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Research and development


Football is the most popular sport worldwide with currently approximately 300 million players in 211 Member Associations. The Fédération Internationale de Football Association (FIFA) has, as the world football governing body, the responsibility to ensure the smooth running of its various competitions, and the development of the game for all age groups, at all levels of play, both genders and all in the spirit of fair play.

Mindful that it also has the responsibility towards the players´ health, FIFA decided to play an active role in developing and supporting research on football medicine. In 1994, the FIFA Medical Assessment and Research Centre (F-MARC) was established to reduce football injuries, and to promote football as a health enhancing leisure activity.

In 1994, epidemiological data related to football injury were sparse. Thus, F-MARC established an injury surveillance system at the 1998 FIFA World Cup France, which is now routinely implemented at all subsequent FIFA and Confederations competitions.

At the same time epidemiological data for recreational football players was obtained in studies performed in the Czech Republic and Germany.  The data revealed that each football player sustained on average 2.1 injuries per year, unrelated to the level of skills. Taking into account 300 million footballers worldwide, it was obvious to FMARC that prevention is the way to go, however not only limited to the prevention of injuries but to all negative aspects occurring in relation to the game of football. “11” was used as synonym for prevention in football.

Apart from assessing the epidemiological data, the individual risk factors for injury and the environmental influences on players’ health, F-MARC’s focus is on improving the standards of care and developing a football-specific injury prevention programme. Having thus explored the contribution of medicine to protect the health of football players, it is only logical to reverse and investigate the contribution of football to protect health in general, meaning to proceed from “Medicine for Football” to “Football for Health”.



for Health

Under the umbrella “Football for Health” the effects of recreational football for the prevention and the treatment of non-communicable diseases has been extensively studied involving children, mature women and ageing men. It revealed that playing football on a regular basis twice a week for 45 minutes has a positive impact on the health status, and could even be prescribed as a therapeutic procedure for a number of diseases such as high blood pressure, diabetes, child obesity and others. The results are based upon more than ten years of research work, including a collective effort of more than 150 researchers.

The “FIFA 11 for Health” programme is a football-based health-educational programme for school children. The programme is being promoted by prominent football players and has been successfully implemented in 23 countries. The programme is continuously being developed and is adapted towards the needs of the countries taking into consideration the social economic environment and the risk factors for diseases.

to prevent injuries

FIFA 11+

The first injury prevention programme we developed consisted of ten evidence based and/or best practice exercises enhanced by the promotion of fair play. Thus, we called the programme the “FIFA 11”.

The programme was subsequently further developed to be a complete warm-up programme focusing on the prevention of injuries: “FIFA 11+”. The programme has been tested in prospective controlled studies on female players in Norway, and on male players in California and Nigeria. All came to the same conclusion: if the programme is performed on a regular basis, injuries can be reduced by 30% while severe injuries can be reduced by 50%. Higher compliance with the programme results in less injuries. The simple conclusion is that injury prevention works but only if performed regularly.

FIFA´s Member Associations have understood the power of the injury prevention programme, and many have implemented the programme to all clubs within their countries – to name but a few – Germany, Japan, Iran, Spain, Italy and others. The programme has since been introduced to more than 90 Member Associations, and the “FIFA 11+” programme become an integrated part of some FIFA development courses. The programme has been also adapted for children (FIFA 11+ for Kids) and referees (FIFA 11+ for Referees).

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11 steps to prevent

sudden cardiac death

Following the tragic death of Marc Vivien Foé during the FIFA Confederations Cup 2003 France, FIFA has been fully committed to a programme of research, education and practical implementation to prevent and manage emergency cardiac arrest on the football field. The pre-competition medical assessment (PCMA) has been routinely implemented for all FIFA competitions. It has also been adapted for the routine examination within the Member Associations in accordance with the international accepted guidelines and recommendations. A clear protocol has been developed and applied for field of play for the recognition, response, resuscitation and the removal of the player under sudden cardiac arrest. In 2013, FIFA has introduced and distributed the FIFA Medical Emergency Bag (FMEB), including an automated external defibrillator (AED), to all Member Associations worldwide. It has been reported that lives have been saved by using this equipment or as a result of educational courses provided by FIFA and/or the Member Associations.

FIFA Medical Centres and Clinics of


As part of the sustainable development of football medicine, 49 FIFA Medical Centres and Clinics of Excellence for football players have been accredited around the world since 2005. The FIFA Medical Centres and Clinics of Excellence, serving the needs of footballers at all levels of play, offering independent assessments including state-of-the-art treatment. Moreover, the centres and clinics have become an important part of the worldwide network for medical football doctors, physiotherapists and paramedical staff who deal with problems on a day-to-day basis with clubs and individual players.


