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

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.

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.