The most interesting comment to come in after the “Most Common Noob Mistakes” post was one by Dr. Richard Keatinge, a general practitioner from Wales, in the United Kingdom. Although failing to wear a helmet was fourth on our little informal list, Dr. Keatinge says helmets don’t do the job they’re supposed to do. He is a member of the editorial board of the Bicycle Helmet Research Foundation, an organization whose purpose is “to undertake, encourage, and spread the scientific study of the use of bicycle helmets, in the context of risk compensation and sustainable transport.” It appears to be a largely European group. I’ll let Dr. Keatinge take it from here, then add some thoughts of my own.
I no longer wear a helmet and haven’t pressed them on my children. I do check that their brakes work, their saddles are the right height, their lights are bright at night, and that they have a good idea of the rules of the road.
At my moderately advanced age it’s far too dangerous not to cycle – regular cycling, Danish style, not too far, not too fast, nearly halves the death rate, see http://archinte.ama-assn.org/cgi/content/abstract/160/11/1621 All-Cause Mortality Associated With Physical Activity During Leisure Time, Work, Sports, and Cycling to Work. Andersen et al, Arch Intern Med. 2000;160:1621-1628. Bicycling is good for health, but helmets don’t seem to be.
Dr. Keatinge makes an interesting case, and supports his claims with scientific evidence. I’ve seen arguments like this in the past. Even the Bicycle Helmet Safety Institute agrees that there are conflicting results to scientific studies on bicycle helmet effectiveness.
The “smush” test Dr. Keatinge links to is hyperbole; no one claims that a helmet will keep your head from being crushed if a car rolls over it. What a helmet is supposed to do, according to the Consumer Product Safety Commission, is “reduce force to the rider’s head when the helmet hits a hard surface.”
The CPSC standard is the one in use in the United States. Testers put a helmet on a headform and drop it a distance of two meters onto an anvil. That’s about the distance a bike rider would fall from a seated position on a bike, and a speed of about 14 miles per hour. A helmet must register less than 300 g’s to pass.
Let’s say you’re traveling at more than 14 mph, as blogger GT in LA was last week. He touched the wheel of the bike ahead of him, and went down hard. His bike slowed instantly, and his head’s speed when he hit the ground was probably less than 20 mph, and maybe less than 14 mph.
Although GT was banged up pretty badly, he had no head injuries. Take a look at the damage his helmet sustained. GT’s experience is anecdotal evidence, and not part of a scientific study, so I’ll cite this one: the Thompson, Rivara, and Thompson article in the New England Journal of Medicine from 1989 that showed riders wearing helmets had an 85 percent reduction in risk of head injury, and an 88 percent reduction in risk of brain injury (Dr. Keatinge’s organization takes issue with these findings).
I’ve fallen three times in the last nine months. No serious injuries, but all three crashes were my fault. That’s a pretty good indicator that I’m likely to fall again. A helmet won’t save me from my own stupidity, carelessness, or inattention while riding, but it will improve the odds that my noggin won’t be damaged if I do go down.
Riding “not too far, not too fast” might be good for overall health, but we’re bike riders, and I for one am going to strap on my $35 CPSC-certified helmet and keep riding.
I’m a believer in science, but two things in your quoted sections bother me: “helmet laws have stopped a lot of people from cycling” and “a broken helmet has simply failed”. The first quote implies an agenda, not independent research. The number of people wearing helmets has nothing to do with their effectiveness WHEN WORN. I question the accuracy of the 2nd quote, regardless of the Wiki “engineer” reference. Helmet materials should absorb impact forces, but not unlimited force. As they absorb force past their design limits, they break, and then transfer force to your head. But they are still absorbing force, reducing the overall impact force on your head.
Like you, I’ve fallen before, and hit my head. If I had not been wearing a helmet, I am absolutely sure I would have had a serious head injury.
The above-quoted GP is simply repeating what is on wikipedia (his GP status seems to have little to do with his statement, making it somewhat of a false appeal to authority), except I’d argue wikipedia presents it better.