11 rules to

prevent doping

Since the last prominent doping case, involving the most celebrated player Diego Maradona who tested positive for a prohibited substance during the 1994 FIFA World Cup, a stringent strategy has been developed and implemented by FIFA to prevent doping in football.

This includes in and out-of-competition doping controls at the level of FIFA, Confederations and National Leagues as well as educational programmes for players, coaches, doctors and paramedical staff. FIFA supports and is compliant with the World Anti-Doping code improving the protocol of controls by developing the biological profile for individual football players. On average, approximately 30’000 doping controls are performed annually in football, revealing 0.4% positive findings (majority are so-called recreational drugs such as marijuana and cocaine) including 0.06% for performance enhancing substances such an anabolic steroids. Although positive findings are rare, FIFA continues the fight against doping in football and sports in general, while being the first International Federation to implement the biological profile, by collecting blood and urine samples at the same time prior to and during the 2014 FIFA World Cup Brazil.


F-MARC Group

President D’HOOGHE Michel, Dr Belgium

Chairman / FIFA Chief Medical Officer

DVOŘÁK Jiří, Prof. Dr


Head of Research

JUNGE Astrid, Prof. Dr


Members PETERSON Lars, Prof. Dr Sweden
  MADERO, Raúl, Dr Argentina
ZERGUINI Yacine, Dr Algeria
CHOMIAK Jiří, Prof. Dr Czech Republic
EDWARDS Tony, Dr New Zealand
FULLER Colin, Dr England
MANDELBAUM Bert, Dr United States
AHMED Hosny Abdelrahman, Prof. Dr Egypt
KIRKENDALL Donald T, Dr United States
BIZZINI Mario, Dr Switzerland
KRAMER Efraim B., Prof. Dr South Africa
SCHMIED Christian M., Dr Switzerland
D’HOOGHE Pieter, Dr Belgium

Develop the game,
touch the world,
built a better future.

Cooperation and acknowledgment

The F-MARC studies could and can only be conducted with the substantial support of a broad number of persons and institutions. F-MARC would like to thank all collaborating experts, team physicians, coaches, research assistants and people “behind the scene” who substantially contributed to the success of the studies and, especially, the players for their participation in the various projects. In particular, we are extremely grateful for the untiring support of the following people and organisations:

FIFA Member Associations

  • The Football Association LTD
  • Fédération Algérienne de Football
  • Botswana Football Association
  • Confederação Brasileira de Futebol
  • Canadian Soccer Association
  • Cayman Islands Football Association
  • Fotbalová Asociace Ceské Republiky
  • Federación Colombiana De Fútbol
  • Fédération Congolaise de Football-Association
  • Federación Costarricense de Fútbol
  • Federashon Futbol Korsou
  • Dansk Boldspil-Union
  • Deutscher Fussball-Bund
  • Real Federación Española de Fútbol
  • Ghana Football Association
  • Grenada Football Association
  • Fédération Guinéenne de Football
  • Federazione Italiana Giuoco Calcio
  • Jamaica Football Federation Limited
  • Japan Football Association
  • Liberia Football Association
  • Fédération Malagasy De Football
  • Football Association of Malawi
  • Football Association of Martinique
  • Mauritius Football Association
  • Federación Mexicana De Fútbol Asociación, A.C.
  • Myanmar Football Federation
  • Namibia Football Association
  • New Zealand Football Inc.
  • Norges Fotballforbund
  • Oman Football Association
  • Federación Puertorriqueña De Fútbol
  • Schweizerischer Fussballverband
  • Sierra Leone Football Association
  • Solomon Islands Football Federation
  • Football Federation of Sri Lanka
  • St. Lucia Football Association
  • Tanzania Football Federation
  • Tonga Football Association
  • Fédération Tunisienne de Football
  • Türkive Futbol Federasyon
  • U.S. Soccer Federation
  • Football Association of Zambia

Players, Coaches, Referees

  • Alonso X
  • Alves D
  • Bale G
  • Boateng J
  • Buffon G
  • Capello F
  • Charisteas A
  • Puyol C
  • del Bosque V
  • Demel G
  • Drogba D
  • Essien M
  • Eto’o S
  • Falcao R
  • Forlan D
  • Gekas T
  • Guardiola P
  • Henry T
  • Hernandez (Chicharito) J
  • Hodgson R
  • Irmatov R
  • Klinsmann J
  • Lahm Ph
  • Luis D
  • Luxemburgo V
  • Magnin L
  • Marta
  • Mascherano J
  • McCarthy B
  • Messi L
  • Mikel J
  • Miyama A
  • Modise P
  • Muamba F
  • Nedved P
  • Neves T
  • Neymar
  • Pagliuca G
  • Parreira C
  • Piqué G
  • Prinz B
  • Rizzoli N
  • Ronaldo C
  • Ronaldo (Fenomeno)
  • Rosetti R
  • Santa Cruz R
  • Sawa H
  • Scolari F
  • Signori G
  • Steinhaus B
  • Touré K
  • Valdez N
  • Varane R
  • Webb H
  • Xavi


