gbg

If it's your time to go (without a helmet)..R.I.P (with a helmet..rock on!!)

The entire purpose of "safety equipment" is to protect you in those situations where there is no time to react. I don't think anyone has a false sense of security as they are stacking it big time. They are in full "how the h*** do I make this hurt the least" mode. I don't think any one is thinking OH I have a helmet I think I will land on my head.
It does not take a lot of speed for serious head injuries. People have died from slipping on ice and hitting the back of their heads. That's 1-2mph and a 6' or so drop (and I would guess the time from slip to head contact is about .25-.5 seconds).

DrPete 

Basically there's no data either way. So you're left with a best educated guess, and in making recommendations to patients you do the best you can with what you have.

As for helmets decreasing mortality, I still think that if an appropriate study were done, it would show minimal, if any, mortality benefit from wearing a helmet.

Why do I say that? Here's why.



There are basically two main types of bike crashes-- bike vs. street or bike, and bike vs. car. The bike vs. car scenario is so devastating because of the huge m of the car and what's usually a very high v. The body doesn't like that kind of energy transfer, and at the end of the day bike helmets aren't designed to protect you from those collisions. Motorcycle helmets are to a greater extent.

The low-energy scenario, i.e. flipping off your bike, etc. etc. involves a drastically lower m, and a v that's usually much less too. These low-energy collisions are what bicycle helmets are made for, and to be honest the number of those injuries that prove fatal is very, very low.

So basically, in order to improve mortality, you need something to protect your brain from the high-energy stuff, which bike helmets flat out aren't designed for. Granted, there are the outliers, i.e. the high-energy impact that hits just right and is lessened by a helmet, or the low-energy impact that proves fatal (usually due to some other patient factor), but they're in the VAST minority.

Again, it's an intuitive educated guess based on what I've learned from people who have written the books on trauma. I freely admit I don't have the data, and it kinda doesn't matter because I still wear a helmet and recommend that others do too.

Basically a quasi-scientific way of saying "if it's time to go, it's time to go." My apologies for causing nausea among any physicists with my crudeness.

Dantebfd

Is the lack of data in part due to underreporting of accidents that result in a broken helmet but insufficient enough injury to require a trip to the ER, whereas if the accident happened without a helmet being worn the person might suffer just enough of an injury that they seek medical help?

I crashed last summer, the helmet did what it was supposed to do and I felt fine so I never got checked out but it was enough of an impact that it is conceivable that I could have required some kind of medical attention had I not been wearing a helmet.

My big worry is not a fatal brain injury but an injury that disrupts my ability to take care of my family or enjoy my current quality of life and if a helmet offers some measure of protection in that regard then why wouldn't I choose to wear one?

Reynolds 

Nobody in this thread said you shouldn't wear a helmet if you want to, I guess.

DrPete 

You do touch on one of the major drawbacks of any study that's been done. Then there's observer bias, the fact that sometimes you don't know what happened, selection bias, etc. etc.

But I fundamentally agree with you that it kinda doesn't matter because there's zero downside to wearing a helmet and it can only help.

Dantebfd

I didn't mean to suggest that anyone did, my point was, based on my experience, that the helmet can offer enough protection to warrant wearing it. I don't think that worst case scenarios make the best argument- it is not always "the helmet saved my life" as much as it could be "the helmet protected me from a concussion or skull abrasion" or whatever and that all I was saying is that happens to be good enough for me.

DrPete 

Yeah, but that's rational. Nobody wants to believe that they would've survived anyway. Makes for less of a story.

pdedes

i started riding again two seasons ago after a significant absence from riding. when riding solo, or with one or two riding partners, i trained helmetless. upon the request of my 4 year old daughter, i am wearing a helmet this season.

fit24hrs

Looks guys, I'll just end the discussion here:

https://www.cochrane.org/reviews/en/ab001855.html

For those who don't know cochrane is one of the most rigorous reviews in healthcare. The fact that these studies have withstood a cochrane review, just take it as a standard. Heck, most your healthcare decisions are based of research that have be reviewed by cochrane. I'm surprise DrPete is not aware of this study. Anecdotal evidence will not convince those who need solid evidence so give up. Helmets help. Let's move on. I recommend helmets for all my patients who cycle.

Reynolds 

I knew about that study, but it has had many critics too. It's not the "end all discussion" some claim(ed) it to be.
Later studies gave completely different results.

timmyquest

Hmm, i feel a little bit cheated.

timmyquest

Physics strikes BF.net again!

schnee

dark13star

People who make the "know how to fall" argument crack me up. I have been practicing martial arts for a good portion of my life, and I know how to fall. However, I have also broken two helmets, two on mountain bikes, and one skiing, and those accidents were so instantaneous, there was no proper way to fall. You are just moving along and suddenly your head is smashing into something, and you aren't even sure how that happened.

