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Neurosurgeon argues for wearing them... trauma specialist (who chairs CTC Scotland) opposes compulsion

Two surgeons in Edinburgh, both of whom ride bikes regularly and both experienced in treating injured cyclists have crossed scalpels over the issue of whether cycle helmets improve riders’ safety.

Lynn Myles, a consultant neurosurgeon at the Western General Hospital in the Scottish capital, described as a “keen cyclist” believes they do.

Taking the opposing view is Chris Oliver, consultant trauma orthopaedic surgeon at Edinburgh Royal Infirmary, who also happens to be chair of cyclists’ organisation CTC Scotland.

The issue is debated by them on Surgeons’ News, the website of the Royal College of Surgeons of Edinburgh, which has some 20,000 fellows and members throughout the world.

Ms Myles begins by acknowledging that she is “under no illusion that it [a helmet] will save me in the event of a high speed collision with a car or lorry (nothing will)” – a common criticism aimed at those who insist all cyclists should wear one – but adds that “most cycling accidents aren’t of the high-speed variety.”

Instead, after outlining other things that can be done to improve cycle safety such as addressing traffic speed and improving road layout, she says: “Most of the head injuries I have seen in cyclists are the result of low velocity crashes or simple falls due to ice or wet roads.

“There is no doubt in my mind that a well-fitting cycle helmet will reduce the incidence of scalp laceration and open fracture and will help to reduce the energy transfer to the brain.”

Apart from in sports, where she believes the type of potential injuries justifies governing bodies making helmets mandatory, Ms Myles isn’t calling for helmets to be made compulsory; she does point out though, that “in my department all neurosurgeons, neurologists neurointensivists and neuroanaesthetists wear cycling helmets when cycling – we can’t all be mad!”

Mr Oliver, however, maintains that “there is no justification for helmet laws or promotional campaigns that portray cycling as a particularly ‘dangerous’ activity, or that make unfounded claims about the effectiveness of helmets.

“By reducing cycle use even slightly, helmet laws or promotion campaigns are likely to cause a significant net disbenefit to public health, regardless of the effectiveness or otherwise of helmets,” he adds.

Like Ms Myles, he points out that helmets “are (and can only be) designed to withstand minor knocks and falls, not serious traffic collisions,” and says there is evidence that wearing one can increase certain types of injury.

Mr Oliver acknowledges that “whilst there is a correlation between helmet guidelines and reduced cyclists’ injury numbers, the evidence suggests this is wholly or mainly due to reductions in cycle use, not improvements in safety for the cyclists who remain.”

He goes on to highlight that a fall in the number of cyclists can put remaining ones at greater risk due to the absence of a safety in numbers effect, and outlines other arguments against compulsion.

He also warns against what can be termed compulsion creep, saying that “schools, employers and the organisers of non-sporting cycling events (e.g. sponsored rides) should not seek to impose helmet rules for their pupils, staff and participants.

“These rules are not justified in terms of health and safety, they are likely to reduce the numbers and diversity of people who take part in cycling, and they may in some circumstances be illegal.”

Mr Oliver believes that “individuals should be free to make their own decisions about whether or not to wear helmets, with parents making these decisions in the case of younger children. Their decisions should be informed by clear information about the uncertainties over helmets.”

As we regularly see here on road.cc, the helmet debate is an emotive one and it’s an issue that strongly polarises opinion; the fact that two senior medical professionals working in the same city and dealing with the aftermath of incidents in which cyclists have been seriously injured have such differing opinions on the subject is a reflection of that.

Born in Scotland, Simon moved to London aged seven and now lives in the Oxfordshire Cotswolds with his miniature schnauzer, Elodie. He fell in love with cycling one Saturday morning in 1994 while living in Italy when Milan-San Remo went past his front door. A daily cycle commuter in London back before riding to work started to boom, he's been news editor at road.cc since 2009. Handily for work, he speaks French and Italian. He doesn't get to ride his Colnago as often as he'd like, and freely admits he's much more adept at cooking than fettling with bikes.

85 comments

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Gkam84 [9068 posts] 2 years ago
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Looks like they may need helmets on if they are going to bashing heads over the subject  19

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mr-andrew [300 posts] 2 years ago
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I fail to see why this is such a contentious issue. I would never advocate making it law, but common sense and personal experience say that they can't be all bad. There are times when you simply come off, no traffic involved. Surely having a bit of extra padding round the head can't hurt?

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FatFreddie [19 posts] 2 years ago
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mr-andrew wrote:

Surely having a bit of extra padding round the head can't hurt?

