sudo bike

I disagree that it has a large impact on brain damage. Brain damage is usually due, AFAIK, to the brain bouncing around inside the skull, not direct damage to the skull itself (which bicycle helmets can help with). Here's some anti-helmet propaganda talking about it https://www.cyclehelmets.org/1139.html . I don't think rotational injury can just be waved off, as it is important to brain damage... just what degree helmets may contribute to this is not really known very well (also no real consensus, as far as I can tell). Again, I don't think it is so much that it is impossible to design a helmet that would be more effective (as noted, some designs are trying to address rotational injury, such as a sliding "scalp" layer), I just think bicycle helmets, particularly the most popular kind that just about everyone wears, are woefully inadequate if their purpose is to prevent brain injury. And I'm skeptical one could be designed that would still meet most riders' expectations of comfort and be significantly effective; I've worn a lot of safety equipment over the years in a lot of different activities (fencing masks, safety harnesses, motorcycle helmets, blah blah), and rarely is safety equipment designed for serious protection what I would call "comfortable".

What it really comes down to, for me, is that I feel I'm pretty unlikely to get in a crash, and if I am, it probably isn't going to be one where a helmet will help me much (getting hit by a car). Helmets really shine in lower speed solo crashes, and unless conditions are pretty nasty or if I'm riding in close contact with a lot of other riders in an event (or drunk), I just don't see it happening. And on the off-chance it does occur, I'm willing to deal with the consequences of not having a helmet, such as stitches for my torn scalp, in exchange for not having to put up with a helmet. We all make these trade-offs, and yours may be different than mine, either because you perceive a helmet to be more effective, or because your conditions are different than mine. I totally don't care if you wear one... I just want people to realize what limitations the equipment may have, because overestimating safety equipment is never good for anybody. If the result is still donning a lid, I'm OK with that. I don't think it will be likely to harm anything... I just don't think it's any more necessary than wearing one for walking for a lot of people.

There have been plenty of studies cited here that show helmets don't have significant effects on reduction of serious head injuries, particularly when crunching real-world numbers (in contrast to evidence presented that they do; conflicting evidence).

sudo bike

*sigh*. Yes, dear.

rydabent

Still waiting for that authentic report of a helmet causing "stiction" harming someone.

Years ago after helmet mfg stopped putting real shells on their helmets, and went to plain foam with a nylon net over it, I could see the possibility of a helmet sticking in some cases, but not now with the plastic shells we have now.

proileri

There's actually two questions in the articles being quoted: first is that if helmets reduce seriousness of injuries in a crash, and second is if wearing a helmet makes you safer in general. Injury reduction is directly related to protective qualities of a helmet, but in comparison the trends in accident numbers are only partially related to wearing a helmet - general riding habits, amount of riding done, safety thinking etc. have a much larger effect on that. A helmet doesn't protect you from getting into an accident, it can only reduce the injuries.

So when talking about reducing severity of head and brain injuries, what we do know is that cyclists and motorcycle riders get head and brain injuries, we have a good model of the injury mechanisms, and we have good test-based evidence that helmets reduce damage by lessening the forces involved in these kind of situations. We also have good data from hospitals - from crashes where injuries are serious enough to ward a hospital visit - and these show that helmets lessen the head and brain injuries when the crash is severe. I think these are pretty good indicators - it's hard to imagine a person getting serious brain damage in a crash and not be taken to a hospital immediately or soon after! In these studies, rotational brain damage is included in the "serious brain damage" group - they do not differentiate between direct and rotational origin of brain damage, only if the damage exists or not. So, even if helmets would increase rotational injury, they are shown to cause a reduction in total number of serious brain damage, meaning that your chances are better when wearing a helmet.

There has been studies into cyclist-vehicle collisions, and did show that helmets do reduce the seriousness of skull and brain damage in case of these accidents

chasm54

Speaking as someone who spent many years running hospitals, I disagree. We do not have "good data from hospitals" on this subject, in general the recording of who was and was not wearing a helmet is not a priority for hospital staff and I would put little faith in it. Plus, even if the data was good, it would have limited value in telling us how a given helmeted individual would have fared in their accident had they been unhelmeted, and vice versa.