I wouldn’t say my helmet has ever saved my life, but it’s certainly prevented me from having some nasty scrapes and bruises, and probably a concussion or two. Any scrape on the helmet is one less on my head! For me, that’s a good enough reason to wear it – never mind the fact that it might make an appreciable difference if I’m in a bad accident.
Side note: One of the problems with helmet research on the population is that helmets are only designed to last a finite number of years, but most people don’t realize this. I pass people nearly every day wearing helmets made in the 80’s and 90’s, all of which are now way beyond their intended shelf life.
Giles from NH says
What injury do we see over, and over, and over in professional cycling (and I know I’ve had a few cyclists friends that have gotten this one as well)?
Not a head injury! I’m thinking of a broken collar bone. Perhaps we should all wear shoulderpads while cycling?
But head injuries–it does seem that all the evidence in favor of helmet usage is anecdotal. My brother was riding about 15 years ago, and was in an accident, got tossed over the bars of his hybrid, and his helmet was split down the middle, with a huge gash right in its temple. He keeps the helmet to this day as a reminder. There is more to the story though–the accident was caused by him plowing in to the back of a parked squad car (lights on) in a road-side weigh station. He had been riding with his head down (getting aero on the hybrid bike?) and ended up plowing right in to it.
Now, I’d say this is more of a case for watching where you’re going than for wearing a helmet. Helmets are GOOD to have, yes. The problem is that they are not the end-all be-all of cycling safety, and people act like they are. They are not comparable to seat belts (you are going to be ejected from a bike crash no matter what) and there are many other severe injuries that you are equally likely to get in a bicycle accident than a head injury. Spleen and liver injuries can be fatal. Helmets don’t protect against neck fractures, which can leave you paralyzed.
Basically I don’t think that one needs a helmet for “danish-style” cycling any more than one needs a helmet for jogging. However, if you’re bombing down the switchbacks of Brokeback Mountain at 80 km/h, it’s probably a good idea to bring some form of protection for your noggin.
As an addendum, the most useful articles of safety attire for a bicycle are definitely the padded (perhaps fingerless) gloves. Chances are that when you go down, you’re going to be clipping in, hitting a sand patch at 10 mph, or something silly and you’re going to instinctively put your hand out. Just some $12 gloves or whatever will void any damage to your palms.
Sine Botchen says
When doing some Google research for a blog (on this very topic) I was wondering at what point/year did the TDF riders start wearing helments. However, after I started searching I was amazed at some of the things I read regarding helmet vs. no helmet debate and the *passion* exhibited on both sides of the arguement. I saw the “professors” quotes as well and immediately wrote him off as a nut job. Any helmet is better than none and just because it won’t stop a sniper’s bullet doesn’t mean you shouldn’t wear one.
You know, you see a few proponents out there for “European” or “Danish” style riding, but that’s not the kind of riding I do. If I were a “European” style rider on an upright cruiser with a basket on the front (nothing wrong with them, by the way) using my bike for basic utility commuting around a location where drivers are used to seeing lots of bikes I probably wouldn’t wear a helmet either. The thing is, I’m not. I ride a road bike at speeds over 20 mph, on roads that might be slick with gravel and other debris, and in traffic where drivers aren’t expecting cyclists, and quite frankly aren’t very courtious when they do see us.
Over the years, I’ve broken a collarbone and two helmets in bike crashes. The collarbone healed quite nicely. I’m not sure how nicely a “broken head” would have healed. Yes, I agree that helmets offer limited protection, but I’ll take what I can get!
I feel compelled to add my 2 cents since I am the one who just went over the handlebars and down head first at 20 mph. My helmet did exactly what it was designed to do: absorb the majority of impact and while doing so broke at 4 different places, which in turn distributed the energy from the impact spot over the surface of the helmet. The pictures on my website only show the cracked helmet, I did not post the skull cap with the helmet design imprinted in dirt and sweat, or my bald noggin which bears about a silver dollar size imprint of the helmet structure. I shudder to think of the outcome without a helmet.
As others already pointed out, the helmet will not be nor is it designed for the end-all be-all solution, it is designed to greatly enhance your chances to survive, and did just that for me.