Depends whether that extra padding catches on something and twists your head off really  3

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mad_scot_rider [581 posts] 2 years ago
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mr-andrew wrote:

I fail to see why this is such a contentious issue. I would never advocate making it law

Great - so where's the debate?

You are happy for personal choice to be maintained

The problem is that not everyone takes that line and many organisations have called for compulsio

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Carvers [36 posts] 2 years ago
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I fell on a snowy commute last year which left a large fracture and a puncture in my helmet from some debris on the road. That impact would otherwise have been directly taken by my skull. There were no rotational-force or whiplash-type injuries at all, just a broken collar-bone and grazes.

I will personally never understand the argument against helmet wearing, it's counter-intuitive for commuting at the very least.

I still don't get the helmet-snagging argument either, are there really any cases where that aspect would override the impact-absorption benfits that a helmet provides?

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ir_bandito [58 posts] 2 years ago
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I'm pro-helmet, but against compulsion. It should be common sense.

How about a simple warning, like with cigarette packets:

"Banging your head into tarmac at 30mph can cause potentially fatal injuries. Wearing a helmet reduces that risk"

I'd really like to see in any news story about a cyclist being injured or killed, when head injuries are the main factor, whether or not they were wearing a helmet.

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Ramaye [25 posts] 2 years ago
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ir_bandito wrote:

I'm pro-helmet, but against compulsion. It should be common sense.

How about a simple warning, like with cigarette packets:

"Banging your head into tarmac at 30mph can cause potentially fatal injuries. Wearing a helmet reduces that risk"

I'd really like to see in any news story about a cyclist being injured or killed, when head injuries are the main factor, whether or not they were wearing a helmet.

How about "Banging your head into tarmac at 30mph can cause potentially fatal injuries. Cycle helmets will not fully protect you from these forces and in some situations can increase the risk of serious or fatal injury"

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Forester [111 posts] 2 years ago
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Does that ever happen? I feel helmet design needs to be improved, especially the straps. The only falls I have had have been very slow speed or stationary when getting used to cleats, and a helmet has undoubtedly helped. Other opinions are available, some more sensible than others.

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Paul J [836 posts] 2 years ago
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Mr Andrew:

Do you wear a helmet when you walk or run? After all, a bit of padding can only help should you fall.

A colleague of mine once got smacked on the head by the wing mirror of a bus pulling into a bus stop, as he was waiting near it. He got a pretty good concussion from it. A helmet might have reduced that.

Basically, if you have the "I can't see why people wouldn't wear them!" attitude, then why aren't you applying the same logic to other activities in your life? I really want to know.

Many cyclists, utility ones particularly, do not cycle faster than a person would when running, perhaps even jogging. My wife cycles at about 12 to 15 km/h generally, and might just hit 20 km/h. If you wouldn't wear a helmet jogging or walking, why should she wear one when cycling slowly?

I am fascinated by the bizarre, inconsistent attitude to risk & safety in this country. People get all concerned by the extremely tiny risks of KSI in cycling (in the main it has overwhelmingly positive effects), but are quite happy to completely ignore the very *certain* and deadly risks of lack of exercise.

Further, then rather than address the primary cause of KSI amongst cyclists and pedestrians (high energy motor traffic), the culture here instead is to place the onus on the victims, the vulnerable, to wear mostly ineffectual safety garments. Nothing is done about the real cause.

This twisted culture surely is a major factor in the UK being right up there in overweight and obesity rates (twice that of NL).

Mad.

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bikeandy61 [500 posts] 2 years ago
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I really can't see that they are debating. They both seem (IMO) to be saying the same thing.

I know it's semantics but I would argue that helmets/seat belts/air bags don't "improve safety" - they decrease the occurrence of serious injury.

That aside.

Lynn isn't advocating compulsion - fine.

Acknowledges that survival in "hi speed impacts" won't be greatly affected - fine.

She treats a lot of brain/head injuries from low speed or stationary cycle accidents. This is the bone of contention for me (there may well be others can't be bothered too get too wrapped up in this). Has she done an analyse of head surgery required by pedestrians who "fall". Low or stationary accidents in the home?

My overall problem with these debates is that when it appears that "experts" are taking the side of a given cause my fear is that reactionary groups/politicians see it as confirmation of their bias.

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Mr_eL_Bee [68 posts] 2 years ago
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While there are some injuries a helmet will not protect against, there are occasions when a smashed helmet is a better option than a smashed skull.
This was the result of a 38mph fall of a Club mate who hit a rock in the ground at impact, lost consciousness for around 3 minutes, and broke a number of bones in his back.

