And now, the bicycle helmet post…

Posted on March 30, 2009 by Dave Feucht

I’ve been avoiding this one like the plague, as this is maybe the one single most heated topic among people who ride bicycles (at least in the US). However, I feel like the time has come to say my peace and be done with it. So, here goes.

I think there are two things I would like to specifically address with relation to bicycle helmets. First of all, I want to address the actual efficacy of them, whether they do really help protect you and how much. Secondly, I’d like to address ideas of culture, safety as a whole, and fear.

Bicycle helmets are fragile and it is not uncommon for them to fail prematurely. The simple fact that you are supposed to replace one if you so much as drop it on the ground, I think speaks volumes about how much protection they can actually give. When bicycle helmets do fail, they do so by breaking catastrophically (cracking, splitting apart, etc), thus minimizing any kind of protection they were giving you. As they are made of styrofoam with a very thin layer of plastic on the outside, they can only take a very moderate amount of force before simply transferring all additional force directly to your head. Modern bicycle helmets are actually less effective than the ones made originally in the 1970′s because they have been made lighter and more lightweight with a much lighter shell in order to be more comfortable. In fact, while cycling helmets are supposed to meet the standards set by one of several international standards agencies, there is no third party testing to assure that they meet those standards, and independent testing has shown that many of them do not meet the standards they claim to. No existing standard requires testing efficacy of a helmet with relation to rotational, or diffuse, injuries.

So, we can see that helmets are designed for a very specific range of protection. Low-impact, direct impact collisions, which would typically result in scrapes, lacerations, bruises, maybe concussion. They are not designed however, and have not been shown effective to prevent rotational injuries (injuries where movement of the brain relative to the skull is the cause of injury). These types of injuries are generally the ones that cause death or permanent damage. There has actually been some concern in the medical community that bicycle helmets can have the effect of converting a direct force into a rotational force, therefore increasing the chance of an internal brain injury from a minor impact.

In a study conducted in 1988, 8 million cases of injury and death among cyclists over 15 years in the US were studied, with the conclusion that riders wearing helmets died more often in bicycle accidents than those not wearing helmets.

In 2001, a story was run by the New York Times in 2001, documenting with research and statistics from the Consumer Product Safety Commission, National Sporting Goods Association, C.D.C, and others that during the 1990′s in the US, as bicycle helmet usage really started to be pushed by city and national officials, bicycle companies, advocacy groups, etc – the percentage of cyclists wearing helmets jumped way up, the number of people riding bicycles declined sharply, and the number of head injuries in cyclists actually increased by 10%. The exact reasons for that aren’t apparent (though there are some very sensible suspicions), however, it is at least clear that bicycle helmets weren’t doing a lot to prevent head injuries.

An analysis of cycling and pedestrian facilities in Canada from 1983 to 2003 showed that likelihood of death was similar between both modes of travel, and that both decreased during the time period – however, while helmet usage in Canada rose from almost nothing to about 50% during that time period, no notable change in rate of fatalities was observed.

In London, police have noted that over the period of time in which usage of bicycle helmets has risen, the severity of bicycle-related injuries has also risen.

In the UK as a whole, the rate of head injuries from 1995 to 2001 fell more drastically for children than for adults. Yet, while helmet usage in adults increased by more than 50% during that time, helmet usage in children declined.

So, in conclusion, bicycle helmets were designed for a very specific purpose, to mitigate minor head injuries in low-impact crashes, usually in crashes not involving more than one party. Whether they may or may not prevent more serious injury in more serious accidents on specific occasions, they have not been shown to do so with any kind of regularity, and they really are not designed to do so.

So, on to culture, safety as a whole, and fear.

In modern American culture, riding a bicycle without a helmet is viewed as almost a death wish. When a bicycle accident is reported in news media, the comment is made “and the cyclist wasn’t wearing a helmet,” even if the cyclist wasn’t injured at all or didn’t suffer any head injuries – as if by wearing a helmet they somehow would have avoided the accident altogether.

