Helmets

This is a work in progress. I will continue to add to this and make corrections as I have time. 

The focus on wearing helmets has, in my opinion, been quite detrimental—to our health, safety, and environment. It has taken the focus off of far more important safety measures such as building safe protected bikeways and it has discouraged people from riding which is far more detrimental to our health than any harm from not wearing a helmet.

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There has been some controversy over my recent comments about wearing or not wearing bicycle helmets.  Here are a few very quick (or not so) points on this.

Firstly, I do not encourage people to not wear bicycle helmets. However, people should know the realities of bicycle helmet effectiveness. They should know that it is OK and safe to ride without a helmet. And especially to do so rather than choose not to ride because they don’t have a helmet, can’t find it, or simply don’t want to wear it.

People should have the freedom to ride a bicycle without being berated for whichever they choose. As we’ll see, both are quite logical choices, and whichever someone chooses likely makes little difference beyond personal preference and fashion.

Our intuition tells us that foam bicycle helmets should be effective in preventing traumatic brain injury (TBI), the reason that we are told to wear them. In reality this has not shown to be the case.

Three Big Grains Of Salt 

Gbikes82

We are often told to take something we hear with a few grains of salt. Wise advice. Here are a three grains of salt for bicycle helmets.

1 – Bicycle riders in The Netherlands, Denmark, and elsewhere do not wear helmets. And yet, with all of their bicycle riding, they do not have higher rates of Traumatic Brain Injury (TBI). In fact, they live longer and healthier lives than we do.

2 – Of the studies of population-wide increases in helmet use, none that I am aware of have shown a corresponding causal decrease in rates of TBI. They consistently show no statistically significant change[1].

3 – Head injuries as a percent of all bicycle injuries are the same in The Netherlands (32% of all injuries) with zero helmet use as in the U.S. (33%) with high helmet use. Minnesota, with very high helmet use, has an even higher rate of 37%.

If bicycle helmets were effective then these should not be. Everything we hear in the U.S. tells us that The Netherlands, Denmark, and similar helmetless countries should have massive numbers of head injuries and fatalities or that if people start wearing helmets fatalities will decrease. Yet neither of these has proven true.

The big smoking gun though is #3 because that takes all other factors, such as Europe’s safer roads and drivers, out of the equation. It looks only at helmet effectiveness and indicates that helmets have no overall affect on reducing brain injury.

Now, let’s look a bit more in depth.

Two Explanations to Consider

Certainly one conclusion is that bicycle helmets are simply not effective in preventing head injuries. There are though two others that we should consider first.

First is that the helmet wearers in these studies (people in Australia, Canada, and the U.S.) were not wearing them correctly and thus did not benefit from wearing them. There would seem to be considerable truth to this as not wearing a helmet correctly does negate it’s benefits and, anecdotally, the vast majority of people I see wearing bicycle helmets in the U.S. are wearing helmets that are too big, with too loose of a strap, or pushed back on their head.

The second bit of explanation is that people in The Netherlands, Denmark, and Sweden are better bicycle riders than we are and have better and safer infrastructure. There is considerable truth to this and does explain the much lower overall injury and fatality rates for these countries but does not explain why they have the same rate of TBI as we do.

Together these do explain some of why we’ve not seen a decrease in TBI with higher helmet use, but likely not close to all. These also point out a couple of critical issues; if people will not wear helmets correctly, is there a point in pushing helmet use? And, if better infrastructure will have a such a greater impact on lives saved, should we focus on that instead?

That latter point is interesting because that is a key reason that we are two to four times as likely to be killed by someone driving a car as someone in Europe is. They’ve focused on preventing crashes, particularly crashes involving pedestrians and bicycles. We’ve focused on moving motorized traffic as far and fast as possible and then tell pedestrians and people riding bicycles that they need to wear hi-viz clothes and helmets to survive in this brave fast world.

There are three elements that we need to consider next. First, are helmets effective at preventing TBI. Second, how often are we likely to ever actually need a helmet. And third, can helmets actually be harmful.

Coming up soon…

Why I Don’t Wear A Helmet

I did for a number of years. And still have a bunch of them.

However, I often found helmets a pain for normal everyday riding, like a quick trip to the store or dinner. I’m not known for always putting stuff where it goes so it wasn’t unusual for me to not be able to find my helmet when I wanted to ride somewhere. I’d often then end up driving instead.

I never found comfort to be a highlight of helmet wearing and it would sometimes leave my hair sweaty when I arrived where I was going. I’m also not known for spending any time styling my hair so any impact on my hair style either wasn’t an issue or maybe even an improvement. I found ski caps much warner and comfortable in the winter and either nothing or a baseball cap more comfortable in the summer. Then there was what to do with it at my destination. Do I leave it hanging on my bike for someone to steal? Carry it around with me? 

