Can we make bicycle helmets that work for children?

By Jonathan Krall

As misleading helmet-promoting “research” continues to appear, and to be promptly debunked[1], the possibility that helmets may yet have some benefit for our most vulnerable population, children, seems to be going  unexplored.

2014 was a rough year for the bicycle helmet industry. The failure of helmets to produce a significant “net protective effect”[2], a result once confined to science journals, repeatedly found its way into the mainstream media. Bicycling Magazine reported that helmets do not reduce concussions[3]. The Washington Post reported that the National Highway Traffic Safety Administration was forced to reverse claims of efficacy because of the Data Quality Act, a law that requires federal officials to avoid claims based on debunked science[4].

In recent years, researchers have generally failed to find convincing proof of helmet efficacy. According to the book City Cycling, “The dramatic difference in injuries between helmeted and bareheaded cyclists reported in the earliest studies has not been seen in population level research.”

City Cycling is a collection of research summaries written for the lay public and co-edited by Ralph Buehler of Virgina Tech. City Cycling goes on to describe studies of jurisdictions where a helmet law suddenly increased helmet use among the general population as well as studies of helmeted versus bareheaded cyclists. In the former, no effect is found. In the latter, bareheaded cyclists suffer not only more head injures, but  more injuries of all types. Further, “intoxicated cyclist rarely wear helmets.” In other words, risk-takers tend to both forgo helmets and get injured.

Other key findings come from Rune Elvik of the Institute of Transport Economics, who showed that helmets are correlated with an increase in neck injuries[2], which can be lethal, and from researcher W. J. Curnow, who showed that current helmets do not protect users from the violent rotational motions that cause concussions[5].

While bicycle helmets are clearly not a magic bullet, there is a vulnerable population that may yet benefit from them. Children may be more vulnerable to head injuries than adults. According to the Center for Disease Control, little is known. According to the CDC[6], “The difficulty of measuring the effects of the injury in the context of naturally occurring developmental changes contributes to the challenge of assessing outcomes of [traumatic brain injury] in young people.” By focusing on this more-vulnerable population, helmet research may yet deliver on promises of public safety.

In one troubling example, researchers seem to be promoting helmets, even to the point of misleading the public. In this case[1], Washington State University researcher Janessa Graves compared bicycling injuries before and after various cities, including Washington, DC, implemented bikeshare systems.

Based on past research, one can guess the results. Bikeshare systems encourage more people to ride, so injuries of all types are likely to decrease, a well-known effect[7] called “safety in numbers.” Bikeshare users tend not to carry helmets everywhere they go, so helmet use tends to be lower, another well-known result. With fewer helmets, head-injury percentages increase while the neck-injury percentages decrease[2], even as both types of injuries decrease in number. In fact, this is exactly what was found. Sadly, and misleadingly, the researchers focused only on the “bad news” head-injury percentage in their summary and in their press releases. The good news, that injuries generally decreased, was not emphasized at all. If science can predict climate change and give us smart phones, it can do better with public safety.

As it stands, helmet design emphasizes comfort and style while ignoring science, a point discussed at length by Curnow. At the very least, we should follow Curnow's recommendations to a) reduce head and neck injuries by designing helmets that do not grip the road during a crash and b) to abandon helmet mandates that discourage cycling. At best, we should be supporting effective, fact-based science to protect our most vulnerable citizens.

[1] http://www.citylab.com/commute/2014/06/head-injuries-didnt-rise-in-bike-share-cities-they-actually-fell/372811/

[2] http://www.sciencedirect.com/science/article/pii/S0001457512004253

[3] http://gearfinder.bicycling.com/senseless/index.html

[4] http://www.washingtonpost.com/national/health-science/do-bike-helmet-laws-really-save-people/2013/06/03/6a6532b4-c6df-11e2-9245-773c0123c027_story.html

[5] http://www.cyclehelmets.org/papers/p787.pdf

[6] http://www.cdc.gov/traumaticbraininjury/assessing_outcomes_in_children.html

[7] http://grist.org/article/2010-10-11-theres-safety-in-numbers-for-cyclists/

Comments

[timo]

I fell on my head (and shoulder, and hip, and ribs, and elbow) 2 weeks ago. Ribs are cracked, shoulder separated, still can't touch my elbow without pain... but... I think I'd be dead if I weren't wearing a helmet. I don't care what the data says.