In fact, only about 6% of reported bicycle accidents in the US result in moderate or higher level head injuries. In reality that percentage is probably much smaller, as many bicycle accidents which don’t result in any major injuries are never reported.

What all this irrational insistence on wearing a bicycle helmet does, along with the overwhelming perception that you are always in imminent danger of suffering a fatal head injury, is cause people to be afraid of riding bicycles.

Without fail, in places where they have mandated use of bicycle helmets, the number of people riding bicycles has fallen significantly. What is also clear, is that whenever a place has seen a significant rise in the number of cyclists, it has also seen a decline in the rate of bicycle-related collisions. That is, the more people cycling, the safer it is for cyclists.

We tend to look at the problem of bicycle safety as being equivalent with the wearing of bicycle helmets. That is, if you wear a helmet, you are safe. If not, you aren’t safe. I think this is an extremely narrow view of things, and I think many other factors play a more important role in the safety of cyclists.

Quoting from the above mentioned New York Times article:

“Dr. Richard A. Schieber, a childhood injury prevention specialist at the Centers for Disease Control and Prevention and the leader of a national bicycle safety initiative, said public health officials were realizing that in addition to promoting helmet use, safety officials must teach good riding skills, promote good driving practices and create safer places for people to ride.

“We have moved the conversation from bicycle helmet use to bicycle safety,” Dr. Schieber said. “Thank God that the public health world is understanding there is more to bicycle safety than helmets.”

This is exactly the philosophy that the Dutch Cyclist’s Union takes, preferring to make people feel as safe and comfortable about riding bikes as they can (through education, infrastructure, etc), so that as many people will ride bikes as possible, and therefore safety will increase. The Netherlands is consistently rated the safest country in the world to ride in, and also has the highest percentages of people cycling, with some cities approaching 60-65% of all trips made by bicycle. They are absolutely against mandatory regulation of bicycle helmets, and that clearly hasn’t hurt the safety of the riders in the Netherlands. They view cycling as completely normal, safe and practical.

So, first of all, head injuries are not nearly as common as people think. You are not necessarily in imminent danger of a head injury on a bike any more than you are walking or swinging in a park or running up and down stairs (or driving, for that matter – as the majority of major head injuries in the US are motor vehicle related). Yes, things happen, but that’s how the world is.

Secondly, I think if we are really concerned about the safety of cyclists, there are much better ways to go about promoting it than making people afraid of bikes, and then selling them bike helmets. If we focused on designing our cities so they were safe for non-automotive traffic (bicycles AND pedestrians), educating both cyclists and motorists on how to interact safely and use the roads and paths responsibly, I think it would go much further towards promoting the safety of cyclists than simply telling them “wear a helmet, or else!”

I tend to be skeptical of anyone trying sell anything by means of fear. To me, that says that they have some ulterior motive for persuading you to buy what they’re selling.

So, all of that to say, I’m not opposed to bicycle helmets in and of themselves. If they make the difference between you getting on a bike or not, go for it. They probably do have some benefit for preventing minor injuries. I also think they make a lot more sense for sport cyclists than for your average everyday getting around town cyclist. The type of bike and the way you ride it make a big difference in your level of risk. What I am opposed to is “promoting” safety by making people afraid, not to mention with pretty slim and sketchy statistics, ignoring the problems of interaction with automobile traffic and then just labeling cycling as extremely dangerous. I’m opposed to mandating the usage of bicycle helmets, because it has been shown to have negative results with regard to the safety of cyclists in places where helmets have been mandated.

The two best places for cycling in the world, the Netherlands and Denmark, both have no mandatory helmet laws, but rather make cycling safe by educating people and by re-arranging their cities to accommodate more than just automobile traffic. They do this because they see the benefits to society of having large numbers of people cycling rather than driving, and so they want to encourage that positively as much as they can.

