Football is a globally popular team sport characterised by complex tactical, technical and physical demands (Van Beijsterveldt et al. 2012). These demands include running, jumping, sprinting, rapid directional changes, ball kicking and physical contact with other players or objects. As a result of its intense physical and physiological nature, football is associated with a high injury rate, surpassing that of many industrial occupations (Hawkins et al. 2001).

A systematic review and meta-analysis by López-Valenciano et al. (2020) reported an overall injury incidence of 8.1 injuries per 1000 h of exposure among footballers. Match play posed a significantly higher risk (36/1000 h) compared to training (3.7/1000 h). Lower limb injuries were the most prevalent (6.8/1000 h), with muscle or tendon injuries being the most common type, often resulting from traumatic incidents rather than overuse.

Professional footballers experience high physical loads throughout their careers, placing them at elevated risk for both contact and non-contact injuries. These injuries can negatively impact their performance and career longevity. Brukner and Khan (eds. 2021) define contact injuries as those resulting from direct physical interaction with another player, object or the playing environment during training or matches. In contrast, non-contact injuries occur without direct physical contact and are typically caused by internal forces generated during movement, often influenced by biomechanical factors, fatigue or poor technique.

Various intrinsic and extrinsic factors contribute to injury risk in football. Intrinsic factors include previous injury history, age, poor flexibility, reduced muscle strength and muscle imbalances (Hägglund et al. 2013). Extrinsic factors encompass fatigue, match type (friendly versus official), location (home versus away) and outcomes, all of which may influence injury rates (Guan et al. 2021).

Larruskain et al. (2018) compared the epidemiology of injuries between elite male and female football players. Injuries acquired and individual exposure time in the male and female teams, both teams playing in the Spanish first division, were recorded by the club’s medical staff for five seasons from 2010 to 2015. The study found that the hours that men were exposed to were 20% higher compared to women. It was also discovered that training and match injury incidence were 30% – 40% higher for men than for women. Various factors between males and females were identified in addition to biological differences, which are training load and content, fixture congestion, staffing and dedication level.

Although contact injuries are more frequently reported, non-contact or overuse injuries remain a significant concern. In the systematic review and meta-analysis, Hall et al. (2020) reported that 443 of these football injuries occur across England, Spain, Uruguay and Brazil. Non-contact injuries accounted for 58.5% of cases, with 44.2% resolving within 8–28 days. Most injuries (75.4%) affected the lower limbs, with muscle/tendon tissue being the most commonly injured (29.6%). Between 31% and 41% of all non-contact injuries involved muscles, predominantly in the upper leg. Hamstring injuries represented up to 37% of all muscle injuries, followed by adductor (23%) and quadriceps femoris (19%) injuries.

The findings by Hall et al. (2020) align with clinical observations in football settings, where non-contact lower limb injuries, particularly those affecting upper leg muscles, are frequently treated. Reduction of injury incidence is crucial for enhancing team performance and minimising lost playing time (Perez-Gomez et al. 2022). Several protocols have been developed to mitigate injury risks and reduce medical and rehabilitation costs. Designing effective injury prevention programmes requires addressing the underlying risk factors. Preventative exercises have emerged as a key strategy for reducing non-contact injuries (McCall et al. 2015), with preseason conditioning training that plays an important role in injury prevention for the upcoming competitive season (Eliakim et al. 2018).

The injury prevention process involves four stages: (1) describing and identifying the extent of the injury, (2) determining contributing factors and mechanisms, (3) implementing preventative strategies and (4) returning to stage one for reassessment. While many studies have focused on the first two stages (Hawkins et al. 2001), few have explored preventative strategies. This scoping review focused on the third point of implementing preventative strategies for non-contact lower limb injuries.

When searching the literature, no scoping review has been found to map the range of preventative strategies targeting non-contact lower limb injuries in football. Our study, therefore, aimed to fill that gap by systematically reviewing the literature on strategies implemented to minimise risk factors associated with non-contact lower limb injuries among male footballers.

Prior to initiating this scoping review, the review title was registered on the Open Science Framework.

This scoping review aimed at mapping the range of literature relating to preventative strategies implemented to minimise risk factors that are associated with non-contact lower limb injuries among male footballers. Twenty-five articles have been reviewed, and 12 preventative strategies emerged from the reviewed articles.

Nordic hamstring exercise is one of the intervention strategies used to minimise non-contact hamstring injuries. The NHE was formerly known as the ‘Russian hamstring exercise’ (Al Attar et al. 2017). The NHE is a partner-based, equipment-free movement performed on the pitch or in the gym, where one player resists a forward-falling motion from a kneeling position to eccentrically load the hamstring muscles.

Clarke and Buckley (2005) suggested that because most hamstring strains occur during eccentric contraction of the hamstring muscles, increased torque in an extended knee position may reduce the occurrence of hamstring strains. A group of scientists from the Oslo Sports Trauma Research Centre (OSTRC) hypothesised in their randomised controlled trial that NHEs could prevent some hamstring strains. In their intervention study, they found that this exercise produced a large increase in eccentric torque production in week 10 post-training, therefore minimising the risk of non-contact hamstring injuries.

