Effect of modified progressive Copenhagen exercise versus sliding hip exercise in adjunct to conventional physiotherapy on strength, core stability and agility in futsal athletes: a study protocol for randomised controlled trial

Abstract

Futsal, a high-intensity sport, places considerable demands on the hip adductors and core musculature, often resulting in strength deficits and reduced agility. Optimising training strategies to prevent injury and enhance performance is a growing area of interest. This study aims to compare the effectiveness of the modified progressive Copenhagen exercise versus sliding hip exercise in adjuncts to conventional physiotherapy in improving strength, core stability and agility in futsal athletes. A parallel, three-arm, randomised controlled trial was conducted over a period of 8 weeks. Participants will be enrolled from four centres. 39 futsal athletes were randomly allocated into three groups via a 1:1:1 allocation. Primary outcome measures included isometric hip adductor strength via handheld dynamometer, core stability assessed via sphygmomanometer and agility performance measured using the agility t-test and secondary outcome measures included isometric hip abductor strength measured by the single-leg squat test. Assessments were conducted pre- and postintervention. The final analysis will include dropouts and treatment side effects. Ethical clearance was obtained from the Institutional Ethical Committee, Ref. No. DMIHER(DU)/ie,C/2025/610. The findings will be published in peer-reviewed journals and disseminated at international conferences. Trial registration number: CTRI/2025/04/084525.

WHAT IS ALREADY KNOWN ON THIS TOPIC

• The Copenhagen adduction exercise has been shown to reduce the risk of groin injuries and enhance hip adductor strength among athletes engaged in football and soccer.

• Sliding hip exercises (SHEs) are used to activate and strengthen hip musculature with a focus on hip abductors and adductors for eccentric control and dynamic movement patterns.

• Despite their known benefits individually, few studies have directly compared these interventions in the context of futsal, especially in combination with the conventional physiotherapy (CPT).

WHAT THIS STUDY ADDS

• The current study evaluates the effect of modified progressive Copenhagen exercise and SHE in adjunct to CPT on altering strength, core and agility among futsal athletes.

• It examines the impact of both interventions on adductor strength, core stability and agility, which are the three key domains for optimal performance.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

• This trial may influence sports physiotherapy protocols by providing comparative data on two widely used hip-focused interventions.

• Results could encourage practitioners to adopt more structured, evidence-based adductor strengthening regimens in athletic populations, particularly in sports like futsal, where dynamic lower limb performance is critical.

• Policymakers and sports organisations may consider integrating these findings into broader athlete screening and injury prevention strategies, thereby improving player safety and performance outcomes.

Introduction

Futsal, also known as five-a-side indoor soccer, is the globe’s most rapidly evolving indoor sport akin to soccer, officially sanctioned by soccer’s international governing body (Federation de Football Association (FIFA)).^{1 2} Futsal is played on a 40 × 20 m hard court surface in two 20-min periods, with a 10-min break between periods, and allows unlimited substitutions.³ Players must meet tremendous physical, technical, tactical and psychological challenges in this fast-intensity, intermittent sport.⁴ Contrary to standard outdoor soccer, futsal uses a smaller (size 3 or 4) low-bounce ball and can be played at elite and recreational levels.⁵ Compared with other intermittent sports, this multiple-sprint sport depicts more intensive stages.⁶ Studies have demonstrated that futsal surpasses soccer,⁷ basketball⁸ and handball⁹ in terms of the overall distance travelled at its highest speed, along with high intensity. The need for concentric and eccentric muscle action in the legs for continually kicking, jumping, pulling up, tackling, turning, changing pace, decelerating and sprinting throughout a game is essential due to the exposure to activities of great intensity.³ Futsal is one of the top ten most injury-prone sports, with a prevalence rate of 55.2 injuries per 10 000 hours of sports participation.¹⁰ Sports involving kicking or rapid shifts in direction are prone to acute adductor injuries.11,13 The adductor longus is especially susceptible to injury during the 30%–45% swing phase. The adductor longus is also eccentrically most active and stretches at its fastest rate during this phase of the kicking cycle.¹³ Evidence points to variation in the strength of the hip adductors and their antagonist abductor muscles, as well as imbalances in hip adductor strength, as inherent risk variables for adductor-related groin injuries.^{14 15} In addition, it has been shown that eccentric hip adduction (EHAD) strength training minimises hip and groin injuries.¹⁶ Injury risk may also be influenced by eccentric hip abduction (EHAB) ratios to EHAD.^{17 18}