I know, some of this is opinion, and while there may not be scientific proof that bicycle helmets can prevent major head injuries, there is still a chance that they may in some cases, I just don’t believe that riding a bicycle is a dangerous activity, in comparison with all the things we do on a normal day in our lives, and I have an objection to people who, intentionally or inadvertently, paint it as something to be feared. I think education and responsible behavior, and not helmet legislation, is the best way to encourage safety on the roads and bicycle paths.

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  • Val

    Well said, all of it – but you’re far too rational, you know. The folks who believe in (bicycle) helmets as a religion do so out of sheer instinct, based on a plethora of anecdotes (“It saved my life!”). It is very difficult for reason to make any headway against instinct. Keep it up, though – bit by bit, we may be heard.

  • melancholic optimist

    Yeah, and I’m fine with people if they really feel more comfortable wearing a helmet – I just wish that before they go and try to tell everyone that they’re sure to die without one, they would look and see that head injuries in cyclists really aren’t that common. Again, of course, anything can happen, but you can get hit with a falling flower pot while walking down the sidewalk too, that doesn’t mean it’s likely. And also, as I mentioned, the type of bike and the way you ride it make a big difference.

  • Adrienne Johnson

    I find the best way for me to go about all of this is to just smile and nod at those who wish to see me in a bucket. I will not argue about it. If pushed, I will point to the millions of people all over the world who manage to keep their heads despite a deplorable lack of helmets. If asked how I could possibly feel comfortable without one, I let my questioner know that I have confidence in my riding skills and many years and miles of bicycle experience. No argument. Just a smile and an agreement to disagree.

  • orc

    “What all this irrational insistence on wearing a bicycle helmet does, along with the overwhelming perception that you are always in imminent danger of suffering a fatal head injury, is cause people to be afraid of riding bicycles.”

    Citation?

    Safety belts, which are legally mandated in large swaths of the United States (and, at least if the drivers manual for my Prius is at all typical of driver’s manuals, are similarly commented in a moderate “IF YOU DO NOT WEAR A SEATBELT, YOU WILL DIE!” style,) do not appear to have caused people to be afraid of riding in automobiles, and which certainly have not caused any decline in automobile use in this country.

    I have some issues with the rest of your arguments, but the “nobody will ride the scary bicycle” line does not seem to be supported by anything other than helmet denialism trying to find an argument.

  • melancholic optimist

    @orc: it’s not *just* the insistence on wearing helmets – there is an extreme focus in American culture on being “safe” on a bicycle, everything from doomsday owner’s manuals to helmet scares to unbelievably bright strobing bike lights to all neon clothes to sensationalist media…

    The point that Andreas Rohl of Copenhagen made at the 2009 National Bike Summit fits here very well: that safety is important, but it is even more important not to talk about it too much, or the people you are trying to get to ride bikes are going to think it’s extremely dangerous. I think that’s absolutely true, and I think that’s exactly what we’ve done in the U.S. It’s not just bicycle helmets, but that is a part of the whole puzzle.

    The difference between a helmet and a seatbelt, is that seatbelts have clearly been shown in testing to prevent major injuries that would have otherwise happened (like your head going through the windshield or into the steering wheel or dash). They are manufactured to be robust and stand up under major collisions. As far as I can tell, there is no such evidence for bicycle helmets. They may help prevent minor injuries, but there seems to be no real proof that they will save you from a life-threatening injury (and may even worsen a minor impact to your head in some cases). They are not manufactured to be robust and to stand up to major collisions (motorcycle helmets are, bicycle helmets are not).

    For that reason, “You *will* die without a bicycle helmet” is a pretty sketchy line to give, in my opinion, especially seeing that only 6% of bicycle crashes even involve more than minor head injuries in the first place. You’re much more likely to die from drowning, poison or suffocation (or an automobile accident).

