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The great bicycle debate: Helmets

Creative commons photo by Kyle F on Flickr.

Creative commons photo by Kyle F on Flickr.

Editor’s note: Long-time Tucsonan and cyclist Steve Wilson was prompted by an interaction between the two of us to write this post. Steve and I saw each other riding in opposite directions a few days ago. I was surprised to see him without a helmet and gestured toward his head, less as an admonishment and more of a question as to whether he had forgotten his helmet. Several hours later this post was in my inbox. My request is that we keep the conversation respectful. 

One of the great debates in cycling in the USA surrounds the question of bicycle helmet use.  It’s basically in the category of what I would call ‘religious arguments’, meaning people generally feel very strongly one way of the other, and they are usually not interested in the arguments from the other side.  For me personally, my opinions on the matter have changed through the years, which I think puts me in a position to understand both sides.  Let me start with what I have seen and what I believe, this will help in understanding what I advocate today.

I’ve been fortunate to observe large numbers of city cyclists in both Copenhagen and Amsterdam.  I don’t think many will challenge the notion that these are the two leading cycling cities in the world.  The combination of the sheer number of cyclists and massive amounts of cycling facilities is something that will amaze most cyclists from the USA who see it for the first time.  What the typical American cyclist will say in the first five minutes is, “Hey, no one is wearing a helmet!”  And it works just fine.

I’ve ridden over 135,000 miles in my adult life, mostly in Tucson.  I commuted 30+ miles roundtrip to work for years, and have been fortunate to have done unsupported touring on 4 continents and Central America.  I like biking.  A lot.

As a result of reams of anecdotal observations in talking with people about cycling over the past 20+ years I have come to believe this – The number one reason people don’t ride (or ride more) in Tucson and the USA is fear.  I believe it’s a bigger reason than all of the others combined.  And I believe this – The maniacal focus on helmet usage at all times contributes to the culture of fear.  Why else would helmets be required if cycling weren’t ‘dangerous’?

Getting back to Denmark and The Netherlands, there are people there who wear helmets.  Who are they?  Primarily they are recreational cyclists on higher end road bikes.  This has made me think – maybe there are multiple modes of cycling, some modes where helmets should be encouraged, and others where it doesn’t matter so much.

There has been twice in my cycling career where I needed a helmet, and both times I had one on.  Both situations involved a relatively high rate of speed on road bikes.  In both cases the helmets were broken but I only had momentary loss of consciousness.  I was happy to have the helmet.

I have come to believe that there are times for helmets and times where it doesn’t matter so much.  For me it has to do with the relative likelihood of a higher speed collision, and the relative control I have over the situation.  Before you start, I fully accept that something could always happen out of my control, but if you are going to argue that you should always do everything you possibly can in all circumstances, I expect to see you driving your car with a crash helmet – because there are possible circumstances where it could save your life.

If I’m on my road bike, you’ll always see me with a helmet.  If I’m on an arterial roadway, you’ll always see me with a helmet.  If I’m riding at night, you’ll always see me with a helmet.  If I’m in the neighborhood taking bikeways over to the UA or 4th Ave, you may or may not see me with a helmet.  I’m comfortable with that.  You may not be and I accept that.  I understand your position – I used to be a ‘helmet always’ guy.  I’ve mellowed with age.

There are some other notes that should be considered.  I think that kids should wear helmets – until their skills are highly developed they are at greater risk all of the time, and as non-drivers they don’t have the instincts of what to do in traffic.  The personal freedom angle doesn’t come in to play for me.  For me not wearing a helmet is not about exercising any particular rights.  I just think that it’s right for me.

My hope is that one person will see me without a helmet and think maybe it’s not so dangerous out there.  And give a bike a try.  Just for a block.  They’ll remember the thrill of gliding down the street with the wind in their face…and just keep going.

20 comments
Vicki
Vicki

This is the seatbelt law all over again.

