Osman Hassan Ahmed

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.

Despite this diversity, national surveillance data suggest that Muslims report lower levels of physical activity compared with other faith groups in England.3 Lower physical activity levels are of public health relevance given the higher prevalence of cardiometabolic conditions reported in several Muslim-majority ethnic groups in the UK, including type 2 diabetes and cardiovascular disease.4 Understanding how structural disadvantage, experiences of discrimination, and faith-related practices may intersect to influence physical activity behaviours is therefore important for Sport and Exercise Medicine (SEM) clinicians and policymakers working to promote equitable participation.

This chapter introduces graduate sport rehabilitators (GSRs) to the complex clinical challenge of sports-related concussion (SRC), a traumatic brain injury caused by biomechanical forces that disrupt neurological function. It outlines the mechanisms of injury, recognition strategies, and the potential short- and long-term consequences of mismanagement. The chapter explores risk factors such as sex differences, recurrence rates, and links to musculoskeletal injury, alongside barriers to symptom disclosure. Emphasis is placed on the GSR’s role in identifying, managing, and supporting safe return-to-sport decisions. Practical guidance is provided to help GSRs reduce SRC risk and apply current evidence in clinical and sporting environments.

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, the battle of 'risk versus reward' explored players' views around the importance of heading for the game and perceived injury risks. Secondly, spare the brain versus train the skill 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, changes in perspectives following concussion and appetite for managing injury risk 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.

Objective To examine prevention strategies and potential modifiable risk factors (MRFs) for sport-related concussion (SRC) and head impact/head acceleration event (HAE) outcomes in female, woman and/or girl athletes. Design Systematic review with meta-analyses and Grading of Recommendations, Assessment, Development and Evaluation. Data sources Medline, CINAHL, PsycINfo, SportDiscus, ERIC, CENTRAL and CDSR. Eligibility Primary data studies with comparison group(s) assessing the association of prevention interventions and/or MRFs for SRC or HAE with ≥1 female/woman/girl in each study group. Results Of the 108 included studies, 67 evaluated a SRC prevention strategy (equipment n=25, policy/rule n=21, training n=10, management n=11) and 41 evaluated potential MRFs (34 distinct MRFs across nine categories). In total, 40/108 (37%) studies (prevention 19/67; MRF 21/41) included female/woman/girl-specific estimates. Three meta-analyses were conducted: two SRC prevention strategies (headgear, eyewear) and one MRF (artificial turf vs grass) based on availability of female/woman/girl-only estimates and similar outcomes and exposure. Headgear was associated with 30% lower SRC rates in adolescent female/girl lacrosse and soccer (IRR=0.70, 95% CI 0.50 to 0.99; very-low certainty). Eyewear use was not protective for SRC (IRR=1.08, 95% CI 0.69 to 1.68; very-low certainty). SRC rates did not differ by artificial turf versus grass (IRR=0.95, 95% CI 0.62 to 1.45; very-low certainty). Conclusion We found limited evidence for prevention strategies and MRFs in female/woman/girl athletes except for very-low certainty evidence supporting headgear use in adolescent lacrosse and soccer. Future studies should consider the design, implementation and evaluation of SRC prevention strategies that target MRFs to guide safe practice recommendations specifically for female/woman/girl athletes.

Background: The use of analgesic and anti-inflammatory (AAI) medications is prevalent among athletes, particularly in contact sports like football. Understanding the perceptions and practices of AAI medication use is crucial for protecting athlete health and enhancing performance. Objectives: To investigate the prevalence and patterns of AAI medication use and the perception towards sports pharmacy and medication use from players in the Egyptian men’s national football team. Methods: A questionnaire-based cross-sectional study was conducted across training camps in 2024 for the Egyptian men’s national football team. Results: Results from the survey indicated a high usage of AAI medication among the participants, with 64% of footballers reporting usage. The survey revealed a lack of awareness among footballers regarding the potential adverse side effects of these medications (including non-steroidal anti-inflammatory drugs) and that footballers felt sports pharmacists have a crucial role in managing and educating athletes. Notably, 76% of footballers (n=19) expressed a desire to have a sports pharmacist as part of their medical team. Conclusion: Our study demonstrated the widespread use of AAI medication among these elite international footballers, accompanied by a perceived need for pharmacists to be integrated into the medical team at the international level. It is hoped that such integration will ensure that footballers receive the necessary guidance and support to use AAI medications responsibly.

Background: Head acceleration is often used as a proxy measurement for concussion risk. It is unclear what factors contribute to head acceleration during a purposeful header. Objective: The objective of this systematic is to identify what factors influence head acceleration during a header and highlight areas that have not been explored. Methods: Studies were included if they assessed the effect of an independent variable on head acceleration during a purposeful header. There were no exclusion criteria relating to age, sex, playing level, study design, or publication date. Databases included Scopus, Web of Science, MEDLINE, EMBASE, CINAHL, SPORTDiscus and ClinicalKey, and grey literature was also searched. Searches were re-run in January 2024. Each included study underwent a risk of bias or quality assessment, using several tools owing to varied study designs (ROBINS-I, RoB2, modified Downs and Black and AXIS). Results are presented in tabular form, categorised by independent variable(s) and accompanied by a narrative results section. Results: A total of 60 studies were included. Study designs included one-off measurements with variable(s), cohort, cross-sectional and randomised controlled trials (RCTs). Influencing factors included ball velocity and characteristics, header type, impact location, neck training interventions, fatigue protocols, neck strength, demographics, playing scenario and personal protective equipment. A wide range of heading trials and methods of measuring head acceleration were used. Results were conflicting for several variables. There was some consistent evidence that increased ball speed/mass/inflation increased head acceleration. Female players sustained greater head accelerations than males, and some evidence suggested that increased neck strength reduced head acceleration, but not in all cases. This review confirmed traditional neck strengthening is not effective in reducing head acceleration; however, adding neuromuscular exercises appeared to be effective. There was a lack of evidence investigating other systems that may affect head acceleration such as vestibular function, oculomotor performance, rate of force development and cervical spine proprioception. Discussion: This review highlights the range of studies investigating head acceleration during a purposeful header. Included studies were of varying quality, and one limitation was the lack of transformation of the acceleration measures to a consistent frame of reference. Implications from this study suggest potential measures that may reduce head acceleration and therefore improve the safety of performing a purposeful header. These include reducing ball inflation pressure, limiting headers from long range/high speed balls (especially in children/adolescents and females) and ensuring neuromuscular exercises are incorporated into neck training programmes. Dynamic muscle strength outcomes, including measures such as rate of force development, are challenging to measure but should be considered an essential component of neck training when the aim is to reduce head acceleration in a ballistic task such as a header. The review is registered under the PROSPERO registry (CRD42022359294).