Man took own life after sustaining head injury in cycling crash, inquest hears

cyclisto wrote:

That is why it is hard for me not to take my helmet when riding. If wearing a piece of shelled foam can prevent some injury that could be in any way disturbing, I will just do it. I have had many nasty falls (most from lost grip in corners) with near head knock so not any reason risking it, especially when my cornering skills do not seem to improve.

Going to put now the popcorn bag in the microwave.

Unfortunately, bike helmets are unlikely to help much with brain injury - they're best suited to prevent skull fractures, but don't really help in a meaningful way with stopping the brain from moving within the skull.

I cannot understand this. Helmets, foam, pillow, layer of grass, all these soft things do is to mitigate the force applied. Brain injuries is a result of force applied. How helmets are unlikely to help much with brain injury?

I would really like to hear the theory that helmets do not prevent brain injury.

What's your theory that they do ?

Not so much a theory as just accepted, but its basically the same principle that a seatbelt will not save you from internal injuries in a serious car crash. It'll stop you flying out the windscreen, and keep you from further injuries, but internally, your organs and soft tissue will crash into each other / your ribs etc. as you deccelarate. 

Similarly, your head / brain has to deccelarate in a crash. Your brain is soft, your skull is hard. When your skull stops, your brain keeps on moving, and if the connective tissues can't sustain the forces, concussive damage is caused. 

Where helmets are useful is if you land on something sharp, they'll offer protection from a piercing injury. If you land on something hard, hard enough to otherwise crack you skull, the helmet will help protect against that happening. If you scrape your head along a surface, it's likely to help protect you from cuts. 

What it is unlikely to protect you from however is a concussion.  

As an aside, I watched a YouTube video the other night, showing 'top crashes from 2021' or some other twisted thing. Anyway, I couldn't help notice in those crashes, a fairly consistent head snap. The rider goes down sideways, and following the initial impact, the inertia of the head / helmet is too great for the cyclist to resist, and the head is catapulted to the ground in a secondary motion. 

I am intending to find footage of pre mandatory helmet racing crashes to see if the same snap effect is evident.

Your skull hits the pavement, it stops moving almost immediately, the shock transfers almost unattenuated; your cycle helmet hits the pavement you have about 2cm of foam to deform before it's your brain structures that do the deforming. In a shearing impact a well designed helmet will be internally shearing, reducing the angular acceleration of the head and then the brain. It won't save in the worst of impacts, but it may well make the difference in many less severe ones.

Jimmy in a very serious collision, say, car at 60mph into a huge concrete block, the accelerations are such that no matter how the human is restrained the body is subject to unsurvivable damage. In other collisions though the seat belts help hold the human in a position where the structures of the vehicle deform around them, including those to which the seat belts are mounted, such that the body is subjected to survivable acceleration and protected from penetrating injury.

cyclisto wrote:

I cannot understand this. Helmets, foam, pillow, layer of grass, all these soft things do is to mitigate the force applied. Brain injuries is a result of force applied. How helmets are unlikely to help much with brain injury?

I would really like to hear the theory that helmets do not prevent brain injury.

You'd be better off having a look here: https://crag.asn.au/the-myth-that-bicycle-helmets-protect-against-brain-injury/

As I understand it, a bike helmet can reduce the peak acceleration (g) that the head undergoes in a collision by the compression of the foam - it's not so much that the force is reduced although the force can be spread over a larger area which helps prevent skull fractures. (Consider that the head is still going from fast movement to a complete stop, so the total force is the same with or without a helmet). Whilst the outside of the head is slightly cushioned, the brain will still be 'sloshed' against the inside of the skull and that is how most of brain injury occurs. Most concussions don't involve deformation of the skull which also supports the 'brain sloshing' theory.

Also, check out: https://pubmed.ncbi.nlm.nih.gov/12504149/

Well I just googled now "helmets and brain injury" and here are the first links most from sites with .gov or .org domain suffixes but I know if the "lobby card" falls on the table, anything may be justified.

https://bmjopen.bmj.com/content/9/9/e027845

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7025438/

https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Sp...

https://www.aap.org/en/news-room/news-releases/aap/2022/american-academy...