Don't believe all the "studies" you read either for against helmet use. The data criteria, collection and reporting is far, far from perfect. For every cyclist wearing a helmet who sustained an injury due to their helmet, there are many more who avoided one. Just like seatbelts, there is a possibility a helmet can work against you in certain types of accidents. Also, if a helmet is worn improperly it will not have the same benefit. There is no such thing as perfect equipment 

So very tired of hearing the Netherlands and Denmark cited when arguing the pros and cons of bike helmets. This is the USA people. We drive differently - that is to say aggressively and without regard to the safety of others. Especially those annoying cyclists who are in the way. Furthermore, most U.S. cities have a very different infrastructure. Our cities tend to be spread out and rather disjointed.  Riders frequently have to share lanes with cars.

The authors idea of inspiring someone to ride a bike because he's not wearing a helmet defies logic. Anyone who is reluctant to ride because it might be 'scary' is exactly the type of person who needs a helmet the most. If rolling down the street intimidates them, I wouldn't want to witness their downhill handling.

For those who like to educate themselves on this subject, there is a link below that describes the specifications and testing of helmets as required by the Consumer Product Safety Commission. There is considerably more data from regulatory sources that is available. 

http://www.cpsc.gov//PageFiles/111494/regsumbicyclehelmets.pdf


MSL
MSL

For me... I am a helmet wearing cyclist.  I ride between 5k to 7K miles a year in the Chicago suburbs, both commuting and on recreational group rides.  Here in the US the infrastructure just does not make me feel secure without protection of my head.  All to often the roadway surface is not in good repair, automobile drivers are not expecting me to be on the road,  or the road surface is cluttered with crap.  The opportunity to take a spill is reasonable enough to take the precaution of a helmet.  On very rare occasions, riding in a known safe area, I might not wear one.... but it's a rare event.  I would welcome the day when the infrastructure for bicyclists is such that we feel safe riding without helmets to do our local errands. 

Red Star
Red Star

Is there something like an Aesop's Fable or even a parable that can capture and present this helmet controversy?

Ride2Wk
Ride2Wk

Some websites with a large amount of data and commentary on most of the helmet reports - http://helmetfreedom.org/ & http://crag.asn.au/

Whether you wear a helmet or not, whatever you do, do NOT support bicycle helmet laws. In Australia they are a public health failure and lead to unintended consequences such as police harassment of cyclists. Such as police letting down the tyres of kid's bikes in an area where previously 2 paedophiles had raped and killed a teenage boy. (Morcombe, Sunshine Coast, Qld)

In the late 1980s Victorian police (Australia) opposed bicycle helmet laws and said that enforcing car helmet laws would prevent far more head injuries. A 1997 Monash University report confirmed car helmet laws would have a far greater public health benefit effect.

http://www.monash.edu.au/miri/research/reports/atsb160.html

http://www.copenhagenize.com/2009/05/motoring-helmets-for-real-high-risk.html

http://www.copenhagenize.com/2009/10/australian-helmet-science-for-motorists.html

Bicycle New South Wales (Australia) has finally got the courage to come out and oppose the mandatory helmet law. They have a summary of the basic information on their website at http://bicyclensw.org.au/advocacy/positions/legal/helmets/

Bicycle helmets can cause injury such as broken necks as shown in this article & it's not the only case I've heard of. http://www.canberratimes.com.au/act-news/insurance-for-cyclists-would-limit-pain-and-hurt-20130413-2ht1w.html

Australian coroners reports have detailed how several kids accidently hung themselves by the helmet strap when the helmet got caught on play equipment or beds.

Kids helmets compulsory? Don't. The 1990 helmet law lead to an immediate 30percent reduction in kids cycling to schools. Most would have been driven instead and hence grew up to be drivers with less road sense or understanding of cyclist behaviour. When I was 12 I went head first when my front wheel fell off during a jump over a bump on a bitumen road at probably 15-20mph. I land on my head and shoulder and rolled with the fall. If I had had a helmet on it would have been smashed to pieces but it would not have "saved my life". It would have made rolling with the fall far more difficult and possibly caused other damage.

Sometimes I snow board with a helmet. The darn thing makes my head hit the snow harder when I fall because of it's larger size and weight. It's also more difficult to roll with the fall & hence puts more stress on my neck. I also clip more overhead branches.

Chris Gillham
Chris Gillham

Re Steve Wilson:

"Does a helmet really make you more likely to be injured or make the head injury worse?"

