Helmets - the definitive thread.. ** Mod Note - Please read Opening Post **

droidus

Agent Smyth wrote: »

The Neurologist was making a general statement based on their experience, we will never know if the outcome would have been different but I am sure the patient wishes they could relive that moment with a helmet

Sure, and if I slip in the shower I will have wished I could relive that moment with a helmet, if the plane Im in drops from the sky I will have wished I could relive that moment with a parachute, and if Im knocked down by a car when crossing the road I will have wished I could relive that moment wearing body armour and wrapped in cotton wool.

dave_o_brien

death1234567 wrote: »

Almost invariably, in these cases the neurologists involved say that wearing a 20/30 quid helmet would have vastly improved outcomes and allowed the patient involved to carry on with their lives.

Firstly, ICU nurses are some of the greatest people I've ever had the misfortune to need around me. I badly injured my neck playing rugby, and spent some time in the National Rehab Hospital after being released from the ICU, and just have so much appreciation for what you do.

Now, I am sceptical about what these neurologists say.

To put it accurately, these experts at dealing with brain trauma speculate that wearing a piece of compressive foam may have altered the outcome. The efficacy of the foam would be totally outside of his or her realm of knowledge expertise, however, it is reasonable to assume that as they are in the ICU and receiving treatment from a neurologist that the trauma sustained was likely so extreme that the impact resistance provided by a standard bicycle helmet was greatly exceeded, and would probably not have been effective.

Brain trauma in this instance may be caused by deformation of the skull, impact internally with the skull, or a combination. The amount of deceleration a helmet can provide may prevent skull fracture, but likely not internal movement.

Where a helmet can be effective is in low speed accidents, and then successful at preventing concussion. To suggest that a helmet may prevent serious brain trauma is wildly speculative.


EDIT: I have put a line through a word I no longer think is fair, and replaced it with a word that is better.

Beasty

galwaycyclist wrote: »

If you read the mod note at the start it is clear that it is hoped that this thread should capture wider aspects of the debate.

Yes, I would like it to become a "one-stop shop" for all "helmet debates", with anyone starting one in the future being referred to this one - that should help avoid going over the same ground time and time again

The thread title is sufficiently "open" to accomodate such discussion, although once the thread has a little more "critical mass" we may change it to incorporate something like "helmet debate megathread"

In the meantime if anyone has any questions over whether something is off-topic please report the post or PM the mods - do not start derailing the thread by raising such question in it.

Thanks

Beasty

dave_o_brien wrote: »

To suggest that a helmet may prevent serious brain trauma is wildly speculative.

I've got to disagree with such a statement - it did not say "will", it said "may". There is absolutely nothing "speculative" about such a statement

It's perfectly reasonable for me to say my helmet "may" have saved my life. I would not say it "did" save my life though

dave_o_brien

toomevara wrote: »

Almost invariably, in these cases the neurologists involved say that wearing a 20/30 quid helmet would have vastly improved outcomes and allowed the patient involved to carry on with their lives.

Beasty wrote: »

I've got to disagree with such a statement - it did not say "will", it said "may". There is absolutely nothing "speculative" about such a statement.

Toomevara said "Would". I said may. So it was speculative.

The second part of your statement was dead right, thought, but so too would be a statement along the lines of "After my collision, while flying through the air, I prayed quickly to land softly. It may have helped me avoid death or serious injury." I know that that's the point you are making, I just wanted to make it clear how avoiding definitive's mitigates any responsibility to the truth in such statements.

smacl

dave_o_brien wrote: »

Toomevara said "Would". I said may. So it was speculative.

Semantics and faith. If the head trauma guy says the helmet would (in all probability) be of significant benefit in this scenario, I'd tend to believe him in the absence of an extremely strong argument to the contrary. If the priest said 'say five hail Marys' before setting off, I'd be a bit more sceptical. We all make out own value judgements in these cases.

