Prevention of Injury

Having learned that one of the most important risk factors for football injuries is a previous injury, F-MARC realised that prevention should begin as soon as players train or play at an organised level.

F-MARC had initially developed a preventive programme for youth amateur players and proven its effect in reducing injuries by a comparison with players not following the programme. Shortly thereafter, a cooperating research group showed that the “Prevent Injury Enhance Performance” (PEP) programme effectively reduced the incidence of ACL ruptures in female football players.

Based on these two initial studies and the meanwhile accumulated body of knowledge, F-MARC developed a simple, catchy and time efficient preventive programme called “The 11” targeting amateur players.

To some extent, improved players´ fitness and skills can prevent injuries, however, a substantial amount of injuries is caused by foul play. Therefore, the observance of the laws of the game, and particularly of Fair Play, is essential for effective prevention of football injuries.

Accordingly, “The 11″consist of ten exercises plus the promotion of Fair Play (click on the right to view a demonstration of “The 11”). In cooperation with the national accident compensation companies and the respective FIFA Member Associations, “The 11” has meanwhile been implemented in countrywide campaigns in Switzerland and New Zealand. In 2007, an advanced version of the programme called “The 11+” has been tested in a large study with youth amateur female players in Norway.

“The 11+” takes new insights from F-MARC studies into consideration and proved successful indeed as it reduced the injury rate in this target group by up to a third.

Quoted from the FIFA Website.

A) The short term outcome of extracorporeal shockwave therapy for the treatment of various soft tissue injuries seen in private practice: a descriptive study.


  • The purpose of this piece is to evaluate the effect of the PowerShocker LGT -2500A Extracorporeal Shock Wave Therapy (ECSWT) on various soft tissue injuries. The use of ECSWT is becoming widely used within the sporting community and more so in the Physiotherapy Community.

Shockwaves are defined as “acoustic waves with high energy, high amplitude wave and non-periodicity.” They are similar to the type of wave left after a sonic boom or lightning strike left in the atmosphere. There use has been documented since the early 1980s where ECSWT was used to treat Kidney Stones 1. Currently, it is used private practice to treat various soft tissue injuries.

Some of the medical effects of ECSWT are Neovascularization of Damaged tissue, causing micro-rupturing of Capillaries which stimulates growth indicators. This leads to the formation of new blood vessels 2. The physiological effects of ECSWT are well known.


  • The aim of the 3 month trial was to determine the short-term effect of ECSWT on pain perception using the visual analogue scale (VAS) and function in patients who presented with soft tissue injuries to the Sports Science Physiotherapy Centre.


  1. To determine the short-term effect of ECSWT on Pain perception of patients who presented with various injuries at the Sports Science Physiotherapy Centre over a period of 3 months, utilising the Visual Analogue Scale
  2. To determine the short-term effect of ECSWT on function in patients who presented with various injuries at the Sports Science Physiotherapy Centre over a period of 3 months, utilising various private practice Functional Outcomes measures.


21 Patients gave their consent to use their information in the 3 month trial period. A Visual Analogue Score (VAS) was used to determine the effect of ECSWT on pain perception. Various functional outcome measures were used to measure functinality. These tests included : Knee-to-wall, Single-leg calf raise, Thomas test, Running distance and shoulder external rotation strength which are used in private practice. All tests were graded 1-4. Injuries of participants ranged from: Achilles tendinopathy, Plantar Fasciitis, Tibialis Posterior Tendinopathy, ITB Syndrome, Patellar Tendinopathy, Hamstring Tendinosis, Biceps Tendinopathy, Medial Tibial Stress Syndrome, Adductor Tendinopathy, Calcific Tendinitis of the Rotator Cuff tendon, Lateral Epicondylitis and Chronic Anterior Knee pain.


