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Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial

BMJ 2008; 337 doi: (Published 10 December 2008) Cite this as: BMJ 2008;337:a2469
  1. Torbjørn Soligard, PhD student1,
  2. Grethe Myklebust, associate professor1,
  3. Kathrin Steffen, research fellow1,
  4. Ingar Holme, professor1,
  5. Holly Silvers, physical therapist2,
  6. Mario Bizzini, physical therapist3,
  7. Astrid Junge, associate professor3,
  8. Jiri Dvorak, professor3,
  9. Roald Bahr, professor1,
  10. Thor Einar Andersen, associate professor1
  1. 1Oslo Sports Trauma Research Centre, Norwegian School of Sport Sciences, PO Box 4014 Ullevaal Stadion, 0806 Oslo, Norway
  2. 2Santa Monica Orthopaedic and Sports Medicine Research Foundation, 1919 Santa Monica Blvd, Suite 350, Santa Monica, CA 90404 USA
  3. 3FIFA Medical Assessment and Research Centre, Schulthess Clinic, Lengghalde 2, CH-8008 Zurich, Switzerland
  1. Correspondence to: T Soligard torbjorn.soligard{at}
  • Accepted 26 September 2008


Objective To examine the effect of a comprehensive warm-up programme designed to reduce the risk of injuries in female youth football.

Design Cluster randomised controlled trial with clubs as the unit of randomisation.

Setting 125 football clubs from the south, east, and middle of Norway (65 clusters in the intervention group; 60 in the control group) followed for one league season (eight months).

Participants 1892 female players aged 13-17 (1055 players in the intervention group; 837 players in the control group).

Intervention A comprehensive warm-up programme to improve strength, awareness, and neuromuscular control during static and dynamic movements.

Main outcome measure Injuries to the lower extremity (foot, ankle, lower leg, knee, thigh, groin, and hip).

Results During one season, 264 players had relevant injuries: 121 players in the intervention group and 143 in the control group (rate ratio 0.71, 95% confidence interval 0.49 to 1.03). In the intervention group there was a significantly lower risk of injuries overall (0.68, 0.48 to 0.98), overuse injuries (0.47, 0.26 to 0.85), and severe injuries (0.55, 0.36 to 0.83).

Conclusion Though the primary outcome of reduction in lower extremity injury did not reach significance, the risk of severe injuries, overuse injuries, and injuries overall was reduced. This indicates that a structured warm-up programme can prevent injuries in young female football players.

Trial registration ISRCTN10306290.


  • We thank the project assistants (Birgitte Lauersen, Agnethe Nilstad, Ellen Blom, Olav Kristianslund, Tone Wigemyr, Monika Bayer, Heidi M Pedersen, Vegar Vallestad, and John Bjørneboe), the coaches, and the players who participated in this study. A poster illustrating various exercise components and progressions of programme is available at Also, videos displaying every exercise in the programme (with Norwegian text and narrator) are available at

  • Contributors: TS, GM, KS, HS, MB, AJ, JD, RB, and TEA contributed to study conception, design, and development of the intervention. TS coordinated the study and managed all aspects of the trial, including data collection. IH conducted and initialised the data analyses, which were planned and checked with TS, RB, and TEA. TS, RB, and TEA wrote the first draft of the paper, and all authors contributed to the final manuscript. TS and TEA are guarantors.

  • Funding: This study was supported by grants from the FIFA Medical Assessment and Research Centre. The Oslo Sports Trauma Research Center has been established at the Norwegian School of Sport Sciences through grants from the Royal Norwegian Ministry of Culture and Church Affairs, the South-Eastern Norway Regional Health Authority, the Norwegian Olympic Committee and Confederation of Sport, and Norsk Tipping AS. No author or related institution has received any financial benefit from research in this study.

  • Competing interests: None declared.

  • Ethical approval: The study was approved by the regional committee for medical research ethics, South-Eastern Norway Regional Health Authority, Norway. Players and parents gave individual written informed consent.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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