Spare the brain: female football players’ perspectives of heading the ball, concussion knowledge and attitudes. A qualitative study

The aim of this study was to explore female football (soccer) players' perspectives of heading the ball, and perceived header injury risk. A qualitative approach was undertaken using reflexive thematic analysis. Focus groups and individual interviews were conducted using a semi-structured interview guide. Participants also completed a survey containing a validated concussion knowledge and attitudes questionnaire. Participants were recruited throughout New Zealand and focus groups/interviews were completed via Zoom. Otter.ai was used to assist in transcription and NVivo was used for coding and initial theme development. Nineteen female football players were included across six focus groups and three individual interviews. Three main themes were generated. Firstly, <i>the battle of 'risk versus reward'</i> explored players' views around the importance of heading for the game and perceived injury risks. Secondly, <i>spare the brain versus train the skill</i> described players' avoidance of heading the ball rather than training the skill due to potential injury risk and/or concern around performing repeated headers. Finally, <i>changes in perspectives following concussion and appetite for managing injury risk</i> explored how players perceived the experience of a concussion to have influenced their headers, factors influencing their concussion attitudes and potential return to heading guidelines and injury prevention tools. Female footballers reported actively avoiding repetitive header training due to their perceived injury risk and experiencing symptoms. While female players value the importance of headers for the game of football, there is also some concern around the safety and potential injury risk, especially in those with a history of concussion.