Giles from NH also correctly pointed out the need for cycling gloves; mine are shredded, and the protected parts of my hands only have minor scratches. I had little stones embedded in the finger tips and tore out half of the right thumb nail, but my palms are unharmed.
Last, I wanted to point out that sometimes speed is not the only factor contributing to an injury. The shape and angle of the object you fall on might be just as devastating as an impact at high speed. Having said that, you might think you can cruise around at 10 mph without helmet, but, you might get hurt pretty bad regardless of your speed.
Putting on a helmet before mounting a bicycle should be second nature. There are no guarantees, but odds are, this habit just may save your life or prevent you from being a vegetable for the rest of your life.
Ride safe and keep the rubber side down!
Richard Keatinge says
It’s always interesting to see the clash between scientific findings and received wisdom. It remains true that the available good-quality research (Robinson’s) doesn’t show any useful effect from helmets, but does suggest that compulsory helmets stop people from cycling. The engineering evidence is interesting too, with (if you check Wikipedia’s references, glad you liked the article) a report from the Australian Department of Transport and a comment from the senior engineer of Bell Helmets which cast serious doubt on whether helmets function as intended. Just to make it clear, they are not designed to function by breaking up, but by crushing; when they do break this is an indication that they have failed.
To pick up a couple of points, there are several claims around that helmets have saved lives after a car or van has gone over someone’s head. After seeing what actually happens when a small car is lowered slowly onto a helmet, those claims lack credibility. They are an extreme example of the common anecdotes, which are less easy to disprove without going into the figures.
Yes, I’m a doctor, it’s of limited relevance, and I certainly wouldn’t use it as authority for any argument. A qualification in epidemiology would give more credibility than a plain medical one, but I generally prefer to let the science speak for itself.
If you want to wear a helmet, carry on with my blessing! People do much sillier things without upsetting me. The problems with pushbike helmets are the scaremongering and the compulsion. Those discourage cycling, which impacts on the health of my patients, and they are very annoying to people who find helmets uncomfortable and inconvenient.
If you don’t want to wear a helmet, you likewise have my blessing.
I think part of the dispute here is the result of a difference in demographics. Dr. Keatinge and his group want to foster sustainable cycling, where it becomes a more routine part of our lifestyle. So he’s looking at the population in general, children and adults, non-cyclists as well as cyclists. Hence his concern that mandatory helmet laws actually reduce the number of cyclists.
Readers of this blog are overwhelmingly adults who are already riding, and take steps to guard their safety. The Robinson study Dr. Keatinge cites concludes that “Cyclists who choose to wear helmets commit fewer traffic violations, have higher socioeconomic status, and are more likely to wear high visibility clothing and use lights at night. Helmeted cyclists in collision with motor vehicles had much less serious non-head injuries than non-helmeted cyclists (suggesting lower impact crashes).” Well, that would be us. We know the risks that accompany cycling, and we take steps to reduce those risks.
The link to the Robinson study Dr. Keatinge provided takes you to a sign-in page that requires payment; if you want to read the whole study without coughing up some money, try this link: http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16565131
David O. says
Seems like a silly argument. Statistics and studies can prove anything. Picking and choosing which statistics one chooses to prove their point is equally simple. Why dropping a car on a helmet is somehow relevant is beyond me.
It’s not rocket science to understand that anything that can distribute energy away from the target (e.g. the head) is a good thing.
If people don’t want to wear helmets in ignorance of local laws is fine with me. I can only hope I don’t come up on them lying on the side of the road with their brains spilling into the gutter. Frankly, I’ll call 911 and keep riding…with my helmet on.
I long ago made a personal decision to generally not wear a helmet while cycling. For me it came down to a tradeoff in risk of having an accident vs consequences if I did have an accident, as well as overall enjoyment of the activity. I sweat. A lot. I am a lot more comfortable without a helmet and find I can pay better attention to road hazards and cars when I don’t wear one. I spend less time dealing with comfort, sweat, and vision problems and more time pro-actively avoiding accidents.
Is this scientific? No. It’s just my own best guess and subsequent decision. I actually wish I didn’t have to make the tradeoff and could just wear a helmet without the negative consequences and have the best of both worlds. More power to those who do wear helmets and don’t have problems, I’m envious.
