My uneasy relationship with helmets


I am in favor of bicycles, bicycling and bicycle safety. I am opposed to bicyclists sustaining injuries and particularly head injuries that result in traumatic brain injury. More bicycles on streets and roadways make all bicyclists safer. Mandatory helmet
laws increase the rate of helmet use but decrease the number of bicyclists. The
health benefits of riding a bicycle far outweigh the risks of injury or death
(in “life years”). Bicycle helmets represent a design compromise that reduces
effectiveness in a crash in favor of lighter weight, comfort and ventilation.
If you are relying on a helmet to keep you safer while riding a bicycle, you
have skipped a number of important steps that can more effectively keep you “safer.”


I ordinarily keep my opinions about bicycle helmets to myself. I never tell anyone not to wear a helmet, though I sometimes wish the helmet people would reciprocate. The only reason I’m going “public” now is because the Active Transportation Alliance has
adopted a policy of making helmet use mandatory for its various fundraising
and/or sponsored events. The language currently being used is “I agree to wear a helmet suitable for cycling at all times during the bicycle tour. Those who refuse to
wear a helmet will not be permitted to ride and will not receive a
refund.”  The attorney side of me suspects this is an insurance underwriting requirement and the ATA needs to include this language to get a break on its liability premium (or possibly, a requirement to get any kind of coverage at all). And lest any of you think that the insurance underwriters are trying to make everyone safer, additional
requirements imposed on the policyholder are typically included in policies to
form a basis for excluding coverage.
The bicyclist side of me is disappointed that an organization which professes
to “advocate for transportation that encourages and promotes safety, physical activity,
health, recreation, social interaction, equity, environmental stewardship and
resource conservation,” has adopted a policy which runs contrary to that
mission statement. (I just became aware that “Bicycle Chicago Meet-up” and
Lee’s Big Shoulders Neighborhood Tours have the same requirement.)


I don’t want this post to be about me, but by way of background, my bicycling “experience” pre-dates the widespread use of helmets
(probably even the old “hairnets”). When I was a kid, you wore a helmet when you played football and when you batted in baseball, but that was pretty much it. In high school

and college, I competed in gymnastics (trampoline, no less), rugby and ski
racing - never wore a helmet, and neither did anyone else. My non-competitive
unhelmeted activities during this period of time included freestyle skiing with
lots of inverted aerials, and lots of vertical mogul runs. Bicycled some in
college, but never wore a helmet. Always wear a helmet snowmobiling, but
seriously, that’s a little like requiring people to wear a helmet when they go
skydiving. How did people survive such ultra-hazardous activities in the
pre-helmet dark ages? We took extra care not to hit our heads when we fell
down. Sometimes the old ways are the best ways.


This is not an academic paper for peer review, so I’m going to omit cites. If you’re really curious about one of them that you can’t find yourself or feel the need to rip on me in general, let me know and I’ll try to find it again. I know there are a lot of engineers and health care professionals on the chainlink, and I hope this post yields some constructive
criticism and feedback.


Bicycle helmets are mostly designed for slow, vertical falls. The testing methodology is to drop the weighted (11 lbs/5 kilos) helmet from a height of 1.2 meters onto a round anvil and/or a curb-shaped anvil and from a height of 2 meters onto a flat anvil. The headform measures the amount of impact attenuation when the helmet comes to rest, expressed in joules. A helmet which “passes the test” can permit a maximum of 98 joules at the headform. Failure threshold is 300 g, which happens to be the level at which you can expect to lose consciousness, and probably suffer some injury which hopefully will not be permanent.


Real world impacts are going to look a lot different from the testing methodology in that they are much more likely to include: multiple impacts, irregularly shaped “anvils,” and rotational forces (think crack the whip or water skiing outside of the wake when the boat turns). Real world impacts are also much more likely to occur with some significant horizontal speed (which has both advantages and disadvantages).


I bought my first helmet in about 1988. It was a thick styrofoam, poorly vented Specialized helmet which had a nylon fabric cover stretched over it and bore certification stickers to the 1984 Snell and ANSI standards. The unfinished styrofoam design was abandoned within five years for the hard shell finish due to the observation of increased neck and brain injury related to rotational forces exerted upon a helmet which was too “grippy” when it contacted pavement.


Bicycle helmet design must strike a balance between fashion and function. As the pressure has built for manufacturers to design “cooler” helmets (both from an aesthetic and ventilation standpoint), more and larger vents have been cut into the helmet surface. This has resulted in helmets which are indeed cooler and lighter, but which lack the structural integrity of my ugly old Specialized helmet. And penetration risk from rocks and tree branches when mountain biking?: Forget it; not even tested anymore; too many vents. Snell standards are gone, the certifying bodies in the U.S. are now CPSC and ASTM both of which require less energy attenuation than the Snell 95 standards
did. If you’re really serious about wearing a helmet to protect yourself from
traumatic brain injury, buy yourself a good, full-faced Arai, Bell or Shoei
motorcycle helmet-much better energy attenuation, and you also get the added
benefit of protection from facial injuries.