The head injury, all-body injury and participation evidence from all-age and child helmet jurisdictions does indicate you are more likely to have a bike accident, which obviously means you're more likely to be injured. There are various theories about this, including greater risk taking by helmet wearers and the safety in numbers concept. The latter is illustrated in all-age helmet jurisdictions where hundreds of thousands of adults stop cycling and instead drive their cars to the local store, beach, work, etc. In child helmet jurisdictions, there are more parents driving their discouraged children to school and other locations, as well as other motorists who encounter fewer child cyclists and are less familiar with their road presence. Those are the most likely reasons for increased accidents per cyclist and thus more injuries.

Most of the time, helmets will reduce head injury and not make it worse. This is certainly the case with low speed crashes where a frequent outcome is a small head wound, maybe a skull fracture, that requires a day or so in hospital with no long-term detriment to health. Helmets are mostly ineffective for impacts above 20 kilometres per hour because that is the physical limitation of the foam crush. They almost double the circumference of the head area and thus increase the risk of contact - e.g. with a bare head your arms will instinctively act to protect the head which will hopefully miss the bitumen, so to speak, by several centimetres or the width of your lower arm that scrapes the bitumen (ouch!). With a helmet, either your arm is crushed (arm injuries soar in helmet jurisdictions) or the helmet makes contact with the bitumen, stopping your head while the body continues and increasing the risk of rotational brain damage. Various studies suggest a slight increase in neck injury from helmets.

More than 10 years of internet blog evidence suggests that almost all helmet law supporters swear their helmet has been cracked in an accident and saved their life. Look at the pre and post law fatalities and this argument clearly disproves itself. For example. in Western Australia the pre-law cyclist death toll was 8pa and post law it was 6pa, commensurate with a 30%+ reduction in cycling participation. The more helmet wearers swear they'd be dead or paralysed without it, the greater the fear of cycling and the smaller the future pool of cyclists.

Overall, a helmet doesn't make your head injury worse and will often reduce injury, but questions remain about added rotational force causing greater intracranial injury.

"Does anyone think you would be better off in a motorcycle crash without a helmet?"

I doubt it because motorcycle helmets are hard shell and they work. Motorcyclists invariably have the worst death and injury tolls among all road users, largely because of their unprotected vulnerability but suggesting some risk compensation. For example, a motorcyclist with a helmet will likely do top speed on a country road or a speed-free autobahn. Take the helmet off and then see how fast they want to go.

"And if not, isn't a crash on a road bike just a slower speed version of the same thing?"

In all-age mandatory bike helmet Australia, the head causes about 25% of fatalities among cyclists and about 10% of fatalities among motorcyclists. i.e. hard shells work but there's no way you can convince or force bicycle riders to wear hard shells.

"Does wearing a helmet make you more likely to be hit by a car?"

Studies show motorists drive several centimetres closer to helmeted cyclists as they pass them, presumably due to a subconscious belief the rider is less vulnerable because of their helmet (http://www.bath.ac.uk/news/articles/releases/overtaking110906.html). Risk compensation increases the chance of any sort of crash so, yes, wearing a helmet does make you more likely to be hit by a car. For example, just yesterday I was driving and about to turn left into my street. About 50 metres before the turn, I saw a helmeted adult cyclist riding in the same direction at decent speed on the footpath (illegal). I guessed that because of the helmet, he wouldn't look to see if a car was coming as he crossed my road, so I slowed to a crawl in anticipation. Sure enough, he didn't even glance to the right and rode straight in front of me so I easily braked from my very slow speed to a near-stop. If I'd not noticed him or I'd assumed he'd look and stop for oncoming traffic before crossing the road, as the law requires, I would almost certainly have hit him. I beeped and chose some words about checking for cars, but he obviously didn't give a damn.

"All difficult questions that are fun to debate."