  • FC Barcelona
  • Real Madrid C.F.
  • FC Bayern Muenchen
  • Chelsea F.C.,
  • Manchester City FC
  • Olympique Lyon
  • Corinthians São Paulo
  • Flamengo Rio
  • Inter Mailand
  • Atletico Madrid

Collaborating Universities

  • Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
  • Centre for Healthy and Safe Sport & the Australian Centre for Research into Sports Injury and its Prevention, University of Ballarat, Victoria, Australia
  • Sport Injury Prevention Research Centre, University of Calgary, Calgary, Canada
  • Dept. of Sport and Exercise Sciences, University of Copenhagen, Denmark
  • University of Munich, Munich, Germany
  • Ludwig-Maximilians University, Munich, Germany
  • Saarland University, Saarbruecken, Germany
  • CeRiSM, University of Verona, Italy
  • University of Kuala Lumpur, Kuala Lumpur, Malaysia
  • Oslo Sports Trauma Research Center, Oslo, Norway
  • Dept. of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
  • Department of Emergency Medicine of the University of Witwatersrand, Johannesburg, South Africa
  • University of Cape Town, Cape Town, South Africa
  • Department of Social Medicine and Public Health Science, Linköping University, Linköping, Sweden
  • Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
  • University of Zurich, Zurich, Switzerland
  • Laboratoire suisse d‘Analyse du Dopage, University of Lausanne, Switzerland
  • Swiss Federal Institute of Technology, Zurich, Switzerland
  • School of Sport and Exercise Sciences, Loughborough University, Loughborough, UK
  • Exercise Medicine Centre for Sports Medicine, University of Nottingham, UK
  • University of Leicester, UK
  • Santa Monica Orthopaedic Sports Medicine and Research Foundation, USA
  • Indiana University, Indiana, USA
  • University of North Carolina, Chapel Hill, USA
  • Duke University, Durham, USA
  • Dept. of Biomechanical and Movement Sciences and Biostatistics Core Facility, College of Health Sciences, University of Delaware, Newark, USA
  • Centre d’Evaluation et d’Expertise en Médecine du Sport, Alger, Algeria
  • Biokinetics and Associates Ltd, Canada
  • four Danish University Hospitals, Denmark
  • Copenhagen Research Group, Denmark
  • University Hospital Muenster, Muenster, Germany
  • Ministry of Youth and Sport, Port Louis, Mauritius
  • Mauritius Ministry of Health, Port Louis, Mauritius
  • Accident Compensation Company, New Zealand
  • Oslo Sports Trauma and Research Center, Norway
  • Orthopaedic Sports Medicine Unit, Khoula Hospital, Muscat, Oman
  • Aspetar – Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  • Grassroot Soccer Inc, Cape Town, South Africa
  • Balgrist Clinic, University of Zurich, Switzerland
  • Schulthess Clinik, Zurich, Switzerland
  • Swiss Accident Insurance Fund, Switzerland
  • National Center for Medicine and Scientific Research in Sport, Tunis, Tunisia
  • Harvard Combined Orthopaedic Surgery Program, Boston, Massachusetts, USA
  • Cerner Corporation, USA

Collaborating Institutions

Member Associations of:

  • Spain
  • Japan
  • Italy
  • Brazil
  • Germany
  • Costa Rica
  • Hong Kong
  • Netherlands
  • Denmark
  • Poland
  • Hungary
  • Australia
  • England
  • Thailand
  • Liechtenstein
  • FIFA Medical Committee
  • FIFA Medicine & Science Department
  • FIFA Anti-Doping Unit
  • FIFA Education & Technical Development
  • FIFA Legal Affairs Division
  • FIFA TUE Advisory Group
  • FIFA Refereeing Department
  • World Bank Group

Collaborating National and International Federations

  • IOC
  • FIBA
  • FIH
  • FINA
  • FIVB
  • IAAF
  • IBAF
  • IHF
  • IIHF
  • ISF
  • Confederation of African Football
  • Asian Football Confederation
  • National Collegiate Athletic Association, USA
  • Swiss Referees Association, Switzerland
  • New Zealand Rugby Union, New Zealand
  • Football Associations of Zurich and of North-West Switzerland

Corporations & Individuals

Germany (2)

List 2 (1)

List 3 (1)