Abstract
Background: Football is the only sport where players intentionally use their head to shoot, redirect, or pass the ball. This has sparked debate in the literature regarding the safety and potential long-term effects on brain health from cumulative ball heading. Yet there is limited understanding of the players’ perspectives on health and heading.
Purpose: To explore female football players’ perceptions of heading the ball and their knowledge and attitudes towards concussion.
Methods: This qualitative study used semi-structured focus groups and individual interviews. Reflexive thematic analysis was used for analysis and theme development.
Results: Seventeen players (aged 18–40 years, minimum 5 years’ playing experience) participated in six focus groups and one individual interview. Thirteen of these had incurred at least one concussion. Three themes were developed: (1) The battle of “risk vs reward”: views around the importance of heading for the game but also the perceived injury risks; (2) “Spare the brain” vs “train the skill”: players often avoided heading the ball in training rather than practising the skill; (3) Changes in perspectives following concussion: players reported being more apprehensive to head the ball post-concussion, preferring to use other body parts (e.g., the chest) and coaches/family influenced attitudes towards heading and concussion.
Conclusion: In contrast with other injury prevention strategies and skills, the task of heading is often avoided in training rather than practised as a skill, limiting the number of head impacts to “reduce injury risk”. Various factors influence perspectives of heading, particularly following concussion, with some players constantly having to choose whether to avoid heading at the cost of decreased performance.
Implications: The outcome of this study highlights many players’ apprehension to head the ball in training/repetitively and how concussion changes their views on heading. These player perspectives may help to inform return to play protocols and heading guidelines.