Are head injuries something you worry about when cycling?

[Mick F]

This is something that confuses me.

I wonder that the A+E people on here are cyclists, and that's why they're on here?
Maybe other A+E people who are not cyclists, don't frequent cycling forums, but they have probably have something else to say.

Not taking sides here.
Just making an observation that this is a cycling forum and not an A+E forum.

[irc]

Why is it that everyone who works in A&E always works in that magic and special department that never seems to see all the other head injuries, just the cyclists?

I don't think anyone who works in an A+E Dept will see enough cyclist fatalities to form any opinion. Take Scotland for example. In 2016 there were 8 cyclist fatalities. Of course some will have been pronounced dead at the scene. So maybe 5 or 6 reach hospital before dying.

Those 5 or 6 are spread over at least a dozen main A+E Depts. So 1 every 2 years on avaerage. Assuming 4 shifts to provide 24 hr cover the average staff member in an A+E dept would see a cyclist fatality every 8 years. Not much more than anecdotal.

Looking at it from another angle I worked patrol in the police for 20+ years. I saw numerous head injuries. Only 1 cyclist though. The rest were (in no particular order) motor vehicle occupants, pedestrians hit by motor vehicles, assaults, and falls.

Funnily enough nobody suggested helmets as a solution for all the head injuries I saw.

[Harptree]

I'm a newbie cyclist so perhaps not the best person to comment. But I'm a horse rider and I can tell you there is no way I'm getting on one of them, or a cycle, without a riding hat/ helmet. I certainly worry about my head - I've only got one and I'm rather attached to it.

Some years ago I was exercising a horse, walking quietly along the road and suddenly, for no reason at all as far as I can tell, she just stumbled and fell over sideways - like she put her offside front leg down awkwardly and went down - just toppled over to the right, into the carriageway. Obviously, I went with her, sideways, and the side of my head hit and bounced off the tarmac, once, like a basketball - inside my hat/ helmet.

I managed to get back up, get the horse up, get back on and we both carried on, me feeling a bit vomity and shaky/wobbly but not too bad and got home. Without the hat on, that would not have been happening. There was no amount of carefulness or skill that would have avoided that accident - it just happened, out of the blue, one of those things, maybe a stone, oily tarmac, bit of cramp, joint going a funny way - who knows.

I've already fallen over sideways on my bike for no especial reason other than clumsy daftness and anticipate perhaps some more of that if I venture towards clipping my feet to pedals. I've seen others do it too when I've been out on beginners' rides, in fact it seems pretty common to me. Once, one of the ride leaders did it riding across some slimy cobbles on a towpath. Bike completely out from under him, sideways, whoosh.

For the sake of just putting a helmet on - well, why wouldn't you? How can it hurt? Why is it controversial? My husband - who would no more entertain the idea of sitting on a horse or cycle than he would on an active volcano - said pretty starkly to me some years ago that being as he's the person who's likely to have to look after me for life if I end up brain injured doing these things, his strong preference was that I show him the courtesy and consideration of wearing a helmet, please. What could I say except, ' Fair enough' ?

[irc]

For the sake of just putting a helmet on - well, why wouldn't you? How can it hurt? Why is it controversial?

No downside? Hot and uncomfortable for me. Not justified by the risks for me. Do you wear one when walking then? More dangerous than cycling on a per mile basis - see road.cc link below.

