Heading Towards a Safer Future? An exploration of elite male footballers’ perceptions towards heading and the Heading Guidelines in England.

Objective: To explore perceptions of professional male footballers from an English Premier League club on heading in football and the Football Association’s (FA) Heading Guidelines. Design: Focus group interview using a six-stage thematic analysis approach. Setting: A Premier League Football Club in England. Patients (or Participants): Eight male professional footballers. Assessment of Risk Factors: Risk factors related to heading in football were discussed, including the safety of the game and long-term implications of heading. Main Outcome Measures: Perceptions of heading in professional male football and the existing Heading Guidelines. Results: Many footballers perceived the risk of sustaining a head injury to be much lower compared to other sports, and stated that the potential long-term risk associated with heading is not a pressing concern. Some justified continuing to play football and head the ball by reasoning that significant safety related changes have already been made to football. Heading is viewed as a fundamental skill, but players argue that it is already limited in training, further negating the need for Heading Guidelines. Finally, footballers expressed that if they were to follow current FA Heading Guidelines, this would negatively affect their development causing selection and career progression issues. Conclusions: This is the first study to explore the perceptions of professional footballers related to heading and the current Heading Guidelines in England. To increase buy-in and adherence to current and future iterations of Heading Guidelines the perceptions of footballers and other key stakeholders should be taken into consideration, along with the scientific evidence base.