The goal of a modified progressive Copenhagen adduction (MPCA) programme is to decrease postexercise muscle soreness while increasing EHAD strength and maintaining EHAD: EHAB strength ratios that meet the threshold linked to a lower risk of groin issues and adductor-related injuries.^{19 20} The programme begins with isometric muscle contractions and advances to a whole Copenhagen adduction exercise. The sliding hip exercises (SHEs) have also been implemented to increase hip abductor and adductor strength. The athletes exerted a lot of effort when progressively shifting their centre of gravity towards the ground while both legs slid outwards during the sliding hip (SH) performance. The competitors had to surmount the maximum force (F=5 N·ms) while maintaining the SH starting position. Following that, they had to compel their body to descend downwards and induce sliding. Likely, the continuous efforts desired from the hip abductors during SHEs¹⁷ promote muscle strength.¹⁴

Soccer demands significant trunk movement and stability, particularly during kicking,²¹ and constant stress on the abdominal muscles during play has been identified as a contributing factor to the development of groin pain.²² Exercises, such as the Copenhagen adduction exercise, appear to be the most beneficial for targeting the abdominal muscle-tendinous structures to a particular extent because it displays the highest values for the abdominal muscles, attaining 36% and 40% peak nEMG for the external abdominal oblique and rectus abdominis on the non-dominant side, respectively.¹⁷

Futsal necessitates quick direction changes and pace changes multiple times throughout the game. This specific action puts a lot of strain on the adductor muscles since it forces the player to apply force quickly towards the ground. Repeated sprints with numerous direction changes cause 3% to 7% of futsal non-contact injuries. Since the knee, thigh and ankle endure considerable stress when changing directions, these injuries mainly affect them.¹⁰ A substantial amount of player movements in futsal games requires a significant change of direction (COD) as players try to obtain positional advantages, avoid opposing players and mark competitors closely.^{4 6} As a warm-up, the FIFA 11+programme can help young players improve their technical skills and performance while lowering their injury risk.²⁰ To improve athletes’ COD performance, FIFA 11+interventions emphasise proper biomechanical techniques, increased awareness and enhanced movement control during various activities, including standing, running, planting and cutting.²⁰ The first phase of the FIFA 11+programme involves controlled partner encounters, active stretching and slow running. Part 2 includes core stabilisation, eccentric thigh muscle training, proprioceptive training, dynamic stabilisation and plyometric exercises with proper postural alignment. Subsequently, part 3 of the FIFA 11+programme includes running exercises and cutting movements.

A few studies have highlighted the importance of the adductor muscles in a player’s strength, core stability and agility. Not often are the adductor muscles the sole focus of strength training regimens and programmes. Previous systematic reviews have examined adductor strengthening programmes in other sports like football, basketball and ice hockey; however, a focused review specifically focusing on adductor strengthening for futsal athletes is lacking. This research study examines how hip adductor exercises impact futsal players’ strength, core stability and agility. Incorporating adductor–abductor strengthening exercises into preseason and season training regimens and programmes also gives futsal players a foundation for developing their strength, core stability and agility, enhancing their athletic performance. The study aimed to determine the effect of modified progressive Copenhagen exercise and SHE as an adjunct to conventional physiotherapy (CPT) on strength, core stability and agility among futsal athletes.

Objectives of the study

1. To determine the effect of modified progressive Copenhagen exercise in adjunct to CPT on strength, core stability and agility in futsal athletes.

2. To determine the effect of SHE and CPT on strength, core stability and agility in futsal athletes.

3. To compare the effect of modified progressive Copenhagen exercise and SHE in adjunct to CPT on strength, core stability and agility in futsal athletes.