Not sure horse riding is the best comparison. To me (a non horse rider) the potential risks involved both in frequency of falls and injury potential due to height of falls looks much greater. Confirmed by stats IMO in 2011 there was 8 deaths in the UK from horse riding on the roads. Which compares with just over 100 cyclist deaths. Horse riders are a tiny fraction of cyclist numbers. I'd be strapping on full protection before going near a horse.

http://www.medequestrian.co.uk/rider-sa ... anagement/

In the above link it quotes an estimate that horse riding is around 20 times more dangerous than motorcycling. Motorcycling is 3 times more dangerous than cycling on a per mile basis. So horse riding 60 times more dangerous than cycling? Maybe if your husband wants to do your risk assessments for you he would get you to stop horse riding?

https://road.cc/content/news/68212-dft- ... cling-risk

[Vorpal]

For the sake of just putting a helmet on - well, why wouldn't you? How can it hurt? Why is it controversial? My husband - who would no more entertain the idea of sitting on a horse or cycle than he would on an active volcano - said pretty starkly to me some years ago that being as he's the person who's likely to have to look after me for life if I end up brain injured doing these things, his strong preference was that I show him the courtesy and consideration of wearing a helmet, please. What could I say except, ' Fair enough' ?

I learned to ride horses in the US, western style, when no one I ever saw wore helmets. I was thrown a couple of times. Once, I ened up with a wallet-shaped bruise on my hip that hurt for 3 weeks. But I never hit my head. Maybe there's some justification for promoting helmets for horse riding. People fall further from horses, and may be somewhat more likely to hit their heads. Aslo, horses kick.

As for why wouldn't you (on a bike)... Well, this subforum is full of lengthy discussions about just that. But to my mind, the biggest reason is that it makes cycling look like a dangerous activity. Something that, includes risk greater than walking, driving, playing football, or numerous other things that people do without helmets. People feel that it's a good idea because of vulnerability, but that doesn't necessarily translate to risk.The chances of a helmet making any difference in a crash are tiny; miniscule, even. And many cyclists just don't feel that the potential benefits is worth the trouble.

There maybe somewhat higher potential benefit for new or returning cyclists, youth, or people who crash alot. I'm not sure about that. What I am sure about is that there are no statistics that demonstrate a benefit at a population level. In other words, while there is likely some benefit to the user in specific incidents, helmets do not demonstrably make cyclists safer.

[pjclinch]

I always wear an helmet, modern ones let your head breathe well and I don’t overheat in them.

Do I worry about head injuries?

Not really, and I’ve worked in A&E and still work in hospitals. I have seen deaths from head injuries sustained in cycling, these have usually been non helmet wearing low speed accidents. In fact the most recent death I saw was a patient who had fallen off before actually moving off.

I’d be more concerned at a helmet minimising an impact enough for me to survive but not protect me from major head injury. I’d rather not survive such an incident.

I’ve seen massive damage to helmets after higher speed crashes and have been very impressed by the performance of the helmets involved. These patients have tended to have other major injuries just as likely to kill them. Most of the deaths I’ve known have been due to multiple injuries sustained by contact with other vehicles.

Why is it that everyone who works in A&E always works in that magic and special department that never seems to see all the other head injuries, just the cyclists?

Unless they work in A&E in NL, when the cycling ones don't seem to be bother them nearly as much as they do here...

(Everybody, can we say, "confirmation bias"?)

[Harptree]

I agree that there are many injuries that a helmet isn't going to protect you from, and very major head impacts can overcome what protection it offers.

But it does offer some significant protections and I want them. There have been quite a few occasions in my lifetime of horse riding of meeting the ground from horse. Looking at the dings, scuffs and cover rips on the riding hats afterwards - I was pretty glad I'd had them on.

[mjr]

I agree that there are many injuries that a helmet isn't going to protect you from, and very major head impacts can overcome what protection it offers.

But it does offer some significant protections and I want them.

But are they worth the significant drawbacks which seem to cancel them out, for cycling helmets at least, resulting in no significant net benefit?

There have been quite a few occasions in my lifetime of horse riding of meeting the ground from horse. Looking at the dings, scuffs and cover rips on the riding hats afterwards - I was pretty glad I'd had them on.

