Brain health in association football: perspectives of professional players

Introduction: Growing scientific and public concern regarding concussion and the potential long-term neurological consequences of playing professional football has increased attention on brain health within the sport. However, relatively little research has examined professional players' perspectives on concussion management and brain health risks. Method: A cross-sectional, anonymous, online survey was distributed to members of the Professional Footballers' Association (PFA) in March 2023. The survey assessed concussion history, attitudes towards concussion management, support for temporary concussion substitutions, perceptions of heading-related risks, concerns about long-term neurological conditions, as well as engagement with concussion education. Responses from 600 current and former professional football players (97% male; 3% female) across multiple playing levels were analysed using descriptive statistics and non-parametric tests. Results: A larger proportion of players reported having suspected a concussion during their career than reported receiving a formal diagnosis. Although many players indicated a preference to remain on the field following a suspected concussion, most believed that athletes should not be responsible for deciding whether to continue playing. Strong support was observed for the introduction of temporary concussion substitutions, particularly among retired players and those with longer playing careers. Many respondents also expressed concern regarding heading-related risks and the potential development of long-term neurological conditions. Players who had received concussion education demonstrated greater awareness of these risks. Discussion: Professional football players acknowledged important challenges in concussion recognition and management and broadly support policy measures aimed at improving player safety. The findings highlight potential gaps in concussion diagnosis and education within the professional game and suggest that players favour approaches that include thorough medical assessment and reduce pressures to continue playing following head injury. Incorporating athlete perspectives into policy development may help inform effective concussion management strategies and support efforts to protect the long-term brain health of professional footballers.