Methods

Study design

Randomly selected participants will participate in a single-blinded, three-arm randomised controlled trial. Participants will be allocated to either the MPCA, SHE or CPT group. The study will follow Standard Protocol Items: Recommendations for International Trials (SPIRIT) guidelines (see online supplemental table 1). After taking a baseline assessment for strength, core stability and agility, the MPCA, SHE and the CPT group will be compared after 8 weeks of treatment.

Trial sites

Subjects will be randomly recruited from the following centres.

(1) Futsal grounds DMIHER campus, Sawangi, Maharashtra. (2) Futsal grounds opposite the Girls’ hostel, JNMC campus, DMIHER, Sawangi, Maharashtra. (3) Football ground District Sports Stadium, Wardha, Maharashtra

Information will be documented after eligibility screening. They will be allocated to either Group A (MPCA+CPT) or Group B (SHE+CPT) or Group C (CPT alone) on a 1:1:1 ratio through a random allocation procedure. Participants will be blinded throughout the entire trial.

Sample size calculation

The sample size calculation was based on a three-arm trial design using values derived from the means and SD of two groups. Group 1 (baseline EHAD) had a mean score of 3.46 (±0.49),²³ while Group 2 (follow-up EHAD) had a mean score of 4.32 (±0.86). The pooled SD was used to estimate the effect size, and the sample size per group was calculated using the formula:

$${\displaystyle \mathrm{n}=3({\mathrm{Z}}_{\mathrm{a}/2}+{\mathrm{Z}}_{\beta }{)}^2(2{\sigma }^2)/{\mathrm{d}}^2,}$$

where α was set at 0.05 for a two-sided test, and the statistical power (1–β) was 80%. The corresponding Z-scores for α and β were used to compute the minimum required sample size. Based on this, the estimated sample size per group was approximately 10.40, rounded to 11 participants per group for practical implementation. The initial sample size for all three groups (assuming a balanced design) was calculated as 33. To account for a possible 20% drop-out rate (approximately 6 participants), the final adjusted total sample size was increased to 39 participants, with 13 participants in each group.

Participant recruitment and screening

All futsal athletes will be assessed for eligibility. The therapist will obtain informed consent from eligible participants during the recruitment process. After receiving consent, baseline assessment and blinding of the participants through allocation will be initiated. Treatment will commence shortly after the allocation process is completed. The enrolment period will extend over 12 months from 10 June 2025 to 10 June 2026. Results will be assessed and interpreted through the Consolidated Standards of Reporting Trials guidelines (chart).

Eligibility criteria

Inclusion criteria

1. Gave their consent to participate in the study.

2. Athletes between the ages of 19–30 years.

3. Recreational and competitive male and female futsal athletes.

4. Minimum 1 year of regular futsal playing experience.

5. Athletes identified with weak core stability.

6. Athletes with weak adductor and abductor muscle strength.

Exclusion criteria

1. Individuals engaged in systematic resistance training of the hip adductors and abductors (more than one time per week) at least 1 month prior to study initiation.

2. Existing unhealed injuries which may restrict the athlete from performing the protocol.

3. Adherence of less than 75% to the exercise protocol (as per protocol analysis).

4. Groin pain>2/10 on the numeric pain rating scale during adduction–abduction strength testing or exercises,

5. Groin pain resulting in missed football matches or training sessions within 1 month prior to study initiation.

Randomisation procedure

The eligible participants will be recruited by a simple random sampling technique. Allocation to the intervention groups will be concealed by using the sequentially numbered opaque sealed envelope method to ensure allocation concealment. Participants who met the inclusion criteria will be discreetly assigned to the intervention groups using the ‘RAND’ function in Microsoft Excel 2023 (generates a random decimal number between 0 and 1). Participants will be delegated to parallel treatment groups in a 1:1:1 ratio

Blinding

Eligible participants will be blinded to their allocated groups. The consent form will outline this particular information. An assistant trial evaluator will monitor the eligibility of participants and document the baseline values in a Microsoft Excel sheet and will convey these data via a WhatsApp group. The intervention provider seals the document in an envelope and labels it with the participant’s ID. Two impartial trial evaluators will be assigned for each of the three study locations. The trial coordinator will monitor and guide throughout the study. Group A (MPCA+CPT), Group B (SHE+CPT) and Group C (CPT) will receive treatment in three separate rooms to minimise the risk of contamination.