For me it's risk / benefit. The risks mitigated by wearing a helmet may be statistically small. The benefits of not wearing a helmet are totally insignificant. While the anecdotal evidence given by boardsies on this thread is being dismissed as atypical and not scientifically valid, it represents the best match for the type of cycling I'm involved in and the places I cycle. There's nothing I can see in the anti-helmet argument that would give me any good reason to stop wearing a helmet, or to encourage my kids not to wear helmets for that matter. Even worst case, and the helmet has about as much value as a homeopathic contraceptive, its not doing me any harm.

petethedrummer

https://www.youtube.com/watch?v=xgOUgrOHuFc

Agent Smyth

Its a funny sketch but even he wears a helmet when cycling in NewYork

droidus

Agent Smyth wrote: »

Its a funny sketch but even he wears a helmet when cycling in NewYork

But does he wearing rubber soled shoes when performing to prevent the real and recognised risk of electrocution due to an incorrectly set up microphone?

Agent Smyth

droidus wrote: »

But does he wearing rubber soled shoes when performing to prevent the real and recognised risk of electrocution due to an incorrectly set up microphone?

why don't you google "people electrocuted on stage"

dave_o_brien

smacl wrote: »

Semantics and faith. If the head trauma guy says the helmet would (in all probability) be of significant benefit in this scenario, I'd tend to believe him in the absence of an extremely strong argument to the contrary. If the priest said 'say five hail Marys' before setting off, I'd be a bit more sceptical.

Even worst case, and the helmet has about as much value as a homeopathic contraceptive, its not doing me any harm.

In the first part, fair enough, but surely the extremely strong argument to the contrary is the force needed to cause brain trauma of the type described by Toomevara, coupled with the forces a typical helmet is designed to withstand.

Put it another way; if one buys a car that has no crumple zones designed to protect the people inside the car, and the car is hit by an artic moving a 120kmh, and the extent of the damage is such that all in the car are killed or seriously injured, it is not the lack of crumple zones, as the extent of the damage was such that the force of impact where the crumple zones would have been effective was massively exceeded.

For the second part, I agree, and it is why I mostly wear one. But I do so in the belief that it is likely to be either unused or as effective as a homeopathic contraceptive.

smacl

Supposition again, but if the brain trauma guy or gal treats x cases of ABI as a result cycling incidents, and of those cases the larger proportion (in relative terms to the cycling population) were cyclists that were not wearing helmets, he or she could reasonably conclude that they were not encountering many helmeted cyclists, because helmeted cyclists were not suffering the same level of similar injury. Perhaps they don't need to understand the efficacy of the helmet beyond this simple analysis. It is a supposition of course, but to me it seems like a more reasonable one than them coming to a similar conclusion based on their knowledge of ability of polystyrene to absorb impact.

galwaycyclist

smacl wrote: »

Supposition again, but if the brain trauma guy or gal treats x cases of ABI as a result cycling incidents, and of those cases the larger proportion (in relative terms to the cycling population) were cyclists that were not wearing helmets, he or she could reasonably conclude that they were not encountering many helmeted cyclists, because helmeted cyclists were not suffering the same level of similar injury. Perhaps they don't need to understand the efficacy of the helmet beyond this simple analysis. It is a supposition of course, but to me it seems like a more reasonable one than them coming to a similar conclusion based on their knowledge of ability of polystyrene to absorb impact.

Uh no it would still be supposition and a variation on this is part of the junk science that feeds into helmet promotion.

If we take traffic injuries among children as an example.

There is an established correlation between levels of family wealth or social deprivation and risk of being a child pedestrian casualty. So Scottish children from the most deprived backgrounds have been found to be up to 6 times more likely to get knocked down while walking than their peers from the wealthiest sectors of society. A similar pattern is present for child cyclists although the disparity is not as extreme.

There are all kinds of reasons for this the wealthy kids likely experience more supervision and are likely to be protected by their parents from having to use risky environments. So they are more likely do their walking and cycling in parks or traffic calmed leafy suburbs etc.

Among children the wearing of cycle helmets is an indicator of social class.

If a clinician observes that child cyclists who wear helmets tend to experience lower injury severity are they observing the effect of the helmets? Or are they seeing the well established protective effect of membership of the wealthiest socio-economic groups?

Mucco

galwaycyclist wrote: »

Uh no it would still be supposition and a variation on this is part of the junk science that feeds into helmet promotion.

If we take traffic injuries among children as an example.