There's a huge amount of confirmation bias to be dealt with when assessing medical professionals' response to these issues. Most of them have no training in this subject and have never read any of the research, so their knee-jerk response is the same as that of the general population. They assume that a helmet would have helped, so they tend to say things like " it would have been much worse if not for your helmet" without really having any evidence one way or the other.

If we had "good data" about the efficacy of helmets in mitigating severe injuries, one would expect that mitigation to be reflected in a reduction in the incidence of such injuries. But in the real world, increasing helmet use appears to have had little or no impact on those statistics.

Six jours

Short version, for Proileri: you can find "data" supporting any POV you care to hold. That's why this thread so often devolves into "dueling studies".

Six jours

I burned my collection of naked ex-girlfriend pictures onto a CD-ROM. I keep it in the jewel case which used to hold my copy of Graeme Obree's movie, which I know will never be looked at by my wife.

This is known as "Shifting the Flying Scotsman".

proileri

The better studies, such as Bambach et al 2013 - The effectiveness of helmets in bicycle collisions with motor vehicles: a case-control study. links police accident reports with hospital admission records. Considering that in AUS people are required to wear a helmet by the law, it should be apparent in the police records.

A quote from the report findings:

This is a good study also in the sense that it examines only accidents versus a motor vehicle, so the situations are roughly similar and not for example commuting crash vs. MTB fall.

RazrSkutr

In response to Chasm54's questioning of your assertions on the subject of helmets having being shown to reduce brain injury you have (either knowingly or ignorantly) confounded head injuries in general with brain injuries in specific and, further, made the extreme claim that helmets have been shown to lessen rotational brain injuries.

In support of these statements you advance a short extract posted above from a study as a "better" (for some unknown value of better) study:

yet this very study has low sample size associated with it and also includes in the very abstract cited a possible alternate explanation for the correlation between helmet absence and injury:

proileri

I did no such thing. Head and brain injuries are separated in these studies, and I made a point that while exact amount of rotational injury is unknown, any such injury would be included in section "intracranial injury", amount of which in total has decreased amongst helmet users in all severity classes.

"Better" in case of studies refers to better certainty with less sources of error and less unknown factors. Here, both police and hospital records are cross-referenced, making it rather reliable. A sample size running in thousands is by no means small. The particular study had about 6500 cases, of which in about 1000 major injuries were to the head and to the brain.

sudo bike

proileri, I don't know what else to say, man. We've whipped out plenty of studies here supporting the argument of both sides. There's another study that looks at the Australian MHL and doesn't see any significant effect in head injury reduction. That doesn't look like consensus to me. And I doubt we'll have one anytime soon, because our data is actually pretty poor.



The reasons explained why helmets aren't as effective as claimed (even if still effective) make sense to me. The thin shells most cycling helmets have are inadequate to allow the foam to compress properly. They are tested by dropping them straight down at about 15mph on the top of their crown. There is evidence to suggest they increase rotational injury, which is a major cause of brain damage; the more vents, the more popular, the more grabby surfaces, and you lose the beneficial effects of the scalp in mitigating this injury (excepting some new, very rarely seen in public designs). You'll notice all of these (except losing the benefit of the scalp) are all only bicycle helmet issues. Combine this with the fact most cycling fatalities come from collisions with cars, which experience forces in wild excess of what helmets are designed and tested for, and I just don't see the story of a life-saving piece of equipment emerging. And this is all aside from the fact cycling, for most people, isn't anymore dangerous than walking. If I really wanted to protect my head, I'd slap on a motorcycle helmet... but I think I'll leave it at home.