Intervention

Participants will be selected based on the inclusion and exclusion criteria. All the participants will be informed about the study in a language they best understand, and a written consent will be taken from them.

Participants will be screened based on inclusion and exclusion criteria, and individuals who meet the inclusion criteria will be recruited for the study after being informed about the purpose of the study.

Participants will then be divided into two groups: Group A, Group B and Group C. Each group will contain equal participants. Preintervention groups A, B and C will be assessed for strength, core stability and agility in futsal athletes. Once the allocation is done, participants in the group will receive the treatment for 8 weeks. The participants were divided into three groups with different intervention protocols (see online supplemental table 2).

Step 1: baseline evaluation

All participants will undergo baseline assessments to evaluate their initial strength, core stability and ability to change directions.²⁴

Detailed description of assessment procedures is outlined (see online supplemental table 3).

Step 2: intervention groups

Participants will be randomly assigned to one of two intervention groups.

Group A: modified progressive Copenhagen exercise (see online supplemental figure 3) with CPT.

Progressions in sets and repetitions through the modified progressive Copenhagen exercise programme (see online supplemental table 6).²³

Levels 1–5 are isometric muscle contractions advancing in complexity. A classic CA exercise, Level 6, is an eccentric/concentric exercise that has been demonstrated to improve EHAD strength and the EHAD: EHAB ratio and prevent groin issues (see online supplemental table 7).²³

CA, Copenhagen adduction; EHAB, eccentric hip abduction; EHAD, eccentric hip adduction.

Level progressions 1–6: (a) level 1, (b) level 2, (c) level 3, (d) level 4, (e) level 5 and (f) level 6 (see online supplemental figure 3).²³

Group B—SHE with CPT.

With both legs on a plastic sliding pad, the athlete stands with their hands in front of their chest on a sturdy supporting bar, their trunk, hips and knees straight (see online supplemental figure 4). The centre of gravity descends as much as it seems tolerable while abducting both legs.

After 2 s of maintaining the same position after achieving the maximum distance, the legs will be adducted, sliding back to the initial position.

The progression training protocol for the SHE is outlined in the online supplemental table 8.²⁵

Group C—CPT.

Group C received CPT, which included the FIFA 11+warm up protocol (see online supplemental table 9).²⁶

Hip-out running²⁶: the athlete jogs or walks with ease and pauses from time to time to rotate the hip outwards and raise the knee. He switches between using her right and left legs (see online supplemental figure 5). Two sets are performed.

Bench static²⁶: the athlete supports himself on his forearms and toes while lying on the ground in the beginning position. Directly beneath the shoulders is where the elbows should be. Using her forearms as support, the athlete raises his torso, draws his abdomen in and holds the posture for 20–30 s (see online supplemental file 1). Three sets are performed.

Jumping: vertical jumps.²⁶ The athlete begins by placing their hands on their hips and standing with their feet hip-width apart. He does the exercise by slowly bending his knees to around a 90° angle and holding them there for 2 s. He maintains his knees bent forward. He jumps up as far as she can from this squat position. With his hips and knees slightly bent, he falls gently on the balls of her feet. For 20 s, this is repeated (see online supplemental table 7). Two sets are performed.

Toe raises²⁶: the athlete stands upright with feet shoulder-width apart and slowly rises onto the balls of the feet by lifting the heels off the ground, keeping the knees extended but not locked. He holds the top position briefly for 30 s, then lowers the heels back to the floor in a controlled manner (see online supplemental figure 8). Two repetitions are performed with adequate rest in between.