They all above say that wearing helmet is good for keeping your brain working. But it really makes sense any softer hit is a good thing.

If I search a little more I may get to your page, it always does if you search enough https://www.youtube.com/watch?v=Cxqca4RQd_M&t=287s

I can understand the anti-helmet debate about enforcing helmet use would make more people who are put off cycling by the necessity of wearing helmets to die of other sitting life related illness and that is why I strongly oppose to it, but efforts try to convince that helmets do not prevent brain injury seems like herbal mumbo jumbo to me.

cyclisto wrote:

Well I just googled now "helmets and brain injury" and here are the first links most from sites with .gov or .org domain suffixes but I know if the "lobby card" falls on the table, anything may be justified.

https://bmjopen.bmj.com/content/9/9/e027845

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7025438/

https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Sp...

https://www.aap.org/en/news-room/news-releases/aap/2022/american-academy...

They all above say that wearing helmet is good for keeping your brain working. But it really makes sense any softer hit is a good thing.

If I search a little more I may get to your page, it always does if you search enough https://www.youtube.com/watch?v=Cxqca4RQd_M&t=287s

I can understand the anti-helmet debate about enforcing helmet use would make more people who are put off cycling by the necessity of wearing helmets to die of other sitting life related illness and that is why I strongly oppose to it, but efforts try to convince that helmets do not prevent brain injury seems like herbal mumbo jumbo to me.

At a quick glance, I can see some previously discredited articles on that list - the Thompson, Riviera and Thompson one in particular is notorious. From a quick look, only your first BMJ link appears credible.

The problem is that most of the studies are "self-selecting" in that people chose to wear a helmet and that can muddy results when looking at hospital admissions. Obviously, a double-blind study of helmet effectiveness would cross some moral boundaries, so that's off the table.

My takeaway from all the various helmet studies performed (often with money guiding what outcome is desired) is that they likely have a small protective effect, but they are massively over-sold as a solution to RTCs when that is not the kind of impact that they are designed for. I wear a bike helmet, but I don't think it's going to make much difference if a car hits me.

Incidentally, I wasn't attempting to cherry-pick any results, I just put "bike helmets brain skull" into DuckDuckGo and after two advert links, I got the first link that I posted.

I don't think anyone is saying they won't prevent brain injuries at all, simply that their performance against preventing concussion is less than stella. 

If it helps, my mind was blown when I was told this too, but it all stacks up. 

There is still good protection to be provided, but as someone else mentioned, what we should never do, is use helmets as a means to mitigate against improving other road safety measures as a helmet can only do so much... and that is much less than is arguably needed (big picture thinking wise). 

Indeed, Horse riders resisted for years, but you will see very few helmetless now. Motor cyclists, skiers and rock climbers similarly.

Robert Hardy wrote:

Indeed, Horse riders resisted for years, but you will see very few helmetless now. Motor cyclists, skiers and rock climbers similarly.

You are far more likely to get a head injury from those activities than you are cycling.

Walking, rugby, showering and being in a motor vehicle are right up for activities that cause the most head injuries.

F=ma, the acceleration matters! Reduce the acceleration, you reduce the force proportionally. You say most concussions dont involve deformation of the skull, of course they do, just not permanent non elastic deformation. The skull is made of living bone, skin and connective tissue, it offers considerable protection to the brain through its capacity to absorb energy and attenuate acceleration to the head. Evolution has purposed it well to the conflicting exigencies of the lives of our ancestors. No doubt if our ancestral young had habitually downhill mountain biked it might have evolved a rather higher degree of protection.

F = MA - Mr. Newton would seem to be suggesting that the paths to safety are;

1. Ride slower,
2. Move to a planet with rather less by the way of gravity (and don’t speed up),
3. or Get your head shrunk by some helpful folk from the Amazon rainforest.

Option 3 has the added aero benifits.

cyclisto wrote:

I cannot understand this. Helmets, foam, pillow, layer of grass, all these soft things do is to mitigate the force applied. Brain injuries is a result of force applied. How helmets are unlikely to help much with brain injury?

I would really like to hear the theory that helmets do not prevent brain injury.