After 12 years of college, I will do what it takes to protect the brain I have so much invested in...

OP, glad you are ok.

BobLoblaw

+1. Reminds me of a girl I met who rode on the back of her "man's" Harley with no helmet and a leather vest. She said when you crash you just "curl up into a ball and slide on your back."

Among motorcyclists and bicyclists, there are always going to be people who will (sometimes skillfully) rationalize not wearing a helmet. I see some motorcycle and bicycle riders wearing stocking caps and ski masks in the early spring and fall. Why would you not wear a helmet in that situation?

As far as I can tell, some people refuse to wear them simply because everyone thinks they should. Not much you can do to get in the way of that kind of single-mindedness. It's like trying to sell quitting to a healthy smoker.

You have to wear a helmet to race and to participate in any organized charity or group ride. Even a lot of informal rides will turn a helmetless rider away. So even riders who pish the scientific and anecdotal evidence should wear them and get used to them if they plan on doing any social cycling.

BL

icyclist 

>These low-energy collisions are what bicycle helmets are made for, and to be honest the number of those injuries that prove fatal is very, very low.<

DrPete, I enjoyed your analysis of the types of impacts cyclists can suffer. The fact that some low-energy collisions do prove fatal seems reason enough for wearing a helmet. Any accident, fatal or otherwise - on a bike or on a horse, on skis or a snowboard, in a car or in a crosswalk - is rare, compared to the total number of people who leave the relative safety of their homes. But accidents will happen. Which is why I wear a helmet.

We can't always draw the line between low and high energy accidents. No, I won't survive running head-on into the grill of a large truck, even with a helmet on my noggin, and yes, I'll survive falling off my bike when I have trouble unclipping at a stoplight. It's what might happen between those two extremes that makes wearing a helmet make sense.

On the other hand, if we knew it was safer to drive a car or walk than it is to ride a bike, we could argue just as easily that it makes more sense to stop cycling that it does to wear a helmet. Again, it's difficult to draw a line about what is an acceptable risk. For some people, the joy of riding a bike outweighs the risk of injury. For other people, the joy riding a bike without a helmet is worth the risk of injury, too.

KendallF

2 minutes with Google and I come up with some actual studies (summarized here):

https://depts.washington.edu/hiprc/pr...meteffect.html

Not nearly as much fun as name calling, but they may help inform.

tsohg

+1.

DrPete 

I am aware of that review, and if you re-read my posts you'll see that what I'm saying is in agreement--decreased injury, but no impact on mortality in adults.

And Cochrane is not gospel--may point you in the right direction, and it's undoubtedly a high-quality meta-analysis, but it's still a meta-analysis.

DScott

I always wear my helmet. It's red.

DrPete 

I agree with you 100%. For some reason people seem to have pigeon-holed me into the anti-helmet crowd because I'm calling some data into question. Don't get me wrong--I support wearing a helmet 100% for exactly the reasons you state, but I just never think there will ever be a study that conclusively demonstrates at a population level that bike helmets "save lives."

timmyquest

What's wrong with that? Seems like the only applicable type of study in such a broad discussion. Nothing is black and white.

DScott

Seriously, I'm certain there have to be instances where a helmet saved someone's life. Maybe the science isn't there yet, given that prospective studies are a little hard to come by. Add that to the clear data supporting a reduction in injury severity, and I'm further convinced.

I mean really, how many of you would allow your children to ride their bike without a helmet? Probably very few, regardless of their own personal stance on the issue. I see that one all the time: kids riding with their parents and the kids have helmets while the parents don't. Makes no sense to me, at all.

Besides, my helmet matches my shoes.

fauxto nick

You know I'm usually not for these helmet arguments. Call me a ****** but I like the feeling of going out to ride with just a head band or something, hair in the wind. I do this often, especially on recovery rides, or hill repeat days. Then I see something like this and remember why I spent extra to get a LAS helmet I like wearing.

Thanks.

Tulex

I agree that there may not be a study, but isn't it common sense? There has to be hundreds of accidents a day. Of these accidents, they all fall into some measurable range of force to the head. In any given case, each head can only take so much force. A helmet is known to absorb some amount of that force. So, it's reasonable to assume beyond what statistics show that some number of these accidents involved a force to the head that would have been beyond the tolerable amount hand a helmet not absorbed some of the force. I don't get how statistics or studies or literature, all of which are limited to the data used and opinion, can trump that reality. I also agree with an earlier poster that the largest missing data is unreported non injuries.

The argument in this thread is no different than when you get 100 people calling a paper, and 98 are ticked off about something. The paper reports that the public is ticked off. Never mind the fact that 10,000 people didn't call in to say they are happy. These studies are the same. The data collected may not represent the whole picture. Yet it is used to prove a point in some peoples minds.