Arnason et al. (2008) examined the impact of eccentric strength versus flexibility training on hamstring strain incidence in soccer players in Iceland and Norway, finding a 65% lower rate in teams using eccentric training. Bezuglov et al. (2020) further supported their use, noting their benefits for athletes engaged in high-speed running because of eccentric hamstring loading, and emphasised that those using traditional methods. Haroy et al. (2017) confirmed the effectiveness of NHEs both as a standalone and within warm-up routines. Bezuglov et al. (2020) further supported their use, noting their benefits for athletes engaged in high-speed running because of eccentric hamstring loading, and emphasised their simplicity, lack of equipment needs, and ease of implementation.

Our review study found that the FIFA 11 injury prevention programme is one of the strategies used to lower the risks of injuries. This programme was developed by the FIFA Medical Assessment and Research Centre to enhance lower limb strength and reduce injury rates in football through a series of 10 exercises targeting stability, strength, coordination and flexibility (Silvers-Granelli et al. 2015). Although two studies on FIFA 11 (Krist et al. 2013; Van Beijsterveldt 2012) showed no significant differences in injury outcomes between intervention and control groups, the programme was later modified to include the CAE and a dynamic warm-up, resulting in FIFA 11+ (F-MARC 11+).

Four studies that have evaluated FIFA 11+ reported positive outcomes, including improved quadriceps strength ratios, reduced injury rates and severity, and decreased ACL injury incidence among competitive male soccer players (Grooms et al. 2013; Silvers-Granelli et al. 2017). The inclusion of the CAE appears to be a key factor in the programme’s enhanced effectiveness, suggesting that even minor modifications can yield substantial improvements.

However, the lack of significant results in FIFA 11 may also be attributed to poor compliance or other undocumented barriers, highlighting the need for further research to understand implementation challenges and optimise injury prevention strategies.

FIFA 11 and FIFA 11+ programmes have been evaluated across various populations, including both sexes, recreational, amateur and semi-professional soccer players, as well as athletes in court-based sports like basketball (Longo et al. 2012). In a cluster randomised controlled trial involving 11 male basketball teams, Longo et al. found that teams using FIFA 11+ experienced lower injury rates per 1000 athlete-exposures compared to controls, demonstrating the programme’s effectiveness beyond football. Originally designed for football, FIFA 11+ has proven beneficial in reducing injury rates among elite basketball players, suggesting its adaptability across sports requiring frequent jumping, sprinting and rapid directional changes.

While these findings support broader application, further research is needed to validate its effectiveness in diverse athletic populations and performance contexts.

The CAE emerged as a standalone preventative strategy in our review, with two studies meeting the inclusion criteria. This simple, partner-based eccentric exercise requires no equipment and can be performed on the field, making it highly accessible (Haroy et al. 2017).

Weak hip adduction strength has been identified as an intrinsic risk factor for adductor muscle injuries in field-based sports, such as soccer, rugby and American football (Ryan, DeBurca & McCreesh 2014).

The CAE is suitable for high-intensity use before or after training sessions to reduce the risk of non-contact adductor injuries. Ishøi et al. (2016) found that this exercise significantly increased EHAD, EHAB strength and the EHAD/EHAB ratio. Bezuglov et al. (2020) reported that adductor injuries are the second most common lower limb injuries among male footballers, and the CAE helps optimise the length-tension relationship through eccentric loading. Perez-Gomez et al. (2022) further supported its effectiveness, noting a 41% reduction in groin injury risk with eccentric adductor strengthening, while Haroy et al. (2017) confirmed its role in enhancing hip adduction strength and injury prevention.

Adductor muscle injuries are the second most common muscle injuries in football (Ekstrand, Hägglund & Waldén 2011) and the leading cause of acute groin injuries in athletes (Serner et al. 2015).

Strengthening the adductors through eccentric exercises like the Copenhagen adduction protocol is therefore a relevant and practical intervention for reducing non-contact injury risk in football and other field sports. Clinicians working with male athletes should consider incorporating this protocol into training routines to target adductor strength and mitigate injury risk. Ryan et al. (2014) emphasised that low adductor strength is a significant risk factor for groin injuries, reinforcing the importance of targeted eccentric strengthening strategies such as the Copenhagen adduction.

The other preventative strategy found was muscle strengthening exercise. Four articles met the inclusion criteria and identified strength as another preventative strategy. Muscle strength is considered a significant cause of predisposing players to non-contact lower limb injuries (Lauersen et al. 2018). The management of sports injuries can be troublesome, time-consuming and expensive, but prevention in the form of strength training has proved to be accessible, effective and cost-effective for populations in sports (Lauersen et al. 2018). The role of muscle strength as a risk factor for non-contact lower limb injuries has been discussed by Creaby, Dickson and Clarke (2016). Poor or low isokinetic quadriceps and hamstring muscle strength have been associated with the risk of non-contact lower limb injuries, more particularly for acute muscle injuries and knee ligament injuries in team and non-team sports for both male and female athletes.