There is an established correlation between levels of family wealth or social deprivation and risk of being a child pedestrian casualty. So Scottish children from the most deprived backgrounds have been found to be up to 6 times more likely to get knocked down while walking than their peers from the wealthiest sectors of society. A similar pattern is present for child cyclists although the disparity is not as extreme.

There are all kinds of reasons for this the wealthy kids likely experience more supervision and are likely to be protected by their parents from having to use risky environments. So they are more likely do their walking and cycling in parks or traffic calmed leafy suburbs etc.

Among children the wearing of cycle helmets is an indicator of social class.

If a clinician observes that child cyclists who wear helmets tend to experience lower injury severity are they observing the effect of the helmets? Or are they seeing the well established protective effect of membership of the wealthiest socio-economic groups?

Isn't this that study from the states? I think someone showed that wearing a bike helmet also reduces the risk of being stabbed, probably for the same social class reasons.

galwaycyclist

Mucco wrote: »

Isn't this that study from the states? I think someone showed that wearing a bike helmet also reduces the risk of being stabbed, probably for the same social class reasons.

Yes partially. One of the original Thompson and Rivara studies (the source of the often quoted 88% reduction injury) compared injuries among two groups.

The group they chose as "demonstrators" or "indicators" of the effect of cycle helmet wearing were members of a private health insurance co-operative. (Another indicator of social class)

These were compared with the wider population and the observation that those who could afford health insurance were less likely to be injured was attributed to the fact that they were also more likely to wear helmets.

Did someone mention homeopathy?

chakattack

galwaycyclist wrote: »

Uh no it would still be supposition and a variation on this is part of the junk science that feeds into helmet promotion.

and helmet opposition.....:pac:

It's virtually impossible to derive a scientifically sound answer to this stupid debate without introducing a hefty dose of speculation/supposition/extrapolation of whatever you call it and ruining the whole thing. As soon as you introduce population statistics you introduce a metric sh*tload of potential error and an array of assumptions which may or not be true or applicable.

It's best to deal with the limited facts available and take things back to basics.

We'll assume accidents can happen. I think that's straightforward

There is a spectrum of potential head injuries from superficial bumps to long term brain damage and death.

The energy imparted on the skull in a crash can vary based on all sorts of factors. There is some relationship between the amount of energy involved, where it is applied and the severity of an injury.

Helmets are known to absorb or deflect an unknown amount of this energy.

This reduction in energy may move the injury one or two steps down the severity scale. It may be the difference between 20 stitches and a 20 second memory span...or it may not. It introduces a little more protection or even chance and that can't be a bad thing.

Now can we let people decide for themselves or should the festering of wildly speculative and unproven ideas that helmets are somehow inherently harmful continue?

If there's doubt about any of the above, we can apply the scientific method with a simple experiment involving hard walls or even stationary car bonnets and freshly laid tarmac.

galwaycyclist

chakattack wrote: »

and helmet opposition.....:pac:

It's virtually impossible to derive a scientifically sound answer to this stupid debate without introducing a hefty dose of speculation/supposition/extrapolation of whatever you call it and ruining the whole thing. As soon as you introduce population statistics you introduce a metric sh*tload of potential error and an array of assumptions which may or not be true or applicable.

It's best to deal with the limited facts available and take things back to basics.

We'll assume accidents can happen. I think that's straightforward

Their is a spectrum of potential head injuries from superficial bumps to long term brain damage and death.

The energy imparted on the skull in a crash can vary based on all sorts of factors. There is some relationship between the amount of energy involved, where it is applied and the severity of an injury.

Helmets are known to absorb or deflect an unknown amount of this energy.

This reduction in energy may move the injury one or two steps down the severity scale. It may be the difference between 20 stitches and a 20 second memory span...or it may not. It introduces a little more protection or even chance and that can't be a bad thing.

Now can we let people decide for themselves or should the festering of wildly speculative and unproven ideas that helmets are somehow inherently harmful continue?

If there's doubt about any of the above, we can apply the scientific method with a simple experiment involving hard walls or even stationary car bonnets and freshly laid tarmac.