Patients presented to the Sports Science Physiotherapy Centre (SSPC) with various injuries. They were assessed by a physiotherapist and diagnosed with an injury, after which they were treated and then referred for ECSWT. Only one Physiotherapist administered the ECSWT to the 21 participants. Patients had the procedure explained to them and had an opportunity to ask questions and enquire about more information prior to treatment. Immediately post-treatment, Functional testing was done. Pain perception was done at the commencement of ECSWT (first session) and then at 2 week intervals. Patients were treated according to standard ECSWT protocol for individual injuries devised at SSPC. Treatment prescriptions were indicated for 2,3 weeks or 5 weeks.


At initial treatment, average pain perception was 5,3/10. Pain perception at week 3 averaged 3/10 and at week 5, average was 2/10. Functional scores, according to grading, at initial treatment was 2.3 out of a possible 4 grades. At week 3, functional scores averaged 3.1 out of 4 possible grades. At week 5, functional scores averaged 4 out of a possible 4 grades. Two subjects dropped out of the trial. 21 participants began ECSWT and 19 completed the trial, average treatment time was 3.4 weeks, with the shortest treatment time of 2 weeks and longest being 6 weeks.


In summary, Participants improved on average 1 point per week on the Visual Analogue Scale for pain perception. The funtionality improved by 1 grade every 2 weeks as measured by  the various functional tests. From the above information. From the trial, ECSWT can be seen to have a reduced the VAS scores and increased the Functional Test Grades.


  • 1. Eisenberger F, Fuchs G, Miller K, Bub P, Rassweiler J.Extracorporeal shock wave lithotripsy (ESWL) and endourology: an ideal combination for the treatment of kidney stones. World Journal of Urology,1985;3(1);41-47.
  • 2. van Leeuwen MT, Zwerver J, van der Akker-Scheek I. Extracorporeal shock wave therapy for patellar tendinopathy: a review of the literature. Br J of Sports Med, 2009; 43:163-168.

Advances in football medicine research at SSPC

SSPC associated with SSISA has been accredited as a FIFA F-MARC of Medical Excellence.

After a longstanding association with football in South Africa, and specifically Cape Town through the Ajax Cape Town Football Club, we consider ourselves knowledgable in the field of football medicine.

Theo Calligeris, Rashaad Jakoet, Ian Meder are qualified as FIFA F-Marc 11+ Instructors, and have presented a range of workshops in the Cape Town area. Theo Calligeris was also selected to work at the Cape Town Stadium during the FIFA World Cup 2010!

Theo Calligeris completed his Masters thesis in Sports Physiotherapy at UCT on “the incidence of injury and exposure times in professional footballers playing in a professional football club in the PSL during a football season”. This lead to the develpment of the latest software application called PSS (Professional Soccer Software) in association with SSMS to help develop football in South Africa. Visit for more………

B) The effect of BioScar Serum on the appearance of acute and sub-acute scars – a Pilot Study.

Theodore Calligeris 1  (BSc (Physiotherapy)(Hons) M.Phil (Sports Physiotherapy)

Sports Science Physiotherapy Centre, Sports Science Institute of South Africa, Newlands, Cape Town, South Africa

Address for correspondence:

Theo Calligeris,

Sports Science Physiotherapy Centre, Sports Science Institute of South Africa, Newlands, Cape Town, South Africa


Phone: +27 21 6595684



This trial was undertaken to assess the affect of the BioScar serum on the appearance and function in postoperative scar formation.

Objective:To determine the appearance of the scar formation at month 1, 2 and 3 with the application of the BioScar Care Program.


Patient and observer data of the subjects in the study (n = 13) were recorded on a monthly basis according to the methods acceptable in scar research. The range of motion of the body part was documented


Thirteen subjects were recorded in the study. The affected body parts were the hips, knees, wrists, lumbar area, ankles and feet. The range of motion of the body part was restored to functional and acceptable ranges of motion. The overall improvement in the subjective and objective assessments was 51,2% and 50% respectively. The average time between assessments was one month with the better results at month 3.


The scar assessment scales used in this study have been successfully used in other scar studies and have shown to be reliable. The early application of the BioScar serum has shown to improve the appearance and outcome of the scars in this study. It is suggested that further studies be done to explain the detailed physiological effect of the serum on wound healing and scar appearance.

