Performance Verses Prevention? An Exploration of Elite Coaches' Attitudes Toward Heading and the Implementation of English Heading Guidelines

Objectives: To explore the perceptions and attitudes of professional coaches from an English Premier League club toward heading and the Football Association's Heading Guidelines. Design: This qualitative study used an interpretivist philosophical paradigm. A focus group interview was conducted and analyzed using 6-stage thematic analysis approach. Setting: A Premier League football club in England. Patient (or Participants): Five male professional coaches. Assessment of Risk Factor: Related risk of heading in football had been discussed which included safety risks of heading and long-term implications of heading. Main Outcome Measures: Coaches' perceptions of heading in football and existing heading guidelines in England. Results: Three main themes emerged: (1) How bad is heading? Concerns were raised about the risk of heading on neurodegenerative diseases, with coaches questioning the evidence and comparing risks with other sports; (2) How coaching influences heading in football. This theme highlighted the coaches' perceptions on the importance of heading for certain positions and career progression, and the perceived neglect of heading technique development; and (3) How coaches implement the guidelines , with this theme revealing mixed attitudes toward guideline adherence, with suggestions for safer heading practices and concerns about the guidelines' impact on training and games. Conclusion: Coaches expressed scepticism about the need for Heading Guidelines due to limited evidence on long-term brain health. They emphasized the importance of educating coaches on research evidence as it becomes available, and involving multiple stakeholders in player safety. Effective implementation requires addressing coaches' perceptions and ensuring better communication and education on the guidelines' rationale and benefits. The study highlights the need for improved communication and education to increase buy-in and adoption of Heading Guidelines, considering both coaches' perspectives and the scientific evidence base.