He was undoubtedly a lucky chap, suffering no neurological deficit (the outcome could have been much worse) but there is no doubt in my mind, or that of the paramedics and his trauma surgeon that the helmet ameliorated the effect of the impact and his subsequent injuries
//www.fetcheveryone.com/submitted_images/4996_61149.jpg)

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Thextos [8 posts] 2 years ago
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I love my helmet since moving to Australia. I keeps my head cool. Eyeballs safe from swooping crows. And see that wee plastic visor bit at the front, it actually has a purpose that only those who cycle in the sunshine will appreciate. Oh and i took my mudguards off too.  4

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denzzz28 [28 posts] 2 years ago
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oh dear...! these are those kind arguments that will never end.

do I believe they will protect me? my head, yes! but what about my neck or spinal column? what about chest injuries such as rib cage collapse. they are as fatal as head injuries but i cant see see my self wearing a full body armour like a downhill mountain biker going to work because thats just silly.

I dont believe helmets will increase a cyclist safety. however, im not saying dont wear them. all im saying is they only protect your head which is good, but thats the only part of your body it will protect.

I believe road infrastructures and cyclist/motorist attitudes will make a cyclist safe. most of the time a simple commonsense is all it takes to be safe. If cyclist and motorist lookout and care for each other, accidents will be much... much... less.

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Bill McLaren [7 posts] 2 years ago
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I started wearing a helmet 15+ years ago when my kids were learning to ride, easiest way to get them to do it all the time was if they saw me do it, now I feel odd riding without one. In one instance wearing a helmet has saved me from head injury, my shoulder and the helmet took the damage.

I believe I am in the majority in saying I'd encourage riders to wear one (as a Skyride leader I do just that) but I'm against compulsion (although Skyride has a compulsory policy for riders under 16). Anything that puts people off getting on a bike is bad news, better to get them on the bike then try to convince them a helmet is a good idea too.

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Paul J [836 posts] 2 years ago
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Mr el bee: Perhaps a better lesson to take from your club-mates fall would be "go more slowly". I'd rather fall at low-speed without a helmet, than at high-speed with one.

Helmet can't protect the rest of your body. Injuries to which can be as traumatic as any head injury. Helmet's can't protect your head that much.

The flimsy vented road style ones are especially bad. And anyone here who says "I don't understand people who don't wear helmets", I hope you wear a good Snell certified hard-shell helmet, rather than a flimsy road style one with just EN1078 certification!

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Paul J [836 posts] 2 years ago
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Oh, and let's go through all the logical fallacies:

"Well, why wouldn't you wear a helmet?": Fallacious, because there are many equally risky activities where the same people saying this do not wear them.

"Wearing a helmet can't hurt": Fallacious, helmets increase certain injuries. Further, ignoring the specifics of injuries, there is reason to think that where helmets are viewed as necessary for cycling (legally or culturally) this depresses cycling rates. As cycling is overwhelmingly *good* for people and their long-term health, then those people who have been put-off by helmets have been *harmed*.

"I fell off and my helmet was cracked, it must have saved my life!". Fallacious, it only means your helmet cracked. Indeed, that's a sign your helmet *failed* - helmets absorb energy by crushing, not by cracking. To actually know whether or not it saved your life, you'd have to rerun the accident exactly - which is impossible. Indeed, there is a possibility you actually were injured *more* than otherwise.

Are helmets bad? No. Should you never wear them? No, there may well be times when it might be a good idea (e.g. cycling fast, competitive cycling, cycling on rocky terrain - I'm just guessing). However, equally so, there are times when you may not need them (e.g. utility cycling). Further, there is *definitely* a strong correlation between high rates of helmet use and *low* rates of cycling. It may well be that helmet culture is *BAD FOR CYCLING* generally, which may be bad for people's long-term health!

It may even be that helmets and the warped road-safety culture here are costing the UK a *lot* more money in healthcare for obesity related diseases than are saved in head injuries. Computer model studies suggest so at least!

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londonplayer [620 posts] 2 years ago
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Always wear a helmet. If a motorist gets out of his car and punches you, it will offer protection.

http://www.youtube.com/watch?v=RG-cLftQ9Xw

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Leviathan [1778 posts] 2 years ago
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Commuting/Training/Racing: Helmet
tootling to the shops: no helmet

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pjclinch [85 posts] 2 years ago
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There are times when you simply trip and fall (the largest cause of head injuries). Surely having a bit of extra padding round the head can't hurt?

Cycling is not particularly productive of head injuries. This is understood in NL where the cycling levels are high and though the Dutch sometimes simply come off, no traffic involved, they still hacve the lowest head injury rates going.

