FIFA 11+ Referee

prevention programme

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FIFA 11+ Referee

to prevent injuries in referees and assistant referees

The physiological match demands of refereeing have increased over the years due to the development of modern football. During a high level match, a referee may cover a mean distance of 11.5km (a mix of walking, running, sprinting), which is comparable to the distance covered by a midfielder. Elite referees may perform up to 1,270 activity changes (i.e. direction changes), and take more than 130 decisions during a match. The high demands on the cardiovascular and musculoskeletal system entail a certain risk of acute and overuse injuries.

F-MARC studies showed that the risk of non-contact injuries for elite referees is similar or lower than that of a football player. The career prevalence of musculoskeletal complaints (“overuse”) can be estimated to be at least 90%. The most common injuries were hamstring strains, calf strains and ankle sprains. Musculoskeletal complaints in the low back, hamstring, knee, calf and Achilles tendon were frequent. The injury type and location of musculoskeletal complaints were similar amongst referees at all levels of performance and between genders.

The “FIFA 11+ Referee” injury prevention programme has been developed by an international group of experts based on the specific injury profile of referees and on the “FIFA 11+”.


„Prevention is a key component in the overall training of today’s referees: also thanks to this approach we’ve achieved great results in the two last FIFA World Cups (2014, 2015)“

Massimo Busacca, Head of FIFA Refereeing

FIFA 11+ Referee


The “FIFA 11+ Referee” aims to reduce acute non-contact injuries and minimise musculoskeletal complaints throughout referees’ careers. It is a complete warm-up programme and consists of three parts with a total of 18 exercises, which takes around 20 minutes and should be performed in the given sequence before each training session. Prior to matches, only the running exercises (see manual/ poster) should be performed. For all exercises, optimal technique and performance is of great importance. Therefore, a coach should supervise the programme and correct the referees if necessary.


World champions as a

role model

Nicola Rizzoli, Italian FIFA referee and match official of the 2014 FIFA World Cup final in Brasil, is one of the ambassadors of the ‘FIFA 11+ Referee’.

The program was first launched in 2013 in Italy with the cooperation of the Italian Referee Association (Associazione Italiana Arbitri), and the Italian elite (Serie A) referees were the first ambassadors of the ‘FIFA 11+ Referee’.


FIFA 11+ Referee

Worldwide Implementation

Since 2014, the ‘FIFA 11+ Referee’ is distributed to the FIFA member associations through the Refereeing Assistance Programme, specifically at FUTURO III courses for refereeing instructors as well at refereeing course at confederation and member association level.

Referees Placeholder
  • AA CAN A
  • AA CAN B

Courtesy of Carlo Castagna (AIA, F-MARC)


Fewer Injuries

Within the FIFA referee selections, the implementation of the’FIFA 11+ Referee’ injury prevention programme showed a reduced incidence of non-contact match injuries sustained by the male and female FIFA referees selected for the most recent World Cups (2010/2014 and 2011/2015) when compared to the previous World Cups (2006 and 2007).

On the left side: an investigation on the impact of ‘FIFA 11+ Referee’ in match officials is currently being conducted by the Italian Referees Association and F-MARC, with a special focus on overuse injuries (preliminary results show lower prevalences in referees of league A -Can A- versus league B -Can B-; CAN A implemented the programme).

Most important


Scientific peer-reviewed papers

  • Bizzini M, Junge A, Bahr R, Helsen W, Dvorak J. Injuries and musculoskeletal complaints in referees and assistant referees selected for the 2006 FIFA World Cup: retrospective and prospective survey. Br J Sports Med. 2009 Jul;43(7):490-7. Epub 2008 Jul 4.
  • Bizzini M, Junge A, Bahr R, Dvorak J. Female soccer referees selected for the FIFA Women’s World Cup 2007: survey of injuries and musculoskeletal problems. Br J Sports Med. 2009 Dec;43(12):936-42. Epub 2008 Oct 16.
  • Castagna C, Abt G, D’Ottavio S. Physiological aspects of soccer refereeing performance and training. Sports Med. 2007;37(7):625-46. Review.
  • Weston M, Castagna C, Impellizzeri FM, Bizzini M, Williams AM, Gregson W. Science and Medicine Applied to Soccer Refereeing: An Update. Sports Med. 2012 Jul 1;42(7):615-31. doi: 10.2165/11632360-000000000-00000. Review.
  • Bizzini M, Junge A, Dvorak J. Implementation of the FIFA 11+ football warm up program: how to approach and convince the Football associations to invest in prevention. Br J Sports Med. 2013 Aug;47(12):803-6. doi: 10.1136/bjsports-2012-092124. Epub 2013 Jun 27.
  • Bizzini M, Dvorak J. FIFA 11+: an effective programme to prevent football injuries in various player groups worldwide-a narrative review. Br J Sports Med. 2015 May;49(9):577-9. doi: 10.1136/bjsports-2015-094765

FIFA Material


Bizzini M, Castagna C, Perez-Leguizamon A, Dvořák J (2013). FIFA 11+ for referees. Official publication of the Fédération Internationale de Football Association (FIFA), Zurich, Switzerland



Bizzini M, Castagna C, Perez-Leguizamon A, Dvořák J (2013). FIFA 11+ for referees. Official publication of the Fédération Internationale de Football Association (FIFA), Zurich, Switzerland