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 Barbra Mann on October 31, 2010 at 5:29am
Enjoyed the read, Kevin.
Permalink Reply by Matt M. 18.5KM on November 3, 2010 at 4:03pm
Tough love. Lives and quality of life have been saved for people who happened to be wearing helmets when it mattered the most.


Tank-Ridin' Ryan said:
Killing 'em with kindness, Matt?

Matt M. said:
Dear Kevin,

Screw you. I've seen the effects of head trauma as a result of cycling accidents and it's nothing to debate about. Wear a fucking helmet, moron.

Sincerely,

Matt M
Permalink Reply by Dan Korn on November 4, 2010 at 3:06am
The main reason I wear a helmet is so that, when I do get killed by a car (hopefully an electric one!), the story in the paper won't say, "He wasn't wearing a helmet," implying that (a) it would have made a difference, and (b) it was my own damn fault. Now, as for riding a freak bike....

As for "official" rides which require helmets and signed waivers and the like, I love ActiveTrans and Lee Diamond and all the folks putting on great rides, but with a few exceptions such as Bike the Drive, the vast majority of these rides take place on open, public streets, and there's really no way anyone can keep you from participating, whether you follow their rules or not.
Permalink Reply by Michael Perz on November 4, 2010 at 5:08am
The logic here is a bit backward. If proposed mandatory helmet laws are to have any significant effect they'd be aimed primarily at adults. Bones lose mass and density and become more brittle with age, thus making adults more susceptible to head and brain injury from impact.



Brendan Kevenides said:
I think I am for mandatory helmet laws. (I could perhaps be talked down from this position.) I am for such laws because I want parents to require their children to wear helmets while biking. Kids are more liking to hit their heads in low speed crashes. Also, if children grow up wearing helmets it becomes no big deal.
Permalink Reply by Kevin C Dormant on November 4, 2010 at 5:25am
As we age, our brains are also subject to shrinkage and the structures become more susceptible to injury. There's also speculation among some researchers that the effects of head injury are cumulative, and that impacts over a lifetime that do not even elevate to the level of "concussion" have an adverse effect on the brain. (the research currently being conducted with the reluctant cooperation of the NFL is going to yield some very interesting findings over the next five years or so IMHO). I believe the rationale for targeting children with mandatory helmet laws is to change the "culture" through evolutionary change. It's the "old dog/new trick" conundrum.


Michael Perz said:
The logic here is a bit backward. If proposed mandatory helmet laws are to have any significant effect they'd be aimed primarily at adults. Bones lose mass and density and become more brittle with age, thus making adults more susceptible to head and brain injury from impact.



Brendan Kevenides said:
I think I am for mandatory helmet laws. (I could perhaps be talked down from this position.) I am for such laws because I want parents to require their children to wear helmets while biking. Kids are more liking to hit their heads in low speed crashes. Also, if children grow up wearing helmets it becomes no big deal.
Permalink Reply by Anne Alt on November 4, 2010 at 5:59am
That's my understanding as well - having kids grow up wearing helmets, then the next generation, and so on...

Kevin Conway said:
...I believe the rationale for targeting children with mandatory helmet laws is to change the "culture" through evolutionary change. It's the "old dog/new trick" conundrum.
Permalink Reply by Far'arned Retrogrumpalunkus #63 on November 4, 2010 at 8:50am
Magic force-field.

Helmets are marginally effective at reducing a small amount of force from effecting the head in a minor impact in some instances.

No, they are not a magic force-field that will make all the difference in the world -their difference is so marginal that it is almost impossible to measure in real-world riding.

Do I believe they do more good than harm? Probably -but only if they do not give the rider a false sense of security or feeling of invincibility. Helmets give such a minor increase in armor-protection to a limited area of the head in a very limited type of impact that ANY change in the behavior of the rider towards increased risk-taking will easily negate their fractional utility as a safety device and quickly become an albatross upon the rider's head instead of the magic talisman they believe it to be.

And I'm talking about really effective unpopular and barely-marketable "ugly" helmets that most riders eschew in the first place for glorified disposable beer coolers which they believe to be just as effective as the ugly/heavy/hot models that I rarely see people wearing when they do have helmets on.

That all said, I still wear a bike helmet (actually it is a heavy-duty all-sport/skate hardshell) 95% of the time when I'm riding but I don't kid myself about it being some sort of magic artifact that'll save my head "if only I was wearing it." I'm also a motorcycle rider and wear my Snell-approved $400 Shoei TZ-R 95% of the time I'm riding as well. But a helmet is only one small part of the gear equation. On the motorcycle I'm wearing a $1000 Textile riding suit that is nearly as effective against abrasion as racing leather with built-in padding/armor in the knees/elbows/hips/shoulders and with a built-in back brace. I'm wearing top-end $150 Held-brand armored gloves and $400 Sidi armored motorcycle-specific boots approved for track use. I think I'd rather go without the helmet than the rest of the gear if I had to make a choice.

The same goes for riding my bicycle. I wear good shoes (not sandals or flip-flops) when on a bicycle and protective gloves all the time because I like using my feet and hands and want to keep using them even if I crash the bike. The road is a big grinding wheel. Dress accordingly before falling onto it!