Because they don't stop the brain bouncing around inside the skull.

Is there anything in the main story, or the followup story with Kelly Catlin that indicates neither were wearing helmets when having a crash?

cyclisto wrote:

That is why it is hard for me not to take my helmet when riding. If wearing a piece of shelled foam can prevent some injury that could be in any way disturbing, I will just do it.

So I assume you also wear your helmet while driving a car? Or whilst having a bath/shower?

(and if you think it's just old people that fall in the bath/shower think again - this study found 74% of patients with a bath/shower related head injury were aged 16-60)

I'm with you that not choosing to wear a helmet cycling is fully justifyable given the risk profile of every day cycling. On the whole we do not cycle at speeds above those we can manage on two legs, we rarely fall and when we do (outside of collisions with motor vehicles) the fall tends to have dynamic aspects that protect from high head accelerations. As we up the speeds or the crash potential of our cycling style then the balance changes and it becomes highly irresponsible not to wear a helmet just as is the case with motorists who chose to drive in sporting events.

There are few members on this site that point blank refuse to consider that a helmet *may* have a roll in helping to save your life.

It was calculated that the impact speed between myself and the Mondeo being driven by an 80 year gent as in excess of 60mph.

The impact, and subsequent landing broke 11 ribs, punctured my left lung, gave me internal bleeding; it also dislocated my left elbow, broke my left ulna and cracked 3 vertebrae.
It also shattered my left kneecap in to 4 pieces.

My helmeted head faired somewhat better ... fragments of my helmet were found inside the car after my head had gone through the windscreen.
My helmet was shown to me while I was in Resuss and it was a deformed, crumbling mess.
Yes, I *still* got a traumatic brain injury - it probably got bounced around in there like a ping-pong ball (plenty of room, my wife would suggest) ...
However ... it is believed that the TBI I received is less than the TBI I would have received - which personally I can only attribute to the helmet doing its job and helping to dissipate the impact through its structure and helping reduce the stresses on me.
It also had the benefit of meaning that it was not skull to windscreen, so I've kept all my hair and stunning* good looks.

* by stunning, I mean similar to "what the holy fuck was that? ... Mary ... he wasn't just hit by the ugly branch, ot was a whole fecking forest" type of stunning.

Oldfatgit wrote:

There are few members on this site that point blank refuse to consider that a helmet *may* have a roll in helping to save your life.

I don't consider myself one of those although I am sceptical about bike helmets.

I think the reason why some cyclists get fed up with bike helmet stories is that far too much attention is placed on cyclists wearing helmets. It's a common thing for non-cyclists to shout and accuse non-helmetted cyclists for being idiots even though the chances are that the cyclist might well be familiar with the literature and more importantly the proper role of PPE.

It's all a huge distraction from the proven methods of improving cyclist safety.

(I'm very glad that you're still with us and personally, I would happily cover myself in helmets if I was about to be struck by a 60mph vehicle guided by a madman)

Thank you Hawkinspeter :-).

Even though it helped me, I still support others rights to chose not to wear one; it's not a legally compulsory item and like hi-viz and daytime running lights (which, BTW, I was also proudly displaying), and heaven help us if every they are made mandatory.

Helmets are just PPE and absolutley should be the first line of defence ... however we don't live in an ideal world where not everyone is out to kill us ...
(also my wife wont let me out the house on the bike unless I'm wearing a helmet. She's seen first hand the damage left by the TBI, and clearly remembers the helmet falling apart in the A&E doctors hands. I don't even show her the NMOTD or my own near misses - she'd ban me from cycling ....)

Oldfatgit wrote:

Thank you Hawkinspeter :-).

Even though it helped me, I still support others rights to chose not to wear one; it's not a legally compulsory item and like hi-viz and daytime running lights (which, BTW, I was also proudly displaying), and heaven help us if every they are made mandatory.

Helmets are just PPE and absolutley should be the first line of defence ... however we don't live in an ideal world where not everyone is out to kill us ...
(also my wife wont let me out the house on the bike unless I'm wearing a helmet. She's seen first hand the damage left by the TBI, and clearly remembers the helmet falling apart in the A&E doctors hands. I don't even show her the NMOTD or my own near misses - she'd ban me from cycling ....)

