Few topics are more hotly debated among cyclists, and the general public, than bicycle helmet use. People on both sides of the issue feel passionately about their beliefs. One side maintains that wearing a helmet saves lives; the other side maintains that helmets are of no use and make no difference in terms of a cyclist’s injuries. The truth lies somewhere in the middle.
The extremity in the viewpoints is primarily caused by passion. Neither side is entirely rational. But, both sides make some valid points.
Helmets are of value. They do prevent injuries, and in some circumstances, they can prevent or mitigate injuries that can result in death. However, they cannot prevent all injuries, and they cannot prevent death from serious injuries affecting parts of the body other than the head.
A common argument made by the anti-helmet faction is that if a cyclist is hit by a car, the helmet won’t help. He or she will die from other injuries. This may or may not be true because circumstances differ dramatically in different accidents. Just getting hit by a car doesn’t mean that a cyclist will die. Some cyclists have been hit more than once, and depending on the circumstances, may or may not have been saved by their helmet.
More important than saving a life is mitigating injury. The number of lives saved by helmets is difficult to determine since there is no way to know what a cyclist’s injuries would have been without a helmet. It is easier to estimate the effectiveness of helmets with respect to mitigating injury.
Certain impacts to the head are known to result in severe brain injury. In this scenario, allowing the helmet to absorb some of the impact, when the head hits a hard surface, can reduce the severity of the injury. But, helmets are less effective for other injuries, such as concussions, which can be caused by the brain being jolted inside the head.
One often overlooked problem is the long-term impact of non-life threatening head injuries. Even minor injuries can cause symptoms for weeks or years. A head injury does not have to be lethal to be debilitating. This should be considered more carefully in helmet use discussions where a preoccupation with lethal head injuries overshadows the conversations.
Ultimately, the value of a helmet lies in its ability to protect the head, to some degree, during specific types of impacts. With this information, decisions about helmet use can be made.
When deciding whether to wear a helmet, one must assess risk. Cyclists must ask themselves: What is the risk of head injury without the helmet and how much risk of injury are they willing to take? Despite the strong opinions on both sides of the issue, what it boils down to is variable risk.
Some types of riding present more risk of injury than others. This may be why the anti-helmet use group is so adamantly opposed to helmet use, and particularly, laws mandating their use by all cyclists. Cycling in certain settings carries less risk of head injury than in others.
For example, riding on a bike path with little traffic poses a much lower risk of head injury than riding in city traffic. Often the path is less hilly and the speeds ridden are lower — at least for casual riders. While it’s not a bad idea to err on the side of caution, the risk of falling, let alone hitting one’s head, is quite low.
Urban riding poses a much greater risk due to the cyclist’s interaction with motor vehicles and pedestrians. Congestion, erratic driving, and unexpected behavior on the part of pedestrians all create hazards which could result in a fall. Further, the cyclist’s proximity to objects such as parked cars, poles, and curbs makes a fall more difficult to predict and control.
Controlling a fall has a lot to do with how likely cyclists are to hit their heads. When I was a ski racer, I learned to fall properly to avoid injury when crashing at high speeds. The trick to falling properly involves using limbs to protect the head, and letting the body move with the crash. Fighting the fall can cause more injury than going with it.
The same principles can be applied to falls from a bicycle, although the issue is complicated by the presence of obstacles in a cyclist’s path. Having a bicycle between a cyclist’s legs also affects how well the crash can be controlled. When crashing a bike, it’s common for the cyclist’s legs to get tangled up in the frame, making it more difficult to control a fall, and increasing the odds of slamming one’s head against the ground. This is where wearing a helmet can make a difference. Clearly, the risk of head injury is greater in this scenario, as is the potential benefit from wearing a helmet.
Other factors ought to be considered such as the lay of the road. Steep descents pose a greater risk than flat ground. And uneven roadways pose a greater risk than smooth, well-paved roads.
Even when riding in traffic, the driving culture can influence risk. In places like the Netherlands, where the roads are flat, and bicycling is commonplace, the risk of falling off of a bike and hitting one’s head is much lower than when riding in countries with aggressive drivers and steep hills.
Aside from riding conditions, a cyclist’s riding ability should be taken into consideration. A novice cyclist has a greater chance of falling than an experienced cyclist. And an athletic cyclist has a better chance of controlling a fall, to avoid injury, than a non-athletic cyclist.
After weighing the probability of falling and striking one’s head, it is necessary to consider how much risk the cyclist is willing to take. Some cyclists want to protect their head in all circumstances. This is the “better safe than sorry” approach. Other cyclists have confidence in their ability to protect their heads from injury in a crash and prefer to leave it up to fate to determine what will happen to them should they be struck by a car.
Therefore, the the decision to wear a helmet comes down to risk assessment and the probability of a head injury in different scenarios.
My own view is that helmets should always be worn for urban riding, high speed riding and steep descents. Although I always wear a helmet when I ride, I believe that there are circumstances where the risk of serious head injury is so low that choosing to forego a helmet is a reasonable choice.
As more states turn to mandatory helmet laws — in an attempt to prevent injury — cyclists will lose the ability to make decisions about helmet use. But in the meantime, all cyclists should think carefully about how much of an impact symptoms from a head injury will have on their lives. And, with this knowledge, each cyclist must consider whether enduring such symptoms is worth the risk of riding without a helmet.