I wear a helmet approximately 25% of the time I ride a bike. My decision to wear a helmet is usually based on: a) likelihood of sustained speeds in excess of 18 mph; b) exceedingly long rides (>6 hours); and/or c) riding with a lot of strangers. I ALWAYS wear a helmet when I ride a mountain bike on trails. The only time I have ever hit my head when bicycling was when I was wearing a helmet. It’s not that I’m such a genius at predicting crashes, it’s simply because a helmet adds an additional 2-3 inches to the
radius of my head and that confuses my muscles and my sensory nervous system. I
have spent a lifetime “learning” where the perimeter of my head ends and I
can’t rewire my perceptual system to account for that extra 2-3 inches. I have
never been hit by a car, but I’m not counting being doored three times over the
years.


Fear is a very effective marketing tool. Whether you’re Rahm Emanuel not wanting to let a good crisis go to waste, or you’re the Bush administration trying to head off the impending invasion of the U.S. by Islamic extremists, a lot of things get “sold” in this country based on an inflated perception of danger. Bike accidents result in approximately 540,000 emergency room visits in the U.S. every year. Of those, 67,000 (12.4%) involve head injuries, and 8375 involve brain injuries [TBI] (1.5%). I can’t find the exact cite for this one folks, but it’s fairly representative of any given year in
the U.S. I’m going to make a pure guess that emergency room visits as an
accident index result in underreporting the total number of bicycle accidents
by a minimum of a factor of three; i.e. there are 3 times as many bicycle
accidents in the U.S. each year and that for every one that sends someone to
the emergency room, another two go unreported or at least don’t result in a
trip to the hospital. I’m also going to guess that an accident serious enough
to result in a TBI is unlikely to result in no hospital visit, so the 8375 TBI
number is probably pretty close to accurate. If this data and these guesses are
true, your risk of TBI is about 0.5% for any given accident, and probably even
lower than that.


Riding a bicycle can improve cardiovascular fitness and improve Body Mass Index, but it doesn’t change certain hard-wired physiological traits or cognitive functions that assist in making you a “safer” bicyclist. We all have differences in strength (including the composition of slow-twitch vs. fast-twitch muscles), balance, visual acuity, (including depth perception and ability to detect motion), hearing, proprioception, and judgment, to name just a few.  I have seen at least a half a dozen bicyclists in the past week, after dark, wearing a helmet, with no lights on the front or the back of their bicycle. I have told two of them they’re going to need a bigger helmet.


As stated, I am opposed to head injuries and particularly traumatic brain injuries. My brain has remained a solid second on my list of favorite organs since adolescence. If I’m ever in a bicycle accident with a car, I want to be dressed like the guy in “The Hurt Locker.” Most studies of the efficacy of bicycle helmets have found them to be effective at reducing the risk of head injury. In my estimation, that takes the risk down from remote to infinitesimal. 


Mandatory helmet laws increase the rate of helmet use, but reduce the number of cyclists on the road (Australia, New Zealand, Canada - British Columbia and Nova Scotia).


More cyclists on the road make all cyclists safer. In 1994, 796 bicyclists were killed in crashes with motor vehicles; in 2009, 630 bicyclists were killed in crashes with motor vehicles (-21%). Trips by bicycle have increased from 0.7% in 1990 to 1.0% in 2009 (+43%).


Portland reported this year that their rate of helmet wearing has increased to 80%, all through promotions and peer pressure. I have no problem with encouraging people
to wear helmets, strongly recommending that people wear helmets, but REQUIRING,
and EXCLUDING?  Can’t we all just get along?

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Replies to This Discussion

Permalink Reply by Doug Haynes on October 29, 2010 at 1:33am
I'm usually not one to preach helmets but while on the subject...

I used to never wear one and used the 'don't fall on your head' logic to justify it; a couple of bad wrecks proved that it is a viable theory but I gave it up after losing a tooth in a wreck a little over a year ago. The accident happened so fast I was on the ground before I even knew what had happened; there was no chance for me to decide how I hit the ground. After that I started wearing a helmet because I realized how easy it is to hit your head if you get surprised by a crash.

Since then I have had a friend shatter w windshield with a helmet and walk away; not something that would have happened with a bare head. I also had my now GF crash hard enough to crack a helmet and had she not been wearing one there would have been an ambulance ride involved instead of just having to walk bikes home.