Lunges²⁶: the athlete stands upright with feet hip-width apart. He steps forward with one leg, lowering the hips until both knees are bent at approximately 90°. The back knee hovers just above the ground, and the front knee remains aligned over the ankle for 30 s. He then pushes back through the front foot to return to the starting position (see online supplemental figure 9). Two repetitions are performed with rest in between.

Running²⁶: plant and cut. After jogging four or five steps, the runner changes direction by planting on the outer leg and cutting. He quickly accelerates and dashes for five to seven steps before slowing down. He then does another cut and plant. His knees remain bent forward. He repeats this in the available space (see online supplemental table 10). Two sets are performed.

Single-leg squat

Stand on one leg and raise the other leg off the floor in front of you such that the hip of the non-stance leg is about 45° flexed and the knee is about 90° flexed. The hands are clasped together and the arms are extended straight out in front. Squat down from this posture until your knees are roughly 60° bent, then raise yourself back to the starting position. Take note of the tested leg. After that, they were told to stand on one leg and do ten consecutive squats on each leg separately, each one simply touching the string barrier.

Step 3: postintervention assessment (after 8 weeks)

After 8 weeks, the same assessments as in the pretreatment phase will be conducted in the post-treatment phase.

1. Adductor strength (handheld dynamometer (HHD)): the same testing procedure will be repeated as in the baseline.

2. Core stability (sphygmomanometer and prone plank test): the ability to maintain intra-abdominal pressure and the time held in the plank will be reassessed.

3. Agility t-test.

4. Single-leg squat test.

Outcome measurements and assessment points

Primary outcome

Handheld dynamometer

HHDs are portable devices that measure isometric muscle strength, providing a reliable and efficient way to assess physical performance. Standard units: pounds (lbs), Newtons (N) or kilogram-force (kgf).

To adjust for the angle–torque connection and reduce the impact of the segment’s weight on the measurements, careful consideration should be given to the individual’s position and the joint angle used during testing.²⁷

HHD showed weak-to-moderate concurrent validity with isokinetic dynamometry, the ‘gold standard’ test of muscular strength evaluation (r value 0.37–0.51, p≤0.05).²⁸

Intrarater reliability was excellent (ICC=0.8–0.96).²⁹

Sphygmomanometer

A typical tool for measuring blood pressure is the sphygmomanometer. However, it can additionally be used to assess the stability and strength of the core muscles. The sphygmomanometer measures the pressure that the back and abdominal muscles exert during particular core activities, giving considerable information on the strength and functionality of these muscles.³⁰

The intraclass correlation coefficients for intrarater reliability were 0.92 (95% CI 0.89 to 0.94), and inter-rater reliability was 0.87 (95% CI 0.80 to 0.91).³¹

Prone plank test (PPT)

The prone plank is a novel core functional strength test that uses handheld dynamometry to measure force exertion capability in a prone bridge posture.

PPT showed acceptable error measurement and excellent to exceptional test–retest reliability. For the PPT, the intratester and intrasession reliability ICCs varied from 0.77 to 0.94.³²

Agility t-test

The agility t-test is frequently used in preseason testing procedures to evaluate team sport athletes’ direction-changing skills, including acceleration, deceleration and lateral movement.^{33 34}

Equipment needed: timing cells, cones and a stopwatch

Benefits: it is an easy agility test to administer, requiring minimal space and equipment.

Cons: the exam may only be administered by one person at a time.³⁵

The intraclass reliability of the t-test was 0.98³⁵

Secondary outcome

Single-leg squat test

A clinical test performed in a single-limb position is the single-leg squat test. The single-leg squat test³⁶ is widely used in clinical settings to offer a quick and easy way to evaluate neuromuscular control in the lumbopelvic area.³⁷

The following domains were used to assess the SLS test’s scoring criteria³⁸: (a) arm technique, (b) trunk movement, (c) pelvic plane, (d) knee attitude and (e) steadiness of a unilateral stance.