I found I made the same tradeoff for rock climbing. I do wear a helmet ice climbing where it’s not a question of if my head will get hit by shards of ice from my partner climbing above me, but how many times. And the sweat/vision problem is a lot less in frozen environments. So a considered judgment based on the circumstances.
I do wear a helmet on group rides, since it’s typically required nowadays. Consequently, I’ve avoided organized group rides for the last 20+ years. Lately I’ve been toying with the idea of trying a short race, so I’ve gone on group speed rides and time trials and I’ve worn a helmet to get used to it since I’d have to wear one in a race. Besides, the chances of going down with a bunch of cyclists riding in close proximity is a lot higher than having an accident riding solo, so again it’s risk/consequence tradeoff again. (I find I’m more comfortable riding in traffic than with other riders since cars tend to be more stable and predictable, even as much as cyclists like to bad-mouth drivers.)
If helmet laws were passed and vigorously enforced, I would likely stop riding and look more to other activities for fitness. But I’d have to use the car a lot more for commuting and errands, which would be a downer.
A helmeted head is a lot bigger than one without a helmet. So just because a helmet gets scraped up in a crash, doesn’t necessarily mean it saved the head. The head might have done just fine in a tuck. It’s going to be pretty hard to tuck and roll with a helmet on without scraping it up. So I think helmets sometimes get a lot more credit in minor accidents than they deserve when people assume that what happened to the helmet would have happened to their head. But for a major ‘slam your head into a hard object’ crash, yes I’d much rather have the helmet.
Make your own considered choices and respect the choices others make. We are not all the same and one solution does not always fit all.
Jeff C says
The above discussion raises some very interesting points. For one, I have always worn a helmet while riding a bicycle. It’s just common sense, you do not expect to have an accident, this is why you are wearing the helmet, to protect you head IN CASE you end up crashing into a hard surface.
You can be a cautious biker all you wish, keeping a close eye on the road and cars, but that will NOT protect you from what you are not expecting. If you have the right of way through an intersection, or are passing an alleyway, you do not expect anyone or anything to be emerging perpendicular to you. In the case that this does happen, there is little chance that you will remain seated on your bike, if you are not wearing a helmet, it’s your very own head that will be meeting that pavement, hard on.
For those who do not partake in this form of city biking, and tend to stick to either calmer, less dense areas, or designated pathways, other unexpected situations can easily arise. You may not notice an imperfection on the surface, the rider ahead of you may stop abruptly, or your judgement of a given situation may be off. It is for these reasons, the unpredictable occurrences that helmet usage is heavily advocated. As I said, you do not expect to have an accident.
Discouraging helmet usage is just plain foolish. Helmets save lives everyday, they are the seatbelts of bike riding, contrary to the opinion in a post above. True, you cannot make a direct comparison, but one does not wear a helmet while riding in a vehicle, the situation is simply not the same. Seatbelts are highly uncomfortable for many people to wear, yet riding in a vehicle is accompanied by several dangers, which seatbelts offer a safeguard against. In many US states, seatbelts are mandatory, I doubt that many people would advocate against the use of seatbelts while riding in a vehicle, due to the fact that it makes certain riders uncomfortable, and they no longer wish to ride in a car.
While it is true that mandatory helmet laws may reduce the number of cyclists, due to certain potential riders having comfort or other issues with them, this is not a valid argument against helmet usage. If you are partaking in the form of cycling quoted as being “not too far, not too fast”, I believe most riders would find common ground in saying that helmets are not necessary. Fact is, that most riders do not practice, nor enjoy this form of cycling, but more extreme, higher risk riding, where wearing a helmet is often a matter of life or death.
The road vehicle equivalent of this ‘danish biking’ would be to encourage everyone to drive at very low speeds, thus not requiring the usage of safety devices, such as seatbelts and airbags.