Firstly, horse-riding helmets seem entirely more solid and substantial than current cycling helmets (which are actually less strictly tested than when I started using them, shockingly). Secondly, a horse rider is far higher up than a cyclist. Thirdly, as pointed out above, horse riders still have a far higher casualty rate. And finally, looking at hit helmets is a very poor way to assess their efficacy - especially cycling helmets seem to have a remarkable ability to destroy themselves in impacts where a bare head wouldn't even have touched the ground - it would be better to look at the average differences between helmetted and unhelmetted riders in similar situations, but even that isn't brilliant.

[softlips]

I always wear an helmet, modern ones let your head breathe well and I don’t overheat in them.

Do I worry about head injuries?

Not really, and I’ve worked in A&E and still work in hospitals. I have seen deaths from head injuries sustained in cycling, these have usually been non helmet wearing low speed accidents. In fact the most recent death I saw was a patient who had fallen off before actually moving off.

I’d be more concerned at a helmet minimising an impact enough for me to survive but not protect me from major head injury. I’d rather not survive such an incident.

I’ve seen massive damage to helmets after higher speed crashes and have been very impressed by the performance of the helmets involved. These patients have tended to have other major injuries just as likely to kill them. Most of the deaths I’ve known have been due to multiple injuries sustained by contact with other vehicles.

Why is it that everyone who works in A&E always works in that magic and special department that never seems to see all the other head injuries, just the cyclists?

The hospital I worked in A&E in was a specialist neurological and spinal unit so I saw loads, also saw people who’d gone through windscreens who would have been saved by seat belts while on the other side saw one young lady who was killed by her seatbelt. On the latter should we stop wearing seat belts? Should we remove airbags too? In the vast majority of accidents they don’t offer any benefit.

[Cunobelin]

Thank you, this is my point

I have spent some 45 years in the medical profession and I personally find it irritating when you get posts along the line of “I see lots of cyclists” when I know from my experience they are far from the majority, something supported by cohort studies

One must also question any professional who denies this simple fact

Then there are the ones who ask “were you wearing a helmet” and castigate a cyclist for not doing so, yet would not dream of doing so for an identical injury
In a pedestriane

I despair at the unprofessionalsm, and non evidence based practice of some of my peers

[NATURAL ANKLING]

Hi,

It might you but me never.

If that's the case then without a helmet you ease off.....why?

In the studies about helmets and risk compensation, people who don't usually wear helmets, don't change their behaviour when they do wear helmets.

It's only the people who habitually wear helmets who change their behaviour. They tend to go slower when they don't wear helmets.

That's possible and you might be right, I don't know and I have not read that (you will probably post the info )

Its all very well to say that after the fact like in the papers etc, "If you had been wearing a helmet" or " a helmet wouldn't of helped"
But of course we still can't predict when we have our next collision or what type on injurie you might have even at home in the kitchen.
I have done many things many silly things and mostly on my own, its easy for me to say now I should or shouldn't have done that, and I have paid for my reckless behaviour, but it remains that we still can't reliably pick our next body collision on or off the bike.
So I wear a helmet for my own reasons and don't think that it will save my live where collisions with vehicles are concerned, but more when I self inflict, but still not a high certainty for sure.
To me you either do or don't, there is no in between reason why one day you do and another you don't that you could quantify that holds water I.M.O.

I actually fear in certain circumstances more driving a car than two wheels, probably partly because a car is bigger and you can't get off like two wheels.

[Vorpal]

Hi,

It might you but me never.

If that's the case then without a helmet you ease off.....why?

In the studies about helmets and risk compensation, people who don't usually wear helmets, don't change their behaviour when they do wear helmets.

It's only the people who habitually wear helmets who change their behaviour. They tend to go slower when they don't wear helmets.

That's possible and you might be right, I don't know and I have not read that (you will probably post the info )

https://www.ncbi.nlm.nih.gov/pubmed/21418079 although another study found slightly different results http://www.cyclehelmets.org/1207.html?NKey=89

To me you either do or don't, there is no in between reason why one day you do and another you don't that you could quantify that holds water I.M.O.

When I wear one these days, it is because I am cycling in an event that requires them.