    Which is why your Prius tells you to wear your seatbelt. Firstly, because we know it can protect you, and secondly, because you’re at higher risk in a car. And I think a big part of the reason that people are not afraid to ride in automobiles is simply that they have become so normal, and we have become so dependent on them. We like to conveniently forget how dangerous they can be simply because we depend on them, and it’s easy to do because (nearly) everyone drives one. Not to say people shouldn’t drive (I do), just that maybe it wouldn’t be a bad thing if some people had a bit more respect for the harm their vehicle can cause.

    Again, I think there are much better ways to encourage and promote bicycle safety than simply promoting (or mandating) the usage of helmets.

  • orc

    There’s extreme emphasis in american culture about being safe *everywhere*. There is not an item I purchase new, from bicycles to computers to sewing equipment that doesn’t have at least one dire threat on it saying I’mgonnadie! if I don’t use it in the exact way the vendor expects me to (and on the computer front, this includes doing things like loading different operating systems on the vendor’s piece of crap.)

    The LBSes tell you you should buy a helmet to cover their asses if someone buys a bike and lawndarts sans helmet. The bicycle manufacturers tell you that a grue will eat you if you ride in the dark to cover their asses when some bike ninja gets clobbered by a bus. It’s an artifact of how the United States works, and I think you’ll find that people take that into consideration no matter what they purchase.

    If you look at helmet use, there are some nice studies involving mandatory helmet use on scooters and motorcycles (not bicycles, but the riders are protected just as they are on bicycles, which is not at all.) And they all show modest reduction in TBIs (20-40% on the handful of studies I looked at today, but that 20-40% is a reduction from 3-4 thousand injuries/year to 2-3 thousand injuries a year on a riding population of 100s of thousands to millions) with the largest reductions, of course, being in the faster and riskier populations. The really slow riders will see some reductions, of course, but a 1/100000 chance of a TBI is close enough to 1/950000 so that it’s an understandable decision to forget about the helmet and go about your business. But are they giving up some safety? Yes, of course, but it’s almost noise.

    I’ve lawndarted at low speed (when I was young and foolish; I was riding without a helmet at night, and I only remember catching the bicycle as it fell on top of me. I guess I managed to flip and land mainly on my back, because I eventually got up and continued on my way home) so I’m not going to forgo the helmet. If I was riding a omafeits, I know the helmet would be mainly a good luck token, but the emphasis is on mainly — even at 10mph, a unfortunate fork failure or suicidal squirrel could lawndart me again and it’s be just my bad luck if I fell in that dozen or so extra TBI category. Worthwhile to ignore for the feel of the wind in my hair? In a different world where I hadn’t hit that barrier at speed, yes. But I’d be ignoring it, not denying it.

    In a better world, I’d push for /much/ better bicycle rights-of-way and recommend that people wear helmets. The major threat to a cyclist’s life is our friend the automobile, and if that threat is dealt with then lawndarting would, by attrition, become a significant enough threat to be noticeable.

    And bicycle helmets are like automobile bumpers; one of the ways they absorb impact is by disintegrating. If you lawndart, the first impact will probably stop you (unless you come off your bicycle on a 40mph downhill) and then it won’t really matter if your helmet has converted itself into a collection of loose styrofoam held together by plastic wire. At US$20 a crash, it will take a lot of crashes to catch up to the cost of a single hardshell motorcycle helmet.

  • melancholic optimist

    So, you’ve just re-made my point. The chance of dying without a helmet is much less than we like to make it out to be. It’s certainly not a guarantee. It hasn’t been reliably shown to be much or any less than the chance of dying with a helmet. And I think scooters and motorcycles are significantly different than bicycles, in many ways. By the way, what are TBIs?

    And, as I’ve said a few times now, I’m not against people wearing helmets, I’m against them being mandated, and I’m against the fear of imminent death without one being spread.

    (I think the whole fear and danger game in the US is ridiculous, to address your comment that this is just how things work here. I understand *why* it happens, but I still think it’s silly)

  • Val

    Hmmm….isn’t an “Orc” similar to a “Troll”?