Lauersen et al. (2018) found that higher quadriceps concentric peak torque at 60° was linked to increased overuse injury risk, while greater bilateral adductor strength relative to body weight was associated with reduced knee injury risk, supporting strength training as a preventative measure for non-contact lower limb injuries in male footballers. Similarly, Cohen et al. (2015) emphasised the importance of developing hamstring fatigue resistance and long-length eccentric strength to lower injury incidence. These findings align with the targeted eccentric approaches of the CAE and NHE, which may help reduce adductor and hamstring injuries, respectively. Broader evidence from Lauersen et al. (2018) confirms the effectiveness of strength training across populations, including the elderly and athletes, while Coppack, Etherington and Wills (2011) demonstrated its success in reducing anterior knee pain in military recruits. Additionally, Waldén et al. (2015) reported a 64% reduction in ACL injuries through improved core stability and coordination, reinforcing strength training as a versatile and impactful strategy for clinicians aiming to prevent non-contact lower limb injuries in diverse athletic settings.

Stretching exercises are also widely recognised as a preventative strategy for non-contact lower limb injuries, particularly in sports, with various methods, such as passive, static, isometric, ballistic and proprioceptive neuromuscular facilitation, used to enhance flexibility (Thacker et al. 2004). Research has shown that soccer participation is linked to decreased hip-rotation motion and gradual musculoskeletal changes that negatively affect flexibility and performance (De Castro et al. 2013). Studies, including those by Azuma and Someya (2020), have found that stretching programmes designed by physical therapists can reduce injury rates among male high school soccer players, although further research is needed across broader populations.

Additionally, stretching may mitigate the long-term effects of reduced hip mobility in youth players, but the specific exercises most effective for injury prevention remain unclear. Despite its benefits, stretching can also cause temporary strength deficits, increased blood pressure and reduced running economy, highlighting the need for clinicians and athletes to balance its advantages with awareness of potential adverse effects (Thacker et al. 2004).

Ankle taping is used as a prophylactic strategy to reduce the risk and severity of non-contact ankle injuries in sports by stabilising the tibiotalar and subtalar joints and enhancing proprioception (Bahr & Bahr 1997; Beynnon et al. 2001; Handoll et al. 2001). It is commonly applied both preventatively and during recovery across all levels of athletic participation.

Studies have shown that while adhesive elastic tape can restrict ankle motion, its protective effect diminishes significantly within 15 min – 45 min of activity, suggesting the need for reapplication during halftime (Best et al. 2014; Forbes et al. 2013). However, limitations such as small sample sizes and non-real-world settings highlight the need for further research to determine the cost-effectiveness and optimal application of taping in reducing non-contact ankle injuries among male footballers. Despite these limitations, ankle taping remains a beneficial tool for enhancing mechanical stability and lowering injury risk.

Preseason preparation has been identified as one of the key strategies to reduce non-contact lower limb injuries, although only one article met the inclusion criteria on this topic. The abrupt expansion of the Major League Soccer (MLS) season led to a rise in such injuries, prompting recommendations for prolonged preseason training and limiting matches to one per week. Gabbett (2004) found that reducing preseason training loads in rugby league players lowered injury rates and improved aerobic capacity, suggesting that a combination of extended preparation and moderated training loads may benefit male soccer players. However, further research is needed to validate this approach specifically within soccer.

Sprint mechanics and chronic training loads also play a role in injury prevention. Schuermans et al. (2017) highlighted the risk of hamstring injuries during sprinting and emphasised the importance of coordination in prevention. Malone et al. (2018) found that elite soccer players with moderate to high exposure to high-speed and sprint running had lower injury risks than those with minimal exposure. These findings suggest that a combined focus on sprint technique and consistent training loads could enhance injury prevention strategies, warranting further investigation into their integration.

Efforts to prevent hamstring injuries have also explored exercise programmes like the NHE and the Bounding Exercise Programme (BEP), as reported in this scoping review. Van de Hoef et al. (2019) reported limited effectiveness of BEP because of low compliance, despite its aim to improve neuromuscular control and eccentric strength. Perez-Gomez (2022) reviewed various training programmes and found strength training, proprioceptive training, core stability and multicomponent programmes were effective, although BEP showed no significant benefits. The exclusion of a core stability study as a result of language barriers highlights the need for more accessible and diverse research.

Non-contact lower limb injuries remain a significant challenge among male footballers, arising from a complex interplay of intrinsic and extrinsic factors. Our study identified a variety of preventative strategies currently used in clinical practice, including NHEs, CAEs, muscle strengthening, stretching, ankle taping, FIFA 11 and FIFA 11+, preseason preparation, running mechanics, higher chronic training loads, bounding and multicomponent exercise programmes. While some strategies demonstrated positive outcomes, others showed limited effectiveness in the reviewed studies. As a result of the diverse nature of these injuries and varying team dynamics across different levels of play, these strategies should serve as a guide rather than a definitive solution. Further research is needed to develop comprehensive injury prevention programmes and explore additional contributing factors to reduce both initial and recurrent non-contact injuries. A strength of our study was its rigorous review process, involving a research assistant and a third reviewer to resolve disagreements, along with a piloted data charting process to ensure consistency and reliability.