98 degrees and 95 percent humidity, and you have three games a day, that doesn’t make sense. One thing we do know, with fatigue, all these biomechanical deficiencies that we’re trying to correct worsen. We try and correct bad biomechanics. But with fatigue, we know they crawl out the bottom. All of them. So if you have someone playing in 98 degrees -- and usually with 14-year-old girls it’s playing 60 minutes -- by minute 45 she’s so fatigued the biomechanics just go out. There’s no way of her preventing herself from doing the bad things that she was trying to prevent. The first game is no different than the fifth game. In fact maybe the fifth game is even more intense than the first. I’ve been with MLS since its inception  and we have a hard time getting the guys to play games on Thursday and Sundays. Here are these kids playing five games Saturday and Sunday. I think we’re doing the wrong thing there. I think we’re sending the wrong message. We’re potentially increasing the injury rate. SA: Many coaches feel they have no option but to compete in weekend tournaments because they have become such a major part of the youth soccer culture. What can they do to ensure the health of his or her players? BERT MANDELBAUM: If you have to do this, have more players and substitute as much as you can. Rehydrate them as best you can. And have them live by the concept that "less is more." SA: For what age level is FIFA 11+ designed for? BERT MANDELBAUM: The program was developed initially for 14- to 18-year-olds girls. Then 14- to 18-year-old boys. Now it’s really for all ages. The FIFA 11+ program is set up as a core warmup that can be done for any ages. SA: What do you say to youth coaches who don’t implement the whole warm-up because they may see it as 20 minutes less to train other things during a 90-minute soccer practice? BERT MANDELBAUM: If you brush your teeth only once a week, you’re going to get more cavities. Prevention is prevention. This is a priority. If you look at FIFA 11+ data, you find you can reduce overuse injuries by a half. Yes, that particular evening you’re going to feel pressured to get it all in. The reality is it’s like an investment. You’ll get more on the other side. If you understand the front-end, if you understand the impact, and you calculate the number of days lost [because of injuries] for your team, you’re going to come out way ahead by the end of the season. For more on the Sports Injury Prevention Program, go here and here. For more on the FIFA 11+ Warm-up Program and downloadable Manual, go here. For a video of Cobi Jones and Alex Morgan demonstrating FIFA 11+ exercises, go here.