It is only because we have got in to the habit of thinking cycling is especially dangerous in the UK (wrongly believing that we're far more at risk than pedestrians, who aren't known for crash-helmet wearing) that we have become preoccupied with helmets.

Wear one if you want. But be aware you're around as likely to suffer a nasty head injury popping down to the shops for a pint of milk ansd a paper on your feet as on your bike.

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drfabulous0 [409 posts] 2 years ago
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Everyone should wear a helmet when cycling, otherwise where would one put ones shades when not wearing them?
I guess this must be why Chris Oliver is wearing a lid in every picture of him with a bike on the web, despite the views he has published.

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bbbaird [7 posts] 2 years ago
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I believe it is wise to wear a helmet and if you don't want to: don't. I have suffered from a few concussions and all but one was cycling related. Even the one I did suffer from cycling was related to hitting a pot hole so having a helmet wouldn't matter.

If a helmet can do anything to minimise the force to the brain then all the better. Head injuries are serious, no matter how small.

I am not disillusioned by the protection. For me it is peace of mind as on a few occasions when I jump on the Brompton with my helmet I feel "naked" and subconscious about not having it.

Insurance companies will/may also try to minimise payments as you will be deemed partially responsible for you injuries should you not be wearing a helmet.

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Carvers [36 posts] 2 years ago
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I still say (in the main) just wear one, it's common sense, fast or slow. Comparing the risks to running etc is a pointless exercise, apples and pears in terms of control and dynamics.

Still waiting for any actual facts around this "wearing a helmet can cause certain injuries" argument....where are the examples or stats around this? If there are none, or if there are examples that are just freak accidents, then it's not even worth raising as an issue surely?

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notfastenough [3661 posts] 2 years ago
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Ooh, this thread hasn't been done before.

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dullard [140 posts] 2 years ago
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@PaulJ - excellent post.

I actually take the opposite view on the speed issue to the 'experts' in the story (and just because they're neuro this and trauma that doesn't mean they know everything - I've undergone a couple of brain scans recently for something unrelated to a cycling injury and the consultant neuro man I saw was definitely a nutter, so I suspect it goes with the territory). I fell off on a small patch of gravel on a corner on a Pyrenees descent and hit my head; probably 20-25 mph. My helmet deformed (missus) and stopped bad injury to my head. Higher speed = less reaction space and time. Low-speed riding into work, don't wear one. Eyes and ears are extremely efficient safety devices I find in such circumstances.

@Carvers - yes, there are instances where rotational pull from impacts has caused neck injuries.

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BBB [295 posts] 2 years ago
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The only reason why those pointless public debates about helmet wear, reflective gear, "road tax" etc. take place at all is that cyclists are a tiny minority (of voters) that can be bullied and patronised by "normal" people and politicians.

If anyone fancies saving many more lives then why concentrating on cyclists in particular?
Even with seatbelts many more lives would be saved if drivers and passengers of all vehicles were wearing helmets...

Would doctors and politicians have b***s to initiate a debate about it?

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londonplayer [620 posts] 2 years ago
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bikeboy76 wrote:

Commuting/Training/Racing: Helmet
tootling to the shops: no helmet

Agreed. End of debate. Get the coffee brewing.

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londonplayer [620 posts] 2 years ago
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Talking of helmets, I'm on the lookout for a new one but don't want to pay the earth. Any recommendations?

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northstar [1108 posts] 2 years ago
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Commuting/Training/Racing: Helmet
tootling to the shops: no helmet

Personal choice, end of debate.

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Carvers [36 posts] 2 years ago
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@dullard - and vs the injuries caused by not wearing a helmet how do those stats stack up? That's all that i want to clarify, if it's 1/1,000 injury then is it worth raising? 1/10 is maybe worth worrying about, but I'm pretty sure the odds are stacked in your noggin's favour when you do wear a helmet

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cat1commuter [1418 posts] 2 years ago
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Carvers wrote:

@dullard - and vs the injuries caused by not wearing a helmet how do those stats stack up? That's all that i want to clarify, if it's 1/1,000 injury then is it worth raising? 1/10 is maybe worth worrying about, but I'm pretty sure the odds are stacked in your noggin's favour when you do wear a helmet

Nobody knows if there is a real risk from increased neck injury, or if the protective effect to the head outweighs that. There are too few accidents recorded, an absence of comparable helmeted and helmet-less populations, and the data captured isn't detailed enough. This is part of what makes this debate so eternal - there's no definitive evidence one way or the other, so we're reduced to make a series of assertions based on person belief of what seems reasonable.

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