Does wearing a helmet while cycling protect against brain injury?
Does wearing a helmet while cycling protect against brain injury? In Road Safety Week, we take to the research trail to find out…
Cycling is on the up. Over the past ten years, Great Britain has witnessed a 17 per cent rise in the number of people saddling up for work, school, leisure and health. (1)
But covering 3.3 billion vehicle miles a year does not come without risk.
Between 2008 and 2018, the number of pedal cyclists killed or sustaining serious brain, facial and other injuries on our roads rose by 29%.
It is an increase that further fuels a long-running row: does wearing a helmet while cycling keep you safer?
Here is some of the latest thinking from experts and researchers:
On the frontline
The Royal Society for the Prevention of Accidents: “We strongly recommend that cyclists wear a cycle helmet.” (2)
This 103-year-old UK charity was founded in response to rocketing war-time road accident rates. It believes “preventing the collision happening in the first place should be paramount.”
But it also stresses: “Head injury has been identified as an important cause of death and serious injury in cycling collisions. One way in which cyclists can prevent or reduce the extent of a head injury in a cycle accident is to wear a cycle helmet.”
Headway: the brain injury association: “Cycle helmets save lives and can prevent people sustaining lifelong brain injuries. This fact has been proven by numerous peer-reviewed, published scientific studies.” (3)
The charity wants helmet use to be compulsory for all child cyclists and is throwing its weight behind growing demands for safer road systems.
The cycling circuits
Cycling UK: “Forcing - or strongly encouraging - people to wear helmets deters people from cycling and undermines the public health benefits of cycling.”
Founded in 1878 as the Bicycle Touring Club, this organisation wants to keep helmets an optional choice.
It states: “It is more important to encourage people to cycle than whether or not they wear helmets when doing so. Cycling should be promoted as an essentially safe, normal and enjoyable transport and leisure activity, which anyone can do in whatever clothes they prefer to wear, with or without helmets.”
British Cycling: Britain’s governing body for cycling recommends “wearing a correctly fitted helmet while cycling.”
Acknowledging, however, there is contradictory research as to the level of safety afforded by helmets, it states:
“We also support the right of each individual to choose whether or not to accept this recommendation and recognise the limit to the protection that helmets provide.
Of note, nevertheless, wearing a helmet that conforms to recognised safety standards is mandatory in all British Cycling-approved races.
Sustrans: as custodian of the UK’s cycle network, this walking and cycling charity believes safer road systems should be the focus in preventing road casualties.
“Cycle helmets don’t prevent collisions from happening. Therefore, we strongly support and focus our work on measures that help create and maintain a safe cycling environment to reduce collisions taking place.”
Sustrans points to several studies which suggest cycle helmets can offer protection to the head, but not in every scenario. (4) They also cite evidence showing a 36 per cent drop in cycling in Australia the year after it made helmet wearing mandatory.
The research
Researchers around the world are continually reviewing data for evidence of links between helmet use and injury prevention.
Australia: Findings in Australia are significant as it is one of only two countries worldwide where if you are not wearing a helmet, you are breaking the law.
A review three years ago looked at 40 studies involving 64,000 injured cyclists worldwide to see if bike helmets had mitigated head, face, neck or fatal head injury in a crash or fall. (5) The results?
“Bicycle helmet use was associated with reduced odds of head injury, serious head injury, facial injury and fatal head injury. The reduction was greater for serious or fatal head injury.”
Earlier this year, a team from the same research unit looked at the impact of the bike helmet laws, 27 years after they came into effect.
They found that immediately after the laws were in place, cycling deaths dropped by 46% compared to pre-legislation days.
In other words, 1,332 fewer lives were lost. (6)
The reduction in Australian bicycle-related fatality appears to be primarily due to increased helmet use 
Norway: in 2018 in Norway, a review of 21 studies into helmet laws and injuries found: “Mandatory bicycle helmet legislation for all cyclists reduces head injury among all cyclists by 20%.” (7)
In the same year there, an analysis of a further 55 studies showed helmets reduced head injury by 48% and serious head injury by 60%.