In a nutshell, helmet laws do result in a lower proportion of head injuries but a greater number of accidents and ED visits/hospital admissions per cyclist. The lower proportion of a greater number results in little difference to head injury numbers, more arm, neck and mostly upper body injuries, and fewer people choosing regular, healthy cycling exercise in preference for driving a car that increases risk for all road users. 


pk
pk

No disrespect but I honestly can't believe anyone would debate the benefits of wearing a helmet. Certainly it will not protect you in every event but just think about your skull and the pavement and you have enough reason to wear one.  I skateboarded for years, sometimes in pools without a helmet but I've mellowed in the other direction.  Despite what commuters do in Amsterdam, whether you are going fast or slow, I think it makes sense to protect your head.  I heard about quite a few horrific head injuries that my wife witnessed in med school which were from small heights and not on a moving vehicle at all.  I'd never call you out for not wearing a helmet either but I would bring it up given the opportunity.

Steve Wilson
Steve Wilson

Lots of good comments.  It's a difficult question made more difficult by the excruciatingly difficult task of finding good data (which it true of cycling in general)  Some of the so-called scientific studies have very questionable techniques and data when you look at the detail.  

Does a helmet really make you more likely to be injured or make the head injury worse?  Possible, but I need more convincing.  Does anyone think you would be better off in a motorcycle crash without a helmet?  And if not, isn't a crash on a road bike just a slower speed version of the same thing?  Does wearing a helmet make you more likely to be hit by a car?   All difficult questions that are fun to debate.

I just don't want people to be so afraid that they don't get on the bike.

Tukson
Tukson

I don't like wearing a helmet either. I actually remember when and why I bought my first helmet. I was 18 years old in 1990. They touted the helmet as increasing aerodynamics, and will make you faster! COOL! So I bought my first helmet. It had nothing to do with safety. It was a thick styrofoam shell with an elastic red & white cloth cover over it. It seriously made me look like a character from Spaceballs, the movie. I didn't care, it was supposed to make me faster! Unfortunately, there was no difference in speed. All it did was make my head really really hot as the cloth cover blocked all air vents, and looking like a character from Spaceballs, the movie. In Tucson, at 100F degrees, it was torture.

It's interesting to see the change in attitude towards riding. When I was young (between 5-25), my parents never once mentioned I should wear a helmet. I even built a quarterpipe our backward when I was 15. Fast forward to now. 2 weeks ago I took my cousin out mountain biking for the first time (FI, bunny trail). He's 17 years old, doesn't have a bike, and no helmet. He was exicted that I had a loaner bike, and I'd take him. My dad finds out, and the first thing he asks is "Do you have a spare helmet for him?"

!?!?!?!...Uh,,, of course, I'll just give him mine, but... why.. in all my years... have you never once told ME to wear a helmet? It was really surreal. It was almost an automatic response for him to ask.

Chris Gillham
Chris Gillham

A well written post and congrats for highlighting the detriment caused to cycling participation by helmet-inspired fear. If any pro-law readers want to disprove Michael's contention that you're not interested in arguments from the other side, then visit http://www.cycle-helmets.com

You'll discover a few things you didn't know about the effects of all-age and child bike helmet laws, with spotlights on Australia, New Zealand, Canada and the US.

I know it wins me no friends but I disagree with Michael's belief that helmets should be mandatory for children - for health and safety reasons, not because of that malodorous concept known as personal freedom. Look hard at the data and you'll find the child injury declines don't match the participation declines, which have already contributed to the obesity crisis in several jurisdictions and which will continue to do so as children discouraged by helmets mature into adults without a childhood familiarity or lack of fear of cycling. i.e. the longer helmet laws are in place, the more damage they cause to public health.


DS
DS

This is more balanced than a lot of helmet articles.  But it still pretends that bike helmets really work.  Bicycling magazine recently did a big article on helmets, pointing out that there has been a 50+% RISE in concussions per cyclist since helmets became popular.  It looks like there's a real chance that glancing blows to the helmet (a bigger target than a head) spin the skull around the brain, causing brain damage.  Read the article.  If concussions have gone UP, why still promote these things at all?

Peter
Peter

A bit of sanity at last.

Colin4
Colin4

It is good to see a full debate taking place. 'The case against bicycle helmets and legislation' actually provides some information. Clearly any helmet increases the area of impact and could add to rotational acceleration. There is even evidence that helmet use may increase the accident rate and certainly they make cycling less convenient. So, why buy a product that may lead to more accidents? If you wish to have a debate then why not have someone for and someone against to present both sides.