The combined ICC/kappa results indicated a ‘substantial’ agreement for intrarater reliability (0.68) and a ‘moderate’ agreement for inter-rater reliability (0.58), with 95% CIs ranging from 0.50 to 0.65.³⁹

Study procedure and data collection

After the baseline assessment, data will be collected and participants will be allocated to their respective groups. 8 weeks later, the baseline assessment trial evaluators will collect postintervention data. The trial will follow the SPIRIT 2014 guidelines to ensure consistency with global research studies (see online supplemental table 1).

Intervention adherence

To ensure adherence to the intervention, a qualified physiotherapist will supervise the exercises. Attendance will be recorded for each session. A structured logbook will be maintained to document session attendance, completion of prescribed exercises and any modifications or difficulties encountered.

Strategies to improve adherence will include the following.

• Providing clear verbal instructions on all exercises.

• Offering regular verbal encouragement and feedback during sessions.

• Ensuring that exercises are progressively adapted to match each participant’s capability, minimising discomfort and drop-out risk.

• Maintaining weekly contact with participants to enforce engagement and motivation.

Safety measures and adverse reaction management

Even though any significant side effects are unlikely, the trial evaluators will closely observe for any unexpected incidents throughout and after the treatment. If any serious incident does occur, it will be reported to the ethical board committee by the principal investigator and noted in the final study results.

Auditing

Every week, auditing of the trial will be conducted. All protocol deviations, whether minor or major, will be documented in detail and managed according to the guidelines set by the Institutional Ethics Committee to ensure participant safety and research integrity.

Data management

Baseline data will be gathered after participants have given their consent. After the intervention, postintervention data will be gathered after 8 weeks (see online supplemental table 1). To ensure accuracy, all data files will be screened for any inconsistencies. The designated data manager will be responsible for securely storing all materials related to data collection, whether in physical or digital format. Participants’ private information will be safeguarded in password-protected databases. To maintain anonymity, each participant will be assigned a unique identification number. The identified data will be shared with the statisticians for analysis, ensuring participant confidentiality throughout the study.

Monitoring

To ensure unbiased oversight, two people will be appointed to monitor the participants at the study site. They will carry out daily checks on data accuracy, recruitment progress, adherence to the protocol and any adverse events that arise. Once data collection concludes, the final data will be shared with the lead researcher and coinvestigators. All authors will be granted full access to the anonymised data. Any updates or modifications made in the protocol will be promptly communicated to the ethical committee by the principal investigator.

Statistical analysis

All statistical analyses will be performed using IBM SPSS Statistics V.25.0. Descriptive statistics will be used to summarise demographic data (eg, age and gender) and baseline characteristics of the participants. Measures of central tendency (mean±SD) will be used for continuous variables, including outcomes from the HHD, sphygmomanometer and PPT (primary outcomes) and single-leg squat scoring criteria (secondary outcome).

To ensure data homogeneity, tests, such as the mean, SD, χ² test (for categorical variables) and independent t-test (for continuous variables), will be applied.

Inferential statistics.

• Within-group comparisons (pre- vs postintervention) will be conducted using paired t-tests for normally distributed data.

• Between-group comparisons (Group A vs Group B vs Group C) will be assessed using independent (unpaired) t-tests for parametric data. A p value of<0.05 will be considered statistically significant. This analysis will compare the following groups.

  1. Group A—modified progressive Copenhagen exercise in adjunct to CPT.

  2. Group B—SHE in adjunct to CPT.

  3. Control Group C—CPT alone.

Outcome variables will include:

Primary outcomes:

1. Adductor strength, measured using an HHD in Newtons.

2. Abductor strength, assessed by the single-leg squat test scoring system

3. Core stability, evaluated using a sphygmomanometer (in mm Hg) and the PPT

4. Agility, measured through the agility t-test (in s)

Protocol amendments

The Institutional Ethics Committee held on 30 January 2025 has approved the current research protocol. CTRI registration Ref. No. DMIHER(DU)/ie,C/2025/610.

Ancillary and post-trial care

The entire study procedure will be conducted under the supervision of qualified clinicians and the departmental research committee, including the Principal Investigator, Research Guide, Head of Department, Principal and members of the Research Guidance Cell.