But all of that is only the final defense behind good safety awareness and education. The best armor in the world is that which prevents the accident in the first place. Education not only of the rider but of the other road users as those in both the motorcycle and bicycle commuting/riding communities are well aware that a majority of accidents are caused by the fault of other road users (but a good rider reduces those chances as well by using good strategies and not letting them get to us even when it is their fault).

I'd like to end with stating that the majority of bicycle-safety money comes FROM the helmet manufacturers in grants and gifts to cities/states/municipalities. Yes, it comes from the helmet manufacturers because they know if they push "bicycle safety" it means higher profits from vastly increased helmet SALES. If they can pass laws that FORCE all riders to own and use helmets they will make more MONEY. If they can arm-twist event sponsors through insurance language to MANDATE helmet use at their events they can make more MONEY.

Why is it that while helmet-use is a small fraction of the total rider safety equation helmet-use money from the helmet manufacturers makes up the BULK of the money and time spent by groups and municipalities?

FOLLOW THE MONEY.

Helmets, themselves, are not evil -but a lot of the people who are pushing their use are doing so only for the MONEY and not because it is the most effective or cost-effective use of resources to actually help reduce the negative aspects of the safety equation statistics.

But that is the fact. The helmet manufacturers are the ones throwing money at the "bicycle" (and motorcycle) safety programs and they can therefore dominate the debate and push their own agenda even though it might not be the best for riders in general.

Wear your helmet if you want. I'm not for a law banning the use of them -but neither am I for one MANDATING them. As far as I know helmet use is legal in all 50 states. Nobody is stopping you from wearing one if you wish.

That sounds fair to me...

But please leave well enough alone when it comes to other people. Nobody likes a nanny-ninny who's money is coming from BIG HELMET forcing laws down our throats.
Permalink Reply by in it to win it 8.0 mi on November 4, 2010 at 9:44am
I also think all pedestrians in the Loop should be required to wear helmets. If you work in the Loop, I'm sure you've see all the jaywalkers/people absorbed in their cell phone conversation/absorbed in their texting/etc. walking right into the street without so much as looking right/left. Obviously, they would have to be taught to lead with their head so the impact would be to the helmet . . .
Permalink Reply by Far'arned Retrogrumpalunkus #63 on November 4, 2010 at 9:46am
Let's just require all people to wear hockey-helmets at all times from cradle to grave. Just think of the head injuries we could avoid!

Do it for the children.



Kent Hamilton said:
I also think all pedestrians in the Loop should be required to wear helmets. If you work in the Loop, I'm sure you've see all the jaywalkers/people absorbed in their cell phone conversation/absorbed in their texting/etc. walking right into the street without so much as looking right/left. Obviously, they would have to be taught to lead with their head so the impact would be to the helmet . . .
Permalink Reply by Dr. Doom on November 4, 2010 at 9:59am
I wear magical hats and think others should, too, because why not. The most interesting thing to me, though, is always when you hear someone say, as someone here did, that while they got a concussion in a wreck, their helmet protected them from traumatic brain injury. A concussion is by definition a traumatic brain injury! If helmets were really effective people wouldn't get concussions while wearing them. Such is the power of faith in the magical hat, though, that even when they don't work they're credited for working.
Permalink Reply by ad on November 4, 2010 at 10:36am
I fall into the camp of "one of those people" who credited a helmet with preventing a traumatic brain injury in this thread. I see your point to a degree, and would gladly concede that a better way to phrase the statement is to say a helmet "probably" helped prevent an even more serious traumatic brain injury.

Would it really have been a more serious TBI (rather than a minor/moderate concussion) without the helmet on, hard to say and even harder to prove. The ER doc certainly thought so, though. Kind of enough for me. In the end that experience of feeling like I may have escaped from something much much more serious by wearing one, mixed with the fact that they really aren't that uncomfortable IMHO, is enough to ensure I'll wear one for the rest of my life.




Dr. Doom said:
I wear magical hats and think others should, too, because why not. The most interesting thing to me, though, is always when you hear someone say, as someone here did, that while they got a concussion in a wreck, their helmet protected them from traumatic brain injury. A concussion is by definition a traumatic brain injury! If helmets were really effective people wouldn't get concussions while wearing them. Such is the power of faith in the magical hat, though, that even when they don't work they're credited for working.
Permalink Reply by ad on November 4, 2010 at 11:21am
I'm not advocating for mandatory helmet use, just to get that out of the way.

I'm curious, though, where the assumption comes from that by putting a helmet on, the average rider gets a "false sense of security or feeling of invincibility." I have just never known that be the case with any of the cyclists I know. In fact, it seems like the majority of people I see riding at night without lights, or pulling sketch maneuvers in traffic, are people riding without a helmet. While I have certainly also seen plenty of sketchy riders with helmets on, nothing has ever suggested to me that they are riding that way because they feel a helmet is some type of magical shield that will protect them against any injury. So my real question is, where does this idea come from that by asking someone to wear a helmet you are altering their behavior to be less risk-adverse while riding?


James Baum said:
Magic force-field.

Do I believe they do more good than harm? Probably -but only if they do not give the rider a false sense of security or feeling of invincibility. Helmets give such a minor increase in armor-protection to a limited area of the head in a very limited type of impact that ANY change in the behavior of the rider towards increased risk-taking will easily negate their fractional utility as a safety device and quickly become an albatross upon the rider's head instead of the magic talisman they believe it to be.

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