[The utility cyclist]

I'm a newbie cyclist so perhaps not the best person to comment. But I'm a horse rider and I can tell you there is no way I'm getting on one of them, or a cycle, without a riding hat/ helmet. I certainly worry about my head - I've only got one and I'm rather attached to it.

Some years ago I was exercising a horse, walking quietly along the road and suddenly, for no reason at all as far as I can tell, she just stumbled and fell over sideways - like she put her offside front leg down awkwardly and went down - just toppled over to the right, into the carriageway. Obviously, I went with her, sideways, and the side of my head hit and bounced off the tarmac, once, like a basketball - inside my hat/ helmet.

I managed to get back up, get the horse up, get back on and we both carried on, me feeling a bit vomity and shaky/wobbly but not too bad and got home. Without the hat on, that would not have been happening. There was no amount of carefulness or skill that would have avoided that accident - it just happened, out of the blue, one of those things, maybe a stone, oily tarmac, bit of cramp, joint going a funny way - who knows.

I've already fallen over sideways on my bike for no especial reason other than clumsy daftness and anticipate perhaps some more of that if I venture towards clipping my feet to pedals. I've seen others do it too when I've been out on beginners' rides, in fact it seems pretty common to me. Once, one of the ride leaders did it riding across some slimy cobbles on a towpath. Bike completely out from under him, sideways, whoosh.

For the sake of just putting a helmet on - well, why wouldn't you? How can it hurt? Why is it controversial? My husband - who would no more entertain the idea of sitting on a horse or cycle than he would on an active volcano - said pretty starkly to me some years ago that being as he's the person who's likely to have to look after me for life if I end up brain injured doing these things, his strong preference was that I show him the courtesy and consideration of wearing a helmet, please. What could I say except, ' Fair enough' ?

Do you know the head injury stats for unhelmetted vs helmeted riders on equines?
You need to wear a motorcycle helmet for horse riding if you want to protect your brain from a serious TBI, none of the current modern helmets including the newer MIPS style prevent serious TBI in any meaningful way. A fall from a stationary horse where you would hit your head would give you forces far in excess of the testing spec for a cycle or equine helmet for absorption IF falling on the top part of your head, that absorption does not occur if a helmet splits.
2015 William Fox-Pitt, serious brain trauma and was in a coma, he was wearing a helmet and wasn't struck by his horse, I could repeat that ad nauseam.

If helmets are so brilliant at preventing head injuries why aren't they compulsory at all times with fines handed out for non wearers, the cost to hospitals and tax payers is enormous, greater than that from cyclists. Yet not one country in the world has compulsory helmet wearing for riding equines but it's apparently more dangerous than motorcycle riding per hour .5 injuries per 1000 hours is reported
And yet the equestrian world comes out with the helmets will prevent 80% of all head injuries which like the claims for cycling head injuries is utter nonsense.
Even the top person at Folksam, those people who test equestrian helmets agree. In fact even the best MIPS helmet is only 30% better than the average 'poor' helmet, not really conclusive in terms of protection aginst TBI when the poor helmets are utterly useless.

[Cyril Haearn]

Could one ride a smaller horse, a recumbent?
Are invisible h*****s available?

[JimL]

Thank you, this is my point

I have spent some 45 years in the medical profession and I personally find it irritating when you get posts along the line of “I see lots of cyclists” when I know from my experience they are far from the majority, something supported by cohort studies

One must also question any professional who denies this simple fact

Then there are the ones who ask “were you wearing a helmet” and castigate a cyclist for not doing so, yet would not dream of doing so for an identical injury
In a pedestriane

I despair at the unprofessionalsm, and non evidence based practice of some of my peers

This is very noticable in the TV program 24 hours in A&E .When a cyclist is the subject a big deal is made of whether or not a helmet was worn but when someone falls of a roof or a pedestrian is knocked down no mention of helmets.

Are the really going to assess or treat a cyclist differently depending on whether or not a helmet was worn ?