The more you know!

Theo Calligeris have performed extensive research on football injuries, and has complete his Masters degree at UCT.

Rashaad Jakoet has completed his Masters degree in Physiotherapy at UCT.

Ian Meder has completed his Masters degree in Physiotherapy at UWC.

Brent Hess has completed his Masters degree in Physiotherapy at UWC.

Grethe Geldenhuys has completed her Masters degree at UCT.

Carmen Cowley is currently studying there Master degree at UCT……

C) The incidence of injuries and exposure time of professional football club players in the Premier Soccer League during football season

T Calligeris,1,3 BSc (Hons) (Physio), MPhil (Sports Physio); T Burgess,2,3 BSc (Physio), PhD; M Lambert,2 PhD

Sports Science Physiotherapy Centre, Sports Science Institute of South Africa, Cape Town, South Africa

Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa

Division of Physiotherapy, Department of Health and Rehabilitation Sciences, University of Cape Town, South Africa.

Corresponding author:T Calligeris (


Data on the incidence of football injuries and exposure time of players during matches and training in the South African (SA) Premier Soccer League (PSL) are lacking.


To calculate the incidence of injuries and the exposure time (practice and match) of the players of a PSL team over a full season.


Injury and training data of the players in the squad (N=32) were recorded on a daily basis by the medical support staff, according to the methods of the F-MARC protocol.


One hundred and thirty injuries were recorded in the season. The most affected body parts were the thigh (n=27, 21%) and ankle (n=27, 21%). The overall incidence was 13.4 injuries per 1 000 player-hours. The incidence during training was 6.6 injuries/1 000 player-hours and during matches 88.9 injuries/1 000 player-hours. The most frequent injury was haematoma/contusion/bruising (n=43, 33%). Of the total injuries, 12% were recurrent. Injury through contact with another player was high (62%). Seventy-six percent of the injuries were not associated with any violation of the laws of the game. The average time off due to injury was 8 days. The total exposure time over the full season resulted in a combined average of 18 162 minutes (~303 hours).


These data differ from the data in European studies. Injury and exposure data measured throughout the season have the potential to identify risks and mechanisms of injuries. This study highlights the necessity for all clubs in the PSL to adopt a standardised injury monitoring programme, using standardised methodology, so that the management of professional players in SA may be improved.


The implications of such a study is ground breaking in the field of Football Medicine in South Africa and Africa. It has a far reaching effect in describing the football population and identifying what variables need intervention for change to occur progressing the level and standards in African Football.

Keywords: incidence of football injuries; exposure time; epidemiology; monitoring program; Professional Soccer League

Funding Acknowledgements:This work was self funded by Theo Calligeris as a student and supported by UCT and AJAX CT FC.

S Afr J Sports Med 2015;27(1):16-19. DOI:10.7196/SAJSM.610

Elena Calligeris Featured in Female Entrepreneur Magazine

SALT gives one the opportunity to walk through memory lane and learn neuromuscular patterns that were innate as a child. This inspires a workout experience that is fun.

Overcoming Mental Fears and Challenges
Training with the SALT SWING inspires new muscle techniques. Some exercises take you out of the “norm” of traditional exercise . This encourages one to face and overcome certain fears. Ie: Being upside down, standing on your hands (again).

Trust and Becoming
Through these different muscle patterns we begin to re-educate the neuromuscular patterns, which teaches clients muscle engaging techniques. This elevated state of body awareness translates itself to greater function and mobility in everyday life.

The ongoing learning phase of movement and transition on the SALT SWING creates an element of aspiration and transformation. The restful moments of pause and relaxation inspires psychological refreshment and renewal ie : SALT cocoon – finding your wings : discovering new muscles patterns, changing perspective.

SALT classes are done in a setting with classical music in the background.

Music is a great tool to stimulate the brain, reduce stress and strengthen the immune system . During a salt session we encourage playing gentle classical music.

View full article here