  • Travis A. Wittwer

    Paragraph 20, Dutch Cyclist’s Union. I find this to be the eventual truth. However, I do not know if we, as Americans, have the cohesiveness to make this happen. In addition, we are way too sue-happy which adds to the creation of laws.

  • melancholic optimist

    Yup, I think our sue-happiness is much of why the fear game happens, because everyone feels they have to cover every possible eventuality in a disclaimer, and therefore expound every possible danger that could arise, even if the chance of it happening is such that it’s not likely to happen in 4 persons’ lifetimes.

    I don’t really know what to do about that, but I find it extremely frustrating.

  • Adrienne Johnson

    Fear is a factor of control- others instill fear in order to control, individuals use fear as a means of not facing issues that need to be tackled. Helmet legislation is a symbol of our societal need to ignore individual responsibility and social justice. if the rider can be blamed for her injuries, then the problems of undertrained drivers, poor road conditions, antiquated city planning, over crowding…. can be ignored by the power that we put in place to fix it.

    If we want to get past this discussion, then there has to be a societal shift (that starts with individuals) toward responsibility and personal honor. Each person has to be willing to behave towards others in a patient and non-self serving manner that looks at the whole, at the same time that it looks at the individual.

  • melancholic optimist

    I couldn’t agree more.

  • Anonymous

    I’m rather agnostic on the helmet issue, but I’m wondering about correlations and causation with regard to the lack of helmet use in northern Europe. Dutch riders can oftentimes expect a separated bike path and generally slower speeds on their bikes. When they are on the road, most cars are small and travel relatively slowly. There are many riders around and drivers account for them. For those cyclists, the use of a helmet would seem unnecessarily risk-averse.

    Contrast that with the typical American rider, who usually must ride in traffic that consists of sports cars, big delivery trucks, and oversized SUVs with drivers of questionable ability and focus. That traffic is faster and more aggressive. In this scenario, a helmet might help avert a serious head injury. You are surely right that a styrofoam helmet won’t do much in a collision with a semi or Suburban, but neither is it a major burden to wear and it just might help.

    And, you know, acting prudently means accounting for a likely but not catastrophic event as well as for a very unlikely but highly catastrophic event.

    So I’m just pointing out that the situation is not exactly analogous between the U.S./Dutch riding situations, and people ARE rational when trying to avert in a reasonable way the unlikely but highly damaging event of a head injury.

  • melancholic optimist

    And again, I’m not opposed to people wearing helmets (as I’ve now said more than a handful of times). What I am opposed to, is the propagation of the idea that you will surely die without one, and that wearing a helmet equals safety.

    The Dutch example is a great one, because we can see a perfect example of the idea that, rather than promoting helmet use, a much better way to promote safety as a whole is to help avoid collisions.

    However, we in America, rather than actually wanting to promote the safety of cyclists, just want to get them off our conscience, so we say “just wear a helmet, that makes you safe” – and then if they don’t wear a helmet and they get injured, we can say “well, you weren’t wearing a helmet, what did you expect?” (often even if the injury didn’t involve their head).

    Statistically (even in America), you’re as likely to get a head injury from falling down stairs or tripping over a rock while hiking (or driving a car, or jumping rope, or doing a million other things) as you are from riding a bike for everyday transportation. But I’m personally not going to wear a helmet every time I walk up and down stairs just in case. I understand that riding on roads with cars, there’s a much greater perception of danger than on your stairs, and subjective safety makes a big difference in what people will or won’t do.

    Statistically, you are also much more likely to get a non-head-related injury riding a bike than you are to get a head injury, though the percentage of non-minor bicycle injuries is quite low in general. Most recorded injuries in the US overall are just scrape and bruise type things (road rash), and most of those have nothing to do with your head.