There is no denying that riding in a vehicle is dangerous, and you just accept the fact that you must buckle-up when partaking in that activity. That being said, it is not uncommon for people to choose to not wear seatbelt. Unfortunately for these people, their chances of injury if involved in road collision gravely increase. You can be the most cautious driver on the roads, yet find yourself in a crash, due to the negligence of others. It is the same with bike riding, no matter how skilled or cautious you are, it does not do anything to protect you for the errors of others, or that which you cannot influence, or miscalculate.
I would now like to share with you two real-life examples pertaining to helmet usage;
A good friend of mine never wore a helmet while biking. His reason, was that when he was involved in a previous bike accident, his helmet did nothing to protect him. In response to this, I asked him which part of his body was involved in the crash, needless to say, that it was not his head. It is of course obvious that if the accident you are in does involve your cranial area, the helmet will not do much for you. However, if you do end up in a crash where your head is involved, wearing a helmet could be your saving grace.
But hours ago, I was out cycling with a friend of mine, we had chosen to stick to recreational bike paths, where of course other like-minded exercisers are the common sight, and your exposure to road hazards is greatly reduced to a minimum. One would think that this may be the perfect environment to ride helmet-free, due to a lower exposure to hazardous situations. You may no longer have to worry about as many out-of-your-control factors, which was remains one of my main arguments towards wearing a helmet, but there is still very much potential risk of collision. Not only could you find yourself staring the back or front of another cyclist in your face, but you may also make contact with the inanimate surface around you.
Picture this, you are cycling down the path at a moderate speed, trailing your cycling partner ahead of you. You are riding smoothly along, worry-free, perhaps sparing a few seconds to daydreaming every now and then, perhaps dodging those biking at a slower pace than you, or imperfections in the surface, branches etc. You are approaching a fork in the road, your partner decides to hang right, without much need to slow down. You approach the curve repeating the actions of your partener. Next thing you know, your front tire is scrapping the edge of the raised surface to your left, you are ejected from the comfort of your seat, scrapping across this surface, as your head thumbs downwards HARD, your body continuing it’s path forward.
Ahead you see your friend slowing down and rushing back to find out what happened. You lay there motionless for a while, as your get over the shock of what has just occurred, and attempt to examine the damage to your body. Passers by rush over, and lean down to offer their assistance, making sure that you are alright as they witnessed your treacherous fall. Luckily you have not suffered many injuries, and are conscious. After a few moments, you gather the energy and strength to sit up and better inspect your person. Those around you question your state, and offer kind advice as to what to do next.
You do your best to recall what has just happened, and remember smashing your head against the pavement as you made contact with the ground. You quickly unstrap your helmet and notice two large cracks in the styrafoam structure towards the rear of the helmet. You realize that the portion of helmet between these two cracks is where the impact occurred, and was absorbed by the foam barrier. Had you not been wearing a helmet, it would have been your very own skull making contact with the rock hard concrete and suffering the cracks en lieu of your helmet!
You then try and think back to discover what went wrong, and arrive at the conclusion that your took the curve way too fast, and should have been better prepared. Your cycling partner then admits to the fact that they were going to tell you to both slow down, and lean hard as they have already passed by the exact same spot previously. Since you were following your partners lead, and they were so swift in their maneuvering, you did not expect anything to go wrong as such. Of course they failed to reveal the secret of the curve, which was essential to making it through at the speed you both were going unscathed.
It was not entirely your fault that you crashed, not was it fully in your control, you believed you had everything under control, and were re-assured by your partner’s swift taking of the turn. It was what you didnt know and didnt expect that created the recipe for disaster. No matter how much you do to protect yourself against the dangers of cycling, you cannot prevent the unexpected from occuring. Had you not been wearing that helmet you would not have faired so well.
This is exactly what happened to me but hours ago, I was doing everything in my power to cycle safely, but did not realize just how dangerous the turn ahead was, and being reassured by my friend’s inherent mastery of the curve seconds before, I had nothing to worry about. What I did not know was that he had been down this way before, slower that first time, and was ready to lean in hard this time around, holding previous knowledge of the turn. Fact is, accidents occur unexpectedly, and are not within your control, that is why helmets are there, to save your life, in case something does happen.