I agree helmets suck but the plus side outweighs the minus for me. I also think that if you are wearing a helmet you actually prevent other serious injuries because you are not working so hard to avoid hitting your head; being able to fall on a shoulder instead of putting a hand out can prevent a broken wrist.

Either way, it's your choice what you do and nobody should tell you how you can ride.
Permalink Reply by thang van ung on October 29, 2010 at 1:35am
i have been acquainted with helmets but we're not close. like watching a foreign film w/ subtitles i (mentally) replay the film back in the subtitle language, i tend to recall people sans helmets -- unless i prefer the person even less than the helmet. :}

p.s., i've already hit my quota on relationships with inanimate objects.
Permalink Reply by Adam "Cezar" Jenkins on October 29, 2010 at 1:57am
I think they most important thing to take away from helmet usage is that it's a great thing to promote and pressure people into, but if enforced legally it results in less people on the road, making all of us less safe.

More people cycling, not less.
Permalink Reply by Mike Bullis 5.5-6.5 miles on October 29, 2010 at 1:58am
From personal experience, (a wipeout that flattened the back of that helmet and flying across the hood and roof of a Lancer, within a month of each other), I'll take the helmet. Will it save my life? Maybe, maybe not. Can it REDUCE the risk of a serious head injury? Past experience puts the odds in my favor. Will I insist that you wear a helmet if you ride with me? Kick me square in the balls if I do.

On the other hand, an event that 'requires' me to wear said helmet will not see any money or participation from me. Must be one of the myriad of reasons I don't do invitational rides anymore.
Permalink Reply by Vilda on October 29, 2010 at 2:04am
I think if you just use the group rides argument the helmet issue becomes a little silly. It would be far less likely for a guy to go barreling through a group of bike riders than for just one to get hit riding alone. (not impossible - there is video out there). But when i do skip wearing a helmet it's a group ride. ;-) Safety in a large pack. ;-)
Permalink Reply by Craig S. on October 29, 2010 at 2:39am
"I want my 2 dollars!"

Ha! I love that movie, it's one of John Cusack's better acting jobs.

Adriana said:
Listen, do what you will, but when it’s your time, it’s your time. My father was in three major wrecks, the last one completely totaling his 18 wheeler and he walked away; the only casualty being a Playstation 2 (and memory card), which my brother mourned for quite some time. In the end, I saw him suffer an excruciating death to cancer, ‘in his sleep’ my ass! I’m at odds with free will, so since the great puppet master of the universe will do with me what it will, I am going to sit back and enjoy the ride…can’t fight your density, I mean uh destiny! I’m not saying I’m going to jump in front of a truck any time soon since…

"You've succeeded in convincing me life is worth living. By showing how
bad my funeral will suck!"
-Bender

though I’m Better Off Dead!

Feliz Dia de Los Muertos, muahahaha

Permalink Reply by Dr. Doom on October 29, 2010 at 2:40am
I really wish that some fraction of the effort put into helmet propaganda was put into lighting propaganda. I'd guess that less than half of the riders I see out after dark have lights. It's incredibly unsafe and irresponsible.
Permalink Reply by Dave Jacque on October 29, 2010 at 2:56am
Helmets are cheap, comfortable and reduce the damage to your head when you crash. What's the problem?
Permalink Reply by Davo on October 29, 2010 at 3:30am
Solution?
Also I agree that it is hard to fight density. Weather it is loosing it or gaining it.
Permalink Reply by Juan 2-3 or more mi. on October 29, 2010 at 4:02am
We need more bicyclists out there to feel safe enough to ride Holland style, until then the Dutch Ninja take thier chances and say their prayers.
Permalink Reply by Anne on October 29, 2010 at 4:11am
2) Don't forget to mention that in Holland everyone rides a bike and there are no head injuries.

not true: http://www.swov.nl/rapport/Factsheets/UK/FS_Bicycle_helmets.pdf

and if the weight of a helmet weighs you down, what does a motorcycle helmet do to that rider?
Permalink Reply by Kevin C Dormant on October 29, 2010 at 4:21am
I have already conceded the argument that a bicycle helmet provides some measure of protection not afforded to an unprotected head. I wear a helmet sometimes and I hope that anytime I crash, I am wearing a helmet. My issue relates more to the marketing of bicycling and the benefits that everyone derives from having more cyclists on the road (helmeted and unhelmeted). Mandatory helmet use reduces the number of cyclists and sends the message that danger lurks around every corner. I prefer to see cycling promoted as an everyday activity that everyone can enjoy and from which everyone can benefit.

I also eat bacon.

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