I saw that for the first time earlier this year. Erm... the movie, that is.

proileri

I don't think the reports are in conflict - I think the questions being asked are! There's a lot of studies done from different angles and examining different things - I think part of the 'no consensus' is that there's actually lot of different aspects of helmet wearing and injury statistics being discussed at the same time. So I think we need to better define which aspect of helmets and statistics are we talking about.

In larger picture, when discussing mandatory helmet laws and large-scale accident statistics, I wouldn't call helmets a 'miracle cure' either. They don't stop accidents from happening, and a large amount of serious injuries occur to other parts of the body, not just to the head. In general, I think cyclist safety would be better improved by focusing in traffic safety, visibility etc., so I don't mean to make a claim that helmets should be mandatory to wear.

However, when we are talking if it's beneficial to have a helmet in an accident, I don't think you can argue that helmets wouldn't lessen the seriousness of head injuries. I haven't seen one study saying helmets don't actually absorb impact, or that their impact absorption doesn't improve the results. We have very good data that while cyclists are still hitting their heads hard and getting concussions, the severity of head and brain injuries does lessen with use of helmet. This is visible in all the studies that examine head and brain injury and their severity. So if you're unlucky enough to hit your head badly, yes, a helmet would lessen the injuries on average. However, it should be considered a last line of defense.

How probable are you to get serious injuries, then? The "AUS vs NED" study quotes that in Nederlands where cycling is popular in all age groups and a lot of it is urban areas/short commutes, the population of 16.5 million experiences 67.000 cases of ER-requiring bicycle accidents, 8.000 (12%) of which are serious enough to require hospitalization and there's about 190 deaths (0.3% of 67.000 / 2.4% of 8.000) every year - and about 25% of which in NED happens to people aged 70 or older. It's not a huge amount, considering that accident rate is perhaps what, 1 accident every few years for most people?

I'm also not saying that helmet design is perfect. The question of rotational injury is interesting, and there might be a lot of room for improvement there, as it's been studied a lot less. Same thing goes for helmet shells, foam types, testing procedures etc. However, I don't think it's a show stopper. If current helmets do a lot to lessen serious head injuries at the moment, then the speculated slightly increased chance of rotational injury is no reason not to wear one. It seems that if there's an effect of making rotational injury worse, it's not large enough to negate much of the positive effects of helmets - you're still a lot better off wearing a lid if you happen to get in a serious crash.

mconlonx

This is interesting because it confirms a couple things:
1. The Australian study focusing on serious injury in confirmed by this study -- the more serious the injury, the less helmets do to protect the wearer.
2. Helmets appear to make a bigger difference the less severe the injury.

Pro-helmeteers are still probably wrong if they claim a helmet saved their life -- an injury serious enough to kill without a helmet would probably also do so with a helmet. But this study does support wearing a helmet in cases of less than serious injury, which would be a majority of potential head injuries sustained by cyclists.

Unsure why you are posting this...?

RazrSkutr

Unsure why you're unsure?

mconlonx

Because it doesn't support your side of this argument?

Also, seems to fly in the face of the argument: helmets = more dangerous because of risk compensation. This result you posted contradicts such assertions widely made and believed by the bare-head brigade.

RazrSkutr

It is perfectly possible for there to be a large number of people with a high tolerance for risk (other studies which you should have read in the course of this long thread in which you have participated include the suggestion that biking while drunk is a predictor for head injury) also are not worried about helmets. That does not exclude the possibility that more anal types ignorant of the actual risks involved believe that by strapping on a piece of styrofoam they will be "safe" even when descending at 45mph in a pack of fellow incompetents.

In short: don't ride like a fool and you won't need your lucky charm^W^Whelmet to "save" you.

proileri

Laughs. No matter how smart rider you are, you cannot affect what other people do. Considering you ride amongst hundreds of people all doing their own thing, there's always a risk.

elcruxio

Yes. There is a risk in everything you do. But what you need to realize is that the risk can be lowered to such a level that a helmet is not needed. I'm (again) going anecdotal on you.