For the USA, about 600 - 700 deaths from approximately 30000 road deaths, from a population of 300+ million. One cyclist per 500,000 people roughly. Certainly improve safety by any means that does not discourage cycling or pretends that cycling is high risk. Helmet laws and helmet promotion does actual harm, wise up. e.g. discouraging cycling and fines,

ultrasonik
ultrasonik

Very well put.  I always wear a helmet while on my mountain or road bike, but rarely on my commuter bike.  I've often felt that if I'm wearing a helmet on my low speed commuter bike,  then I should also wear one while in the car, where the danger of a head trauma causing accident is likely higher.

bikrdr
bikrdr

I was always a helmetless bike rider until I had kids, then I felt like a hipocrite making them wear one if I wasn't?  When they came out with the helmet's with the visor, I was in for good, so nice to have the shade for my eyes.

zz
zz

Sure, people point out the absence of a helmet, but do they admonish riders who ride against traffic or blow stop signs or ride unlit at night? It's much easier and more satisfying  to focus on things than it is to say 'no' or 'don't' to threatening behaviors. The best we can hope for is to educate the kids and role-model for the rest. Be a professional out there.

Steve Wilson
Steve Wilson

@Chris Gillham - very thoughtful commentary.  I think we agree on the major points but I would say this - it's not that motorcycle hard shell helmets work and bicycle helmets don't, it's that the hard shells work 'better'.  My two helmet cracking crashes were at around 40 km/h and the bicycle helmet worked just fine.  I should also note that things happened so fast that there wasn't any notion of putting my arms out to break the fall.  It was all over before I know it started.  Basically nothing more than road rash in both cases.

I hadn't addressed helmet laws in my original post, but I agree they are a disaster on every level.

Colin4
Colin4

@pk

It looks like safety can be questioned when it comes to bicycle helmets. The reason why relates to some basic issues, One, head injuries (that part typically covered by a helmet) may be approximately 10% of injuries with 90% for arms, legs, face  etc. So, if helmets prevented 50% of injuries to the part covered, roughly 5 from 100 injuries would be saved. Assuming they save all injuries to that part of the head covered, 10 from 100 total injuries.

On the other hand, Erke A, Elvik R, reported that the accident rate was 14% higher for helmet wearers, the 100 then goes up to 114, assume 11 saved by their helmets, 104 net outcome. But a further problem is helmets make additional contacts and increase neck injuries slightly. To prevent brain injury minimising rotational aspects is a key objective.

So what looks to be a reasonable safety product turns out to have more disadvantages than meets the eye.  The links below may be useful.

Robinson DL;Head injuries and bicycle helmet laws; Accid Anal Prev, 28, 4: p 463-475, 1996

http://www.cycle-helmets.com/robinson-head-injuries.pdf

Erke A, Elvik R, Making Vision Zero real: Preventing Pedestrian Accidents And Making Them Less Severe, Oslo June 2007. page 28

http://www.toi.no/getfile.php/Publikasj ... 7-nett.pdf

Clarke CF, The Case against bicycle helmets and legislation, VeloCity Munich, 2007

http://www.ta.org.br/site/Banco/7manuais/colin_clarke_cycle_helmet.pdf

Clarke, CF, Evaluation of New Zealand’s bicycle law, NZMJ 10 February 2012, Vol 125 No 1349

http://journal.nzma.org.nz/journal/125-1349/5046/

http://www.cyclehelmets.org/papers/p787.pdf

BICYCLE HELMETS: A SCIENTIFIC EVALUATION

W.J. Curnow

Canberra, Australia

Steve Wilson
Steve Wilson

@pk - I completely understand what you are saying, but we come back to the same point.  The place where you decide to wear a helmet or not is a bit arbitrary.  Do you wear one walking or running (or trail running)?  You could suffer a serious head injury in those activities and some people do.  People have serious head injuries in auto accidents.  The question is why do you choose a helmet for one activity and not another?  I propose that part of the rationale is that you choose to use helmets for 'dangerous' activities, which brings us back to the major reason more people don't ride bike (in my opinion)