Korea: researchers here, concerned by the number of elderly people sustaining traumatic brain injury (TBI) in bike accidents, looked at whether helmets were protecting this age group as much as others.
Their discovery was enlightening: “The protective effects of helmets on bicycle-related injuries are greater for elderly individuals, thus reducing TBI incidence.” (8)
A Krysalis Talking Heads Reflection
We understand that brain injury has a significant impact on an individual and their family. Life changing disability as a result of an accident disrupts plans, valued aspirations and relationships to name a few. It changes the view someone holds about themselves and their abilities to engage in valued activities.
The consequences of brain injury are incredibly painful and the impact is enduring.
The question of helmets and cycling is an emotive topic for some, with arguments on both sides of the table for and against legalising the use of helmets when cycling. At present in the UK individuals are required to make their own decisions relating to helmet use. The question however is that are individuals fully aware of the consequences of those decisions?
What for example, was the decision making process of the father who chose to put a helmet on their child but fail to wear one themselves? Is the individual riding through busy city traffic without a helmet on, aware that in the face of a life changing accident they may well be deemed as contributing toward their injuries due to failing to wear appropriate safety gear?
It is very clear that wearing a helmet when cycling is not the only solution to keeping cyclists safe on our roads. Drivers of motor vehicles need to ensure they pay more attention to other road users and space needs to be found on our road to accommodate cyclists not only cars and motor vehicles.
Personal decisions about helmet use go far beyond considering ‘in the moment’ whether to wear a helmet or not. It is bigger than the question “does it feel better?”, is it “less restricting” or “more liberating to feel the ‘wind through my hair’?”. This decision should not be taken lightly. It is about considering all of the potential consequences of not wearing a helmet before acting, proactively making a conscious informed decision and being honest with yourself about the potential consequences.
Asking yourself are you taking adequate steps in safeguarding your own wellbeing and those members of your family who rely on you? Are you prepared, in the face of a life changing accident to accept the potential losses. Are the proposed benefits of cycling without a helmet worth the risk? No one after all believes it would ever happen to them.
Finally, if you are one of those people who refuses to wear a helmet but enjoys cycling consider this. What if, by wearing a helmet today you are taking steps to make returning to cycling after an accident more likely. Without the helmet there is a risk that cycling is an activity you may never enjoy again, and if you are unlucky enough to sustain an acquired brain injury you may need the services of a specialist occupational therapist! We hope not.
*More on the safe road systems that are minimising crash risks here: Road safety week
Meet Ronny
A road crash left motorbiker, Ronny with a life-changing brain injury. Here’s how Krysalis Neurological Occupational Therapists helped him:
References
- Transport, Department for. Reported Road Casualties in Great Britain: 2018. s.l. : Gov.UK, 2019.
- Accidents, The Royal Society for the Prevention of. Road Safety Factsheet. s.l. : RoSPA, 2018.
- Headway. Cycle safety. s.l. : Headway, N/K.
- sustrans.org.uk. Our position on the use of cycle helmets. s.l. : sustrans.org.uk, 2019.
- Olivier, J. and Creighton, P. Bicycle injuries and helmet use: a systematic review and meta-analysis. s.l. : International Journal of Epidemiology, 2016.
- Olivier, J., Boufous, S. and Grzebieta, R. The impact of bicycle helmet legislation on cycling fatalities in Australia. s.l. : International Journal of Epidemiology,, 2019.
- Hoye, A. Recommend or mandate? A systematic review and meta-analysis of the effects of mandatory bicycle helmet legislation. s.l. : Accident Analysis & Prevention, 2018.
- T, Kim, Jung, KY and al, Kim K et. Protective effects of helmets on bicycle-related injuries in elderly individuals. s.l. : BMJ Injury Prevention, 2019.
- Scotland, NHS Health. Cycling. 2019.
*At Krysalis we believe in the use of properly fitted safely helmets when cycling or taking part in any sport where safety equipment is required. Although it is not a law of the United Kingdom to require the use of a helmet whilst cycling we would always urge you to do so.