During and after the intervention, that is, 8 weeks, any adverse events or complications arising from the study will be promptly addressed by the Principal Investigator to ensure participant safety and well-being.

Dissemination policy

The findings of this study will be disseminated through presentation at international conferences and will be submitted for publication in a peer-reviewed, indexed scientific journal. A summary of the results will also be provided to participants on request to ensure transparency and knowledge sharing.

Discussion

As a high-intensity indoor sport, futsal demands frequent cutting, quick acceleration and sudden deceleration, all of which place substantial mechanical stress on the hip adductors and trunk stabilisers. These demands highlight the need for preventative strategies that go beyond routine conditioning. The present study explored the utility of two structured exercise interventions, each embedded within a CPT programme, focusing on enhancing physical attributes central to performance namely, strength, core control and agility.

Previous study has shown that MPCA exercise demonstrated a significant increase in EHAD bilaterally and, thereby, reduced adductor-related injury risk in elite male footballers.²³

In designing this study, consideration was given to both exercise specificity and progression. The modified progressive Copenhagen exercise programme will be implemented with attention to graded exposure, addressing common barriers like delayed onset muscle soreness, thereby reducing the risk of adverse events to a minimum,⁴⁰ suggesting that it can be added into futsal training without affecting their performance parameters.²³ Meanwhile, the SHE, known for its controlled and gliding motion, will be included for its accessibility and capacity to activate hip musculature without a high initial load. A previous study showed an increase in EHAD with average values of 50.8% following the SH protocol.²⁵ Both programmes were selected based on their alignment with the movement demands of futsal, with special attention to exercises that integrate eccentric control, trunk stabilisation and neuromuscular coordination.

In the present study, a modified selection of exercises from the FIFA 11+programme will be incorporated to serve as a dynamic warm-up and neuromuscular activation protocol. The chosen components, such as running hip out/in, vertical jumps, toe raises, lunges and running with plant and cut movements, were selected for their relevance to the functional demands of futsal, emphasising hip mobility, lower limb strength, balance and COD control. Exercises like the bench static hold further supported trunk stabilisation, while plyometric and proprioceptive elements were integrated through vertical jumps and agility-based drills. This simplified adaptation of the FIFA 11+maintains the core principles of the original programme, targeting key injury prevention factors, such as neuromuscular control, coordination and eccentric strength, while improving feasibility and adherence in a futsal-specific training environment.

Previous literature supports the idea that structured eccentric training of the hip adductors plays a meaningful role in injury reduction in sports involving rapid lateral motion.⁴¹ However, most studies have focused on professional football players, with limited data available on futsal athletes, a population with comparable, yet distinct, movement patterns. To address this gap, the current trial was built to reflect sport-specific needs.

Moreover, when considering the broader application of such interventions, practical factors like ease of execution, minimal equipment and adaptability were considered. Both protocols could be implemented on the field or in a clinical setting without a significant logistical burden, an important feature for athletes who often juggle competition, travel and limited recovery time.

Throughout the study, therapy progression was structured to accommodate possible fatigue accumulation, notably as sessions advanced in difficulty. We will make sure that there are sufficient intervals of rest in between. This planning aligns with best practices in sports rehabilitation, which recommend progressive overload within an athlete’s adaptive capacity.

In summary, the findings of this research support clinicians in determining which of the three programmes may be more effective.

Limitations

This study had a few noteworthy limitations. One identified limitation of the current protocol is the requirement for equipment, specifically a box or bench; however, these items are cost-effective and readily accessible within most sports team settings. Second, the relatively small sample size may limit the generalisability of the findings to a broader population. Moreover, the investigation primarily focused on immediate postintervention effects; therefore, long-term outcomes and the sustainability of the observed improvements were not assessed. Future studies with larger cohorts and extended follow-up periods are recommended to validate and expand on these findings.

Trial status

This randomised control trial has not recruited any participants yet (figure 1).

Figure 1. Flow diagram for participant recruitment. CPT, conventional physiotherapy; HHD, handheld dynamometer; MPCA, modified progressive Copenhagen adduction; SHE, sliding hip exercise.

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.