I think this approach is sometimes termed the streetlight theory

A policeman sees a drunk man searching for something under a streetlight and asks what the drunk has lost. He says he lost his keys and they both look under the streetlight together. After a few minutes the policeman asks if he is sure he lost them here, and the drunk replies, no, that he lost them in the park. The policeman asks why he is searching here, and the drunk replies, "this is where the light is."

chakattack

You've lost me there i'm afraid...who's the drunk here?

MediaMan

monkeybutter wrote: »

good article here from the dutch of course

http://www.swov.nl/rapport/Factsheets/UK/FS_Bicycle_helmets.pdf

I'm surprised that there hasn't been more discussion in the thread of this paper. It strongly suggests that helmet wearing has a small but definite benefit based on a meta-review of multiple studies.

I'm not saying we should take is as gospel - I don't have enough context to say that - but I would have thought it was definitely worthy of discussion, give the general lack of good-quality, meaningful data around.

The other point I found interesting from this study was that the vast majority of cycling accidents causing injury (in the samples studied) were cyclist-only - that is they involved the cyclist hitting the ground or an immovable object - rather than a motor vehicle.

My own view on helmet wearing is
- I believe a helmet can mitigate injury in at least some scenarios
- I understand that they may not be much help in many situations
- The downside of wearing one is small
thus on balance I decide to wear one when I cycle.

I would be strenuously against compulsory helmet wearing though. We can make up our own minds.

doozerie

The debate around the benefits, or not, of helmets all too often gets lost in a shouting match, of which the loudest voices tend to be those arguing that helmets are essential to your health. The most patronising of those arguments usually resort to telling people that the pro-helmet reasoning is based on "common sense" as if anyone holding a differing view is utterly devoid of any common sense whatsoever. It's a very weak position to adopt since you fall on your own sword as soon as someone else comes along and puts the argument that, for example, full face helmets are necessary for safety and that anything less defies common sense. (Incidentally, I witnessed one nasty face plant, and personally know the victim of another, and in both cases a full face helmet might have helped save a few teeth in one case (where the rider was wearing a helmet) and a lacerated cheek in the other (no helmet) - for fans of anecdotes there are potentially grounds for some strong arguments in favour of full face helmets there).

The strongest arguments in favour of helmets tend to just jump straight in at the emotive level, recounting tales of people who've incurred serious head injuries, etc. They skip straight past the crucial question about whether there are good grounds to believe that a modern helmet is really the best, or useful even, device to protect someone in a fall or a collision. The assumption seems to be that this is a question that is already answered, personally I believe it isn't. Issues around helmet design and testing have been referred to several times in this thread but I think it's worth repeating that there remain some real questions in these areas that should subjected to further scrutiny. So, for example:

* Why do the helmet safety standards differ in different parts of the world, are our heads really that different from one side of the world to the other?

* Why is the current EU standard arguably weaker than the SNELL standard (if I remember rightly) that it replaced?

* Is current helmet testing really rigorous enough for a product that so many people put so much faith in?

Not to mention the fact that questions about whether helmets actually increase danger in certain circumstances (rotational injuries, bigger object making for greater risk of collision, etc.) can tend to be dismissed out of hand as if they are not relevant. To my mind such questions are very relevant and no debate about the effectiveness and benefits of helmets can be complete without addressing them.

Thankfully there is a lot of interesting debate in this particular thread, it hasn't been drowned out by the zealots at either end of the opinion range. My own experiences add little to the debate. I rode for years without a helmet, both on-road and off-road, and although I had a number of knocks to the head in that time none of them were serious or anything close (by contrast I left some flesh from one elbow behind after one fall, but who cares enough about elbows to campaign for their safety?). At some point in my early 20's I bought into the "helmets are essential" argument and got myself one, though I only wore it off-road. It was a horrible yoke, like wearing a colander, modern helmets are things of beauty by comparison. It's a very insidious thing though, the helmet, after a while I found that I felt vulnerable without it. My riding style hadn't changed, my low rate of falling off the bike hadn't increased, I simply became paranoid and I started to wear my helmet regularly. That paranoia has stayed with me and I still wear a helmet now even though I've been unconvinced by all of the arguments I've encountered which claim that wearing the helmet makes me a sensible person and that not wearing one would mean certain death. I also still have to stop myself from blessing myself when I pass a church - despite having turned my back on catholicism many years ago the drummed in fear of being struck by lightning for sinning remains hard to shake off.