Fact is, helmets work. You just have to find yourself in the wrong situation for them to be of use. Biking down a residential street at the pace of a tortoise, won’t expose you to that many risks. But baumbing around a corner way too fast, under false presences will. It is for those situations that we advocate the sporting of protective headgear.
Richard Keatinge says
Thanks Jeff C – the only trouble with your eloquent comment is that it has nothing to do with science. Good-quality research shows no useful effects from helmets, but does suggest that compulsory helmets stop people from cycling. Your imaginary helmet cracked and failed, likely without doing any good and possibly causing increased rotational injury to your brain in the process. And the only known connection between helmets and deaths is the few children who have been hanged by their own helmet straps.
Stories not based on reality just aren’t very useful. Yours may frighten a few people into not cycling, which is a shame. In a free country you’ve every right to believe and tell any stories you like, but actually moving a rational debate forwards does require careful attention to the evidence.
Charles Cushman says
I have two problems with the anti-helmet group:
1) The question is, “Do helmets work?” not do they deter people from riding. By bringing up the second issue they are clouding the discussion. We should focus on the question, and once we have an answer to the efficacy of helmet usage, then we can discuss the social aspects.
2) If the current tests for the helmets are misleading (inelastic versus elastic skulls, does not simulate real world situations) then let’s create a new test. Maybe the testing should be like car crash testing with dummies having built in accelerometers. But don’t just discredit the tests and cal it a day, but create a test that will prove your point and maybe will even help design a helmet that does work.
In a related note I work in the construction industry and every day I hear arguments against hardhats, safety harnesses, and the like. How the worker would be safer without that gear. It may be an inconvenience at times, but it does save lives. And that is what the underlying argument seems to be for people who don’t want to wear a bicycle helmet, the fact that they perceive it to be an inconvenience.
Richard Keatinge says
Well, the reality test – the good-quality research – doesn’t show any useful effect of bicycle helmets. Feel free to design better helmets. Until then, I really don’t see the point of pushing them. Actually the injury rate is low enough that even much better helmets would hardly be worth the trouble.
The social response is important because cycling is so beneficial for health – the benefits are far greater than all the accidents. Inconvenient and uncomfortable items tend to discourage people from doing things. It’s not good to tell scary stories that discourage people from getting on their bikes.
Charles Cushman says
I will concede the fact that helmet laws deter people from riding. The yes and no on that is not really my question.
The research that I have seen, and the studies quoted, are not clear. There are too many variables to be considered from proper usage of the helmet to the riding style of the wearer.
Going back to the car industry, when ABS brakes first came out studies showed that there was no difference in the accident rates. However, the industry agreed that ABS brakes are safer. The same thing occurred when drum brakes switched to disc brakes.
To prove this point, the car industry crashes cars. A lot of them. Over and over again. We know exactly what happens when a Toyota Camry is rear ended at 25 mph. The same thing should be occurring for helmets of all types (motorcycle, skateboard, bicycle). Then, and only then, will a clear piece of data be provided.
Maybe it’s just me but I cant see the logic in wearing an object that will force the head, upon impact, to react in a way that’s unnatural to it’s original shape causing damage to the neck and spine. Also the base of the skull is always exposed in riding helmets. I speak with some experience in the fact that I was hit by a small truck while in the bike lane and yet there was no damage received on the area that “would have been” protected by a helmet, only from the nose down. Nose teeth, ribs, shoulder, and knees. And then the only reason I took that damage was because I was clipped into my bike, which in-turn anchored itself to the car and whipped me it to the vehicle.
The only helmets I see that would prevent ANY damage is a full helmet covering the face in it’s entirety.
My helmet saved my life a few days ago. In my case my helmet didn’t prevent me from going unconscious or save me from road rash on my face, however, I have no doubt I’d be in the morgue right now had I not been wearing it. Brain injuries are not fun, not for you and certainly not for anyone who has to deal with you afterwards. Like Jeff says, it can happen in a split second. In my case, I remember my handlebars dipping unexpectantly and then I woke up with some stranger asking me my name. I later checked my GPS bike computer and I had apparently been there for over 20 minutes….face down in the road.
Wear your helmet!