[ACyclistInThePortCity]

death from having your head cracked open is different from the much more common, but less severe, concussion. Concussions are not (IIUC) necessarily from direct contact of the head with the ground, but from the head being suddenly jarred, which can happen while wearing a helmet. The belief that helmets protect against all head injuries may be unfortunately masking the subset of head injuries where helmets do help. Whether that subset outweighs the negative impact on neck injuries I am not certain, but I continue to wear a helmet when I ride. But I think it is clear the marginal benefit is not worth the negative impact of mandatory helmet laws, and may not be worth the negative impact of the over focus on helmets in safety campaigns.

[Jonathan Krall]

This article is a crosspost, with permission, from Alexandria News. Thanks go out to Mr. Washcycle for posting it. http://www.alexandrianews.org/can-we-make-bicycle-helmets-that-work-for-children/

Personally, the only time I ever hit my head in a crash, my head hit the inside of a helmet. I have no way of knowing if my head would have hit anything if I hadn't been wearing a helmet, since the helmet makes my head effectively bigger and increases the chance of my head hitting something.

In personal conversations, I continue to stress that helmet use is a personal decision. While helmets are of questionable value, study after study shows that bicycling is, on average, extremely healthy. My feeling is that people should wear whatever makes them most likely to ride a bicycle.

I also feel that people who ride should stop pressuring each other to wear helmets. People who ride bicycles get enough negative messages already, either directly (get off the road/sidewalk!) or indirectly, often in the form of bike lanes to nowhere or bike parking that either doesn't exist or doesn't work.

[Brett Young]

@Jonathan
Goto Amazon and read the reviews on Bicycle helmets. Many people say the helmets prevented bad accidents from getting worse.
I never worse helmets as a kid. But as an adult, I figure I ride about 18 mph and a $20 helmet might prevent a terrible accident.

[Jonathan Krall]

For some reason, many people say "I fell and got a concussion while wearing a helmet; it would have been much worse without the helmet" instead of "I fell and got a concussion while wearing a helmet; my POS helmet couldn't even prevent a concussion." Each statement contains the same actual information (fell, helmet on, concussion). Neither has enough information to draw a useful conclusion.

I prefer to rely on the scientific literature because science works. Without it, you wouldn't be able to read what I am writing here. A host of science results are embodied in your web-browsing hardware and they work so reliably that you are likely to be pissed off if that hardware doesn't work every time.

Long story short, I was pretty religious about wearing a helmet until I educated myself and changed my conclusion. Then again, as a cycling advocate, I am motivated to move beyond helmets and to look to modern infrastructure for safety.

[E'beth]

Perhaps we need to rethink the purpose of helmets. Football players get concussions while wearing helmets. That doesn't stop them from wearing helmets. Maybe the bike helmet keeps us from getting banged in the head, and scraping up our head and face, or protects our head in case our bike falls on our head in a crash. Wear helmets, please.

[Crickey7]

I don't really want to get into the helmet debate, other than to note that the state of current helmet design is poor. Part of the issue revolves around the fact that this creates a sense of greater protection than they actually confer.

[CyclistPedestrianMotorist]

"Football players get concussions while wearing helmets. That doesn't stop them from wearing helmets."

That's because the purpose of football is to crush your opponent with as much force as possible albeit in a framework of rules. When cycling becomes a contact sport, we can consider the comparison valid. Until then, it's apples and oranges comparing American football and bicycling.

[duh]

"For some reason, many people say "I fell and got a concussion while wearing a helmet; it would have been much worse without the helmet" instead of "I fell and got a concussion while wearing a helmet; my POS helmet couldn't even prevent a concussion." "

Well, yeah, because nobody said a helmet will keep your head perfectly safe, just safer than without it.

[duh]

"the purpose of football is to crush your opponent with as much force as possible albeit in a framework of rules. When cycling becomes a contact sport, we can consider the comparison valid."

The comparison is perfectly valid. When you fall and hit your head, it's contact, even if it wasn't the purpose of cycling.

[CyclistPedestrianMotorist]

"The comparison is perfectly valid. When you fall and hit your head, it's contact, even if it wasn't the purpose of cycling."

You are comparing two completely different situations. In football, you get hit. It is the nature of the activity.

Falling is not the nature of the activity when cycling. It is an anomalous occurrence, not an inescapable part of the activity itself.

So in essence, discussing falling in cycling means talking about a hypothetical scenario whereas in football, contact is part of the game.

Based on the logic being employed here, we should be calling for people to wear helmets all the time, when walking, driving, cycling, and perhaps even on buses and trains just in case something happens.

The comparison does not stand.