Consider a person on a road bike riding 20-25mph. A well behaving road bike can handle some serious speeds without problem (60mph) so the actual speed is not the problem. The problem is how fast situations occur in those 20-25 (and max 60)mph speeds. Same thing in mountain biking. I think we can all agree that sometimes situations occur quickly relative to these speeds and reaction time is limited. This is when the behaviour of other people becomes crucial, since you yourself might have too little reaction time to avoid an accident. Be it in traffic someone right hooking you or blasting down a singletrack trail and your riding buddy otb:s right in front of you. These kinds of situations are the one's where you protect yourself because you can't predict the odds. You don't have to but considering ones overall situation, protection might be wise.

Then let's take the netherlandian example. Everyone are riding bikes which have upright riding positions, speeds are really low (10-15mph) and the environtment for cycling is safe in general. Absolutely no helmet needed, because speed stay below the critical reactional threshold, and with a such a vintage bike hitting one's head is really unlikely. Don't believe me? I have ridden those oldie bikes my whole life and I tell you now, hitting your head when walking has a bigger probability than with those bikes. At least if you posess normal reactions of a human being.

"But your tire might burst or someone could run a red light and drive you over nontheless!" you say. Well yes, but also someone might fall asleeps while driving and mow you down while you are walking on the sidewalk, or the ground might develop a massive hole 100 feet deep and kill you instantly (this seemigly tends to happen in south america for some reason) or you might choke on a chicken bone, or you might get a clot in your brain or or or etc. You can eat aspirin to prevent clots, carry around ground sonars to see if massive holes are about to open up, wear fullbody armor to prevent sleeping drivers.
Or you could just accept that life is not safe. Safety gear is good for some activities, like cycling. It's not so useful for some activities, like cycling.

njkayaker

That interpretation isn't necessarily correct.

There's an flat/slightly-upward trend in cycling head injuries fro 1981-1986.
There is a clear decline in head injuries from 1986-1992 that matches a similar increase in helmet use.
The MHL was implemented after that clear decline.

That is, it's possible that the cyclists for whom helmets were beneficial chose to wear them voluntarily (before the MHL) and that the MHL forced helmets on to the remaining cyclists (eg, casual slow-speed cyclists who rarely ride anyway) for whom helmets have no clear benefit.

njkayaker

It's not clear what you are getting at.

No one is arguing to that one can make life completely "safe". No one (here) is arguing that people should be required to wear helmets.

sharp

On my Saturday ride, I crashed. Not 100% sure what caused it, but we are thinking the front tire flatted, causing me to lose control. I do know that my front tire lost traction and slid out to the right and next thing I knew I was trying to pick myself up off the road. We were descending, through some twisties, at about 30mph when it happened. My partner said that I slid / rolled down the road about 4-5 "truck lengths" after hitting the ground. It felt like my head took a lot of the impact. I came up dizzy and bleeding from my ear. Long story short, my friend flagged down a driver who gave me a ride to my truck, where I met my wife and she took me to the ER. I didn't want to go to the ER, but I was over-ruled 5-1 (my wife plus the other 4 guys who were riding with me). They said my ear was part way torn off. So a few hours later, I had a sewn up ear, a negative c-scan, a lot of cleaned out road rash OUCH, and some scrips for some antibiotics and pain pills. Now, two and a half days later, I'm still woozy...feeling the effects of a concussion and thinking that it was a good thing I was wearing my helmet.....

Folks, please wear your helmets.

escarpment

Pics or it didnt happen

rearviewbeer

My son was saved by his helmet a couple years ago. Both front teeth fully excised from impact. Scary to think what would have happened to him had he not been wearing a helmet.

Wear a helmet people!

OP - glad you are ok and doing better!

chasm54

Road helmets don't typically cover one's mouth, so what difference it made to his front teeth I really can't imagine.

****.

rearviewbeer

He hit his head so hard that his front two teeth popped out. He hit his forehead, smashed the helmet in the front, cracked it all the way to the back. His teeth did not come into contact with the road...

Well they came into contact with the road once they fell out.