Did you mean "shouldn't" there? I'd consider PPE should be the last line of defence. The first line of defence should be separating motor vehicles from vulnerable road users (not much of that in the UK) and I'd consider traffic policing to be more important (cue WTJS). Unfortunately, the oil/motor lobby wants to keep pushing cycle helmets as that deflects the discussion away from more useful discussions.

I absolutley meant "Shouldn't be the first line of defence"*

I'm in two minds about segregation. 
I feel that it is illusionary and only masks and delays the risk.
Drivers and operators of motor vehicles get used to being the only traffic in their version of the road; vulnerable road users get used to being the only traffic in their version of the road.
When both sides meet - as they will do - there is a risk that neither side will behave appropriately towards each other and conflict will occur.
Yes, I know that the model works elsewhere ... but that's because it has a missing component - the Brit. If there is a way to take a proven model that is for 'the greater good' and fubar it, the average Brit will find it.

Increased traffic policing of *all* road users - and not just motorised vehicles ... but all of us is the better way forward. 
People behave like shit because they know that they can get away with it, that there is no one there to enforce it. 

* Proof reading ... doesn't matter how many times I'll say 'read it before you punch it' ... I'll be proof reading it after I've commited it ...
 

Yeah, I've got mixed feelings about segregation - I'd rather use the road than poorly implemented infrastructure.

That's an unfortunate UK perspective - other countries don't allow the feelings to mix when considering segregation, each feeling has its own space and they are carefully controlled where they must interact...

Oldfatgit wrote:

Yes, I know that the model works elsewhere ... but that's because it has a missing component - the Brit. If there is a way to take a proven model that is for 'the greater good' and fubar it, the average Brit will find it.
 

As a patriotic Brit I tried hard to be offended by this but sadly I have come to the conclusion you are correct.

I agree - some of our bad examples would be actively harmful to "more cycling" - if that were possible...  Now this is the kind of discussion we need (not "waste of money, because we have roads already" or "no-one uses the crap we have now so that means it doesn't work" or "it's deadly AND inconvenient" or "but we're not Dutch / Scandinavian / Spanish / German / Swiss" ...)

There are subtleties in the details of "proper infra".  As can be seen from some of the UK "look-a-likey" cargo-cult wastes of cash.  Two key points (well, three...) from what I understand of it (recommend also Robert Weetman's blog and the Ranty Highwayman):

a) Even in NL separation is not total - so drivers are entirely used to seeing cyclists "in the road".  Actually most of the infra is "shared" in some way between motor vehicles and cyclists [1] [2].  Why?  Streets.  There are thousands of miles of streets - in residential neighbourhoods, in "historic town centres".  Cyclists want to access their houses and shops too!  As long as the motor vehicles are controlled both modes can can co-exist.  That needs strict caveats - motor vehicles are limited to very slow speeds (by UK standards), there aren't ever many of them, you shouldn't have a parking free-for-all, in some places they're not allowed to overtake cyclists (or each other).  There are lots of useful techniques here but the key is "filtering" (see e.g. Utrecht).

b) Interactions must be much better controlled - by design, not just rules.  In NL lots of junctions involve no interactions between cyclists and motorists at all [1] [2].  Where they do cross the gold standard is that responsibility for their own safety is given back to the cyclists.  They are not expected to rely on the drivers doing it right.  The best infra ensures that modes cross at right angles with clear sight lines where everyone's slowed slightly.  Everyone only deals with traffic from one direction at a time.

c) Unlike in the UK in e.g. NL it really is the case that most people who drive also cycle (and so do their friends and relatives).  Many (not all) cyclists drive.  They all get training in both from an early age.

Can we "get there from here"?  Well other countries experiences suggest we can start from "not much cycling" and that can lead to more people cycling.  It seems this does create more understanding and then demand for infra.  Tested in several countries and cultures now - even works occasionally in parts of the UK.

Is it going to be easy to turn the oil tanker around from where we are in the UK?  No.  Not at all - there will be push-back from every conceivable interest at every stage.