So I am full of contradictions. ("No I'm not!". "Yes, I am!" - see), just one more reason why I see no sense in my arguing strongly in favour of, or against, wearing a helmet. I will argue strongly in favour of people making up their own minds though, and I'll go further and argue strongly that they should make an *informed* choice hence my questions above. Bicycle helmets represent what I imagine is a lucrative industry, before we give the more of our money we should be asking the manufacturers (and the safety standards authorities) to justify the faith that they encourage us to have in their expensive pieces of polystyrene.

Anyway, yayyy to reasoned debate and booo to emotive rants.

monkeybutter

I don't believe that the helmet argument falls on full face helmets being better at protecting the face chin area than say road helmets.

Just like full face motorbike helmets are safer than flip or open face helmets.

It's just that they can be too warm to be practical, so you compromise it's design.

Whereas there's no real reason than the wind in your face for not wearing a full face helmet on a motorbike. I certainly wouldn't want my face plastered on the road at 100kph.

If you move to sport where you don't need to cycle as much and the chance of crashing goes up past the downside of the full face, they tend to get worn, for example downhill.

Of course helmets can evolve within that compromise and as you said, they have come a long way and there may be a better solution at some point, but no alternative makes no sense.

For the anecdotes on whether a helmet saved someone from doom or not is too be taken with a pinch of salt, but as the people telling the story were presumably there to witness it, we aren't exactly in a position to argue otherwise.

I have witnessed similar myself and it seemed obvious at the time the injury was reduced by the helmet taking the brunt of it.

As you got older, you just got wiser, it happens to us all. :pac:

monkeybutter

galwaycyclist wrote: »

If you read the legislation they quote, it became mandatory to fit seatbelts to certain classes of vehicle in 1971.

Compulsory wearing didnt come in until 1979.

Even moving it to 1979 , and basing it on the citizen info website being incorrect, there is still a marked decrease from 628 deaths in 1978 to 410 in 1985. What are we attributing that to? Infact moving it to 1979 makes an even stronger argument for it.

Obviously not all are passengers or drivers in cars, but a marked decrease all the same, unless there was a reduction of 200 in pedestrian cyclist etc deaths, certainly no argument against the use of seat belts.

WillyFXP

James Cracknell, Shane Sutton, Bradley Wiggins. I will ALWAYS wear a helmet.

doozerie

monkeybutter wrote: »

I don't believe that the helmet argument falls on full face helmets being better at protecting the face chin area than say road helmets.

I wasn't claiming that it does, I was saying that the "common sense" claim that is often pinned to the wearing of helmets isn't as common, or as sensible, as those touting that view would like to believe. To some people "common sense" suggests a full face helmet, and they'll quite likely have anecdotes to support that view, to others a full face helmet and body armour is probably the minimum that common sense dictates, and to some others again simply not riding a bike at all is the only "sensible" option. Different people draw the line at different levels of protective gear, and they'll all believe they are right and that the others are either too cautious or too reckless. The "common sense" justification is basically silly.

monkeybutter wrote:

I have witnessed similar myself and it seemed obvious at the time the injury was reduced by the helmet taking the brunt of it.

As you got older, you just got wiser, it happens to us all. :pac:

I have no doubt, from personal experience in some cases, that wearing a helmet has been of some benefit to some people in some crashes. I also have no doubt, again from some personal experience, that not wearing a helmet has not been detrimental to some people in some crashes. From the stuff I've read I believe that wearing a helmet can be detrimental to some people in some cases. Generalising any of those is, I believe, silly.

An individual using anecodotes and their own experiences to inform their own decision to wear or not to wear a helmet I see no issue with at all, the same individual trying to use anecdotes to brow beat others into wearing or not wearing a helmet I find distasteful. The "it's only common sense" argument falls into the latter category.

As for getting getting wiser as I get older, no, if anything I'm shedding brain cells at an alarming rate. I suspect my paranoia is keeping itself fueled by scooping up and eating those brain cells.

smacl

galwaycyclist wrote: »

Uh no it would still be supposition and a variation on this is part of the junk science that feeds into helmet promotion.