I never even considered not wearing a helmet until one day it occurred to me that all of the bicyclists I saw in Europe never wore helmets. Were they just that far behind the times? This led to a bit of research that surprised me with there being any doubt about the effectiveness of helmets. More research indicated that effectiveness was at best inconclusive and that more than likely any benefit was quite miniscule.

(This also gets to why I said earlier that both choices, to wear a helmet or not wear a helmet, are rational and logical. Most people in the U.S. hear nothing but that helmets are critical to safety and that we should always wear them when riding a bicycle. So, many people, logically, wear a helmet. I don’t blame them.)

On the other hand, a bit of research indicates that helmets are likely not very beneficial and are, more often than not, harmful to our overall health if they contribute at all to our not riding. These people, logically, often choose not to wear helmets.

For me, unless I was also going to start wearing a helmet every time I walked somewhere or got in a car the benefits weren’t there. 

To Be Continued…

 

  • Emily Malone

    I first want to mention that we live in the USA and not in all those other counties you mention and should not be compared to them. In the USA for whatever reason there are many head injuries and 85% of bicycle related head injuries could be prevented by wearing a helmet, just ask the Brain Injury Alliance of MN. You use all the famous reasons for not wearing a helmet, but you know what…. keep your helmet hanging on the handle bars of your bicycle so you can’t use the excuse that you can’t find it, lock your helmet up right along with you bicycle so you don’t have to carry it around, and having to deal with messy hair is no problem at all compared to having to live with a brain injury because you did not have a helmet on. That last comment is what I have to live with every day… I was not wearing a helmet and crashed my bicycle, causing a traumatic brain injury of which I was in a coma for 10 days and was in therapy for months after trying to regain what was lost as a result of my TBI. The effects of a brain injury are frustrating. I look just like everyone else yet there are parts of my brain that do not function the same as everyone else as a result of my TBI and I struggle with common tasks. Bicycle helmets are important, in fact I know someone who had a similar crash as I did though she had on a helmet. This persons helmet was cracked and dented because of the crash yet she walked away with only a few scrapes, not a TBI like I did. The helmet did its job and prevented a serious injury. I have given helmet safety presentations to over a 1,000 students and this is how I always close “So if you don’t already own a bike helmet, please buy one and wear it every time you go for a ride. Speaking from experience, it’s worth it! The choice is yours…

    • Opafiets

      Hi Emily, thank you for your comments. I am very sorry to hear about your head trauma. I can imagine that must be quite frustrating.

      To your points.

      We very much should compare ourselves to other countries. We have the most dangerous road system of all developed countries. Someone in the U.S. is three to four times as likely to be killed or injured on our roads as someone in Europe. That is not something to be proud of nor should we stick our heads in the sand. We should look to Europe for how to make our own roads as safe as theirs. If our roads were as safe as The Netherlands then about 300 of the 387 Minnesotans killed last year would be alive today.

      You state that 85% of head injuries can be prevented by people wearing bicycle helmets. That is a false number from a 1989 study by Thompson, Rivara & Thompson published in the New England Journal of Medicine (Vol 320 No 21 p1361-7) and that has been widely discredited (though people still quote the inaccurate 85% number from it).

      If foam bicycle helmets were effective then there are a number of indicators that we would expect to see from increased helmet use yet we’ve not seen any of them. The number one indicator we look for is a drop in traumatic brain injuries as a percent of all injuries yet we’ve not seen that. In fact, the Minnesota Brian Injury Alliance recently reported that this rate is actually higher in Minnesota than in The Netherlands.

      No increase in helmet use has ever led to a decrease in the rate of TBI. Helmets, at least as currently designed, have proven ineffective.

      Given what we now know about the effectiveness of bicycle helmets from years of actual data, advocating for people to wear bicycle helmets is about akin to telling them that a ball of cotton on their head will prevent brain injury in a crash. The evidence is just not there. There is no indication in real world use that helmets prevent or even reduce TBI.

      Today’s bicycle helmets are good at preventing abrasions in a crash and that may be just about it.

      To your anecdotes, there is no way to know if a bicycle helmet would have changed the outcome of your crash. The data tell us that it likely would not have. Similarly, the outcome of your friend’s crash would likely not have changed had they not been wearing a helmet.

      What has proven to very significantly reduce TBI and other injuries and fatalities is to prevent crashes to begin with. This by making roadways safer for all people; in motor vehicles, riding bicycles, disabled mobility, and pedestrians. If you want to save lives and prevent other people suffering what you have or worse then you should encourage our cities and counties in building Dutch style segregated bicycle/disability paths and safer intersections.

      It sounds like you are a good speaker and enjoy speaking to students. Obesity and lack of activity are massively greater threats than TBI. Rather than make people fearful of riding, how about encouraging people to ride as much as possible — with or without a helmet. Encourage them to ride on the right side of the road and to always use lights at night. These will have a much greater positive impact on these students lives than promoting fear and wearing helmets.