Gordon McQueen: Heading in the Spotlight

What is the Gordon McQueen inquest examining?

The inquest is examining whether cumulative head impacts sustained during Gordon McQueen’s professional football career contributed to the development of vascular dementia and CTE.

A coroner’s inquest establishes how a death occurred and whether any occupational or environmental factors materially contributed. It does not determine civil or criminal liability. In this case, the focus is exposure; specifically, repeated head impacts across training and match play, and whether those exposures are consistent with what is now known about long-term brain injury in sport.

Speaking to BBC Breakfast, McQueen’s daughter Haley described the volume and repetition of heading in daily training sessions over many years; not isolated moments in matches, but routine, repeated exposure. She also made a critical distinction: this is not about blame with hindsight, but about responsibility with foresight ^[1].

That framing matters. The inquest reflects a broader shift across sport, medicine, and the law: an acceptance and acknowledgement that brain trauma is the cumulative exposure and damage of repetitive sub-concussions (impacts that give no signs and symptoms of concussion but still damage the brain) over the course of a playing career, rather than damage which is confined to recognised singular concussions.

What does the evidence actually say about heading?

Heading a football exposes the brain to both linear and rotational acceleration. Repeated exposure can contribute to long-term brain injury and the higher prevalence of neurodegenerative disease in former male professional football players. That much is established.

What requires further understanding is context and nuance. Brain injury in football is not driven by one mechanism e.g. heading the ball, one playing position, one skill, or one dramatic impact. It is driven by cumulative exposure to head impacts, many of which do not cause concussion or brain injury symptoms and therefore go unrecognised.

Sub-concussive impacts are lower-force head impacts that do not produce the signs or symptoms of concussion. They are approximately 500 times more frequent than concussions and are now understood to be a primary contributor to long-term neurodegeneration, including chronic traumatic encephalopathy, a progressive neurodegenerative disease that leads to early-onset dementia in an individual’s 20s, 30s or 40s ^[2].

Heading contributes to that brain injury exposure profile; it is not synonymous with it.

Does banning heading from football help?

Heading is a match-required skill in football under the current Laws of the game. Reducing heading reduces one source of head impact exposure; it does not address the majority of brain injury risk in football.

Biomechanical analysis published in the British Journal of Sports Medicine examined the mechanics and frequency of head impacts in football. The findings are clear: heading accounts for approximately 13% of head impacts. The remaining 87% are angled impacts arising from other sources, including head-to-head contact, head-to-knee or elbow collisions, falls, and accidental contact with limbs ^[3].

These non-heading impacts are more likely to involve rotational acceleration of the brain; they are also less likely to be anticipated, modified by technique, or managed clinically.

Focusing solely on heading risks missing the dominant mechanism of injury. It also risks creating a false sense of protection, particularly in training environments where collisions, falls, and repetitive impacts remain unchanged.

The Football Association (FA) has introduced a new rule aimed to phase out deliberate heading in grassroots youth (under-11 games and below) football games across England. Previously, FA guidelines banned headers in practice and training sessions for children under the age of 12. In the US, similar rules around children not heading the ball have been in place since 2015. This has also created a false sense of protection with players, parents, coaches and volunteers thinking the main head impact mechanism has been removed. In the largest randomised controlled study examining the incidence or severity of sport-related concussion in US youth football (soccer) athletes. 55% of concussions were sustained via contact with another player, not the ball (35%) ^[4].

Why rotational forces matter more than linear force

It has long been established that rotational acceleration (forces) poses a greater risk of injury to the brain than linear acceleration ^[6]. It has now been suggested that increased cumulative exposure to rotational accelerations may predict CTE more accurately than a history of concussive injury ^[7].

Brain injury is caused by rotational forces to the brain in both concussion and sub-concussive impacts.

Rotational acceleration causes the brain to rotate relative to the skull, stretching and shearing neurons and small blood vessels. This microscopic damage leads to disruption of neural networks, breakdown of the blood-brain barrier, and damaging neuro-inflammation. Over time, repeated exposure results in cumulative injury, increased neuro-inflammation and increased risk of neurodegenerative disease including CTE ^[8].

Every head impact involves rotational forces. This includes heading, tackles, falls, and collisions with other players, posts, or the ground. Impacts do not need to be forceful, symptomatic, or diagnosed as concussion to cause damage. Repetition alone is sufficient. Heading is not an insignificant insult to the brain with a recent study recording the mean peak intensity of 1068 rad/s2, and female players recording higher peak rotational acceleration than male players ^[9]. To give some context every additional estimated 1,000,000 rad/s2 cumulative rotational acceleration is associated with 22% increased odds of being diagnosed with CTE.

This is why conventional head protection, which historically focused on preventing cuts, abrasions, or skull injury, or focused on linear forces and impacts, does not adequately address brain injury risk. Protecting the scalp is not the same as protecting the brain. Protecting from linear forces is not the same as protecting from rotational forces.

How head impacts accumulate across a football career

Head impacts in football are frequent, varied, and largely unavoidable.

Across a season, players experience hundreds to thousands of head impacts during training and matches. Most are sub-concussive. Most go unnoticed. None allow time for recovery at the cellular level.

The brain does not reset between impacts. Neuro-inflammatory responses triggered by one impact are likely to still be active when the next occurs. This repetition amplifies damage. Over years and decades, this accumulated exposure increases the risk of long-term cognitive, behavioural, and neurological consequences ^[10].

This is why focusing exclusively on diagnosed concussions is insufficient. Concussion management is reactive. Brain protection must be proactive.

What meaningful risk reduction in football actually looks like

Meaningful risk reduction addresses mechanism, not optics.

Rule changes, technique modification, and heading restrictions may reduce certain exposures, particularly in youth sport. They do not eliminate head impacts, nor do they address the rotational forces present in the majority of football collisions.

Effective brain injury risk reduction must therefore be based on three principles:

• First; it must reduce rotational forces transmitted to the brain. These forces are present in every head impact and are the primary driver of brain injury.
• Second; it must apply to all head impacts, not only those that are intentional or skill-based. This includes collisions, falls, and accidental contact, not just heading.
• Third; it must function during training as well as matches. Training exposure likely accounts for a significant proportion of lifetime head impacts.

This is system-level thinking. It recognises that brain injury risk is structural, cumulative, and biomechanical; not simply behavioural.

Conclusion: What the McQueen inquest might make clear

The Gordon McQueen inquest is not a referendum on heading alone. It is part of a broader reckoning with how football, and sport more widely, understands brain injury risk.

The evidence is clear. Brain injury is caused by cumulative exposure to head impacts; most of which are sub-concussive; almost all will involve rotational forces; and the majority are likely not from heading a football.

Reducing heading can of course play a role. It is not a solution on its own.

Perhaps the inquest will consider preventable actions for future players. We now know more from research about how the brain responds to rotational forces than in the past; we know a child’s brain is more susceptible to these forces. What we don’t know is which child may have a genetic or metabolic risk factor, which child will continue to play sport at university/into adulthood, or as a professional, so given the damage of sub-concussions are cumulative, every child enjoying sport is at risk of a massive lifetime dose, and bluntly their CTE and risk of neurodegenerative disease starts in childhood.

Meaningful progress depends on acknowledging the full exposure profile of the sport and prioritising the adoption of effective brain protection, not just head protection. That means focusing on rotational force reduction across all impacts, in training and competition, and at every level of play.

To learn more about Rezon’s research focus and work on brain protection in sport, visit www.rezonwear.com.