    I agree, the situation is not exactly analogous between the Netherlands and the US, but it is largely because they have made it that way. They seem to actually take the safety of cyclists seriously, and therefore they do the most prudent thing to protect them, and that is to help prevent collisions.

    I think as long as we have this fixation on helmets, it’s going to be much more difficult to get people to see that helmets are not a complete safety solution (in fact, they are a pretty minimal plus in the safety department).

    So, yeah – all of that to say again – I’m not opposed to people wearing helmets. I don’t think you’re stupid if you wear one. What I do think is that all this fixation on safety, all this fearmongering about head injuries, and the fixation on helmets as a safety solution are all very unhealthy for the overall safety of cyclists. If we instead focused on traffic as a whole, the actual primary causes of injury, and how to really make everyone on the road safer, we would be much better off.

    I was reading some documents from the Portland city government recently, and there was a quote to the effect of – “it seems that as the roads become safer for the most vulnerable road users, they become safer for everyone.” This is prime motivation for them to create streets that make direct routes and have traffic calming and re-direction to both reduce the amount and slow the car traffic, making those roads safer for bicyclists, pedestrians, and drivers.

    That seems to me a much better philosophy for encouraging safety.

  • Leticia

    I was wondering what you’re opinion was on wearing a skateboard/inline skate helmet. I did not purchase a bike helmet because I thought they felt pretty flimsy, and instead went for the other. The feel way better as far as durability is concerned, and yet I still have not begun to ride my bike with it. What you wrote really relates to how I feel about it and I have actually been afraid to actually start riding my bike around town because I am afraid of getting into an accident. Your post gave me more confidence.
    Thanks. :)

  • melancholic optimist

    To be honest, I don’t really know anything about skateboarding helmets. It’s possible that they’re made a little more robustly than the average bicycle helmet.

    Whether you wear a helmet or not, your best bet for safety is just riding predictably, and paying attention to what’s going on around you, use lights at night, etc. Those kinds of things help prevent collisions. Of course it depends on the place and the roads you have to ride on, but I would imagine in most places, you can find routes that mostly use less busy roads and have slower, calmer traffic. I would recommend just making some short trips – go get a drink with friends nearby or to your grocery store for a few items or whatever. Do some short trips until you feel more comfortable and start to get the hang of traffic, and you’ll feel more and more comfortable going longer distances. Everyone is nervous about something they haven’t done much, but once you start doing it, it will feel more and more natural.

  • christopher lee

    i’ve crashed in a helmet, hitting my head and had nothing wrong with it, no cracks, dings or dents, just a little scuff. i drop my helmet on the ground all the time to get it out of the way, helmets are great.
    perhaps the increases in injuries among people wearing helmets is due to a superman complex. those studies showed statistics after the fact, they had no way to be there and watch the cyclists behavior before the accident. this doesn’t even account for deadly drivers who seem to treat more dressed up/equipped cyclists differently assuming the rider can “handle theirself”. i bet if everybody wore a helmet ALL THE TIME those numbers would say there were so many injuries, 100% of riders wearing helmets. in other words it seems more coincidence than definitive fact that a helmet is any more or less safe.
    i think a helmet is advisable to be a minimum of protection in the event that something happens.

  • Ajlouny

    Interesting information here, but there are some people that just feel like a better rider when they have their protective gear on. And, if there is a 10% chance that their helmet will help save their head from serious injury, their willing to make that sacrafice.

  • portlandize.com

    @Ajlouny: I realize that, and that's just fine – I would just rather people make informed decisions and not make them out of irrational fear or media hype or whatever – I don't think that kind of thing helps anyone, in any situation.

  • Bicycle Injuries

    According to my opinion, Helmets are be required for all bicycle riders. Helmets save lives and protect the less skilled riders.

  • portlandize.com

    Seeing as you're just trolling for helmet posts on the internet (since this one is well over a year old), all I will say is, if you treat people like they can't make their own decisions, they will stop being able to make their own decisions.