Yep, that's why i started with the statement saying 'this is supposition' and continued with something else that was also pointed out as being supposition, though the junk science in question is based on the Phillips report. The point of the post was that you yourself were also making supposition as to why a neurologist would advocate helmet usage;

When neurologists start getting into making claims on matters of injury prevention based on an apparently flawed understanding of material science then it is time to find other sources of advice.

Why would you suppose that the neurologist is basing their advice on their knowledge of material science? I would suppose that their opinion would come from treatment of those involved in cycling accidents, and observation of the severity of injury versus helmet usage. This supposition is supported by a similar previous debate here*


(* hey, if its good enough for the cyclehelmets.org people to be self referencing, its good enough for me!)

smacl

doozerie wrote: »

The debate around the benefits, or not, of helmets all too often gets lost in a shouting match, of which the loudest voices tend to be those arguing that helmets are essential to your health.

I'd say there are some loud voices on both sides, and wouldn't rush to take either on board at face value. The argument appears very polarised at this point, and IMHO, the actual value of helmets or not lies at some murky point in the middle. YMMV.

MrCreosote

smacl wrote: »

I would suppose that their opinion would come from treatment of those involved in cycling accidents, and observation of the severity of injury versus helmet usage.

That's the problem...they base their opinions on one very particular group of people-those who have a head injury from a cycling crash. A totally biased sample.

smacl

MrCreosote wrote: »

That's the problem...they base their opinions on one very particular group of people-those who have a head injury from a cycling crash. A totally biased sample.

How is a group of people who have a head injuries from cycling crashes an unreasonable indicator of the value of helmets in the event someone incurring a head injury as a result of a cycling crash? The scope of the point was whether helmets were of benefit in these narrow circumstances, as opposed to the broader question of whether this risk/benefit justifies their use.

dave_o_brien

smacl wrote: »

How is a group of people who have a head injuries from cycling crashes an unreasonable indicator of the value of helmets in the event someone incurring a head injury as a result of a cycling crash? The scope of the point was whether helmets were of benefit in these narrow circumstances, as opposed to the broader question of whether this risk/benefit justifies their use.

Firstly, by only analysing those with head injuries, it overlooks the frequency with which those injuries take place. As an argument, it's as useful as looking at those who suffered head injuries while (for example) using a ladder, and deciding that helmet use is necessary while using a ladder. As mentioned, any piece of safety equipment is likely to make any activity safer, but whether or not it makes it sensible to do so is a different matter.

Secondly, the neurologists are probably not in a position to comprehensively quantify how useful a helmet may have been. While emotively, it is appealing to say "a helmet would have been useful", that leaves many questions unanswered, such as:

How many cyclists presenting with acquired brain injuries (ABI) were already wearing a helmet?

What forces were sustained?

What is the helmet designed to cope with?

The cause of the trauma- was it the impact, the brain movement or the swelling?

Also, the remit of this thread, as pointed out by the mods, is to address all issues surrounding the helmet debate.

Mediaman summed up my attitude to it all pretty nicely:

MediaMan wrote: »

My own view on helmet wearing is
- I believe a helmet can mitigate injury in at least some scenarios
- I understand that they may not be much help in many situations
- The downside of wearing one is small
thus on balance I decide to wear one when I cycle.

I would be strenuously against compulsory helmet wearing though. We can make up our own minds.

The problem that I have with the highly emotive arguments pointing to hospital wards is that it is simply misunderstanding the limitations of a helmet. The forces needed in most circumstance for an ABI far exceed the limits of a helmets usefulness. It would be akin to scolding someone for not wearing gardening gloves who presented with missing fingers because they put their hand into their lawnmower blades.

Surveyor11

The cycling helmet debate seems to cause endless debate when raised here, with the "yays and nays" equally entrenched. It sounds like a debate that will go on as long as cycling is around.

I'm curious if this is common in other sports where head impacts at varying speeds are common? For example snow sports, rock climbing, water skiing, sailing? Is this debate just particular to cycling and maybe reflective of the type of people who cycle?