Medical notes: Don't let helmets head off the push for cycling

Published on Tuesday 8 July 2008 20:41

Should wearing cycle helmets be made compulsory in Britain? The statistical case for such a move remains unproven, while the risk of discouraging millions from cycling in the first place is all too real

JUST back from a week in France, where I was struck by the number of people riding bikes. Not only do there appear to be far more cyclists in Paris, but they appear carefree and so much happier. The sunny weather and citywide "freedom bike" rental scheme account for much of the difference, but so must the Parisians' apparent distaste for wearing cycle helmets.

Boris Johnson was recently pilloried for cycling without a helmet, but what sort of impact has their introduction really made? How much safer is Boris now that he reluctantly coats his cranium in carbon-fibre?

It may seem counterintuitive, but the benefits are far from clearcut. On the positive side, there are numerous reported cases where helmets appear to have protected cyclists from serious head injuries that could have left them permanently disabled or dead. Yet, on the negative side, these cases appear to be the exception rather than the rule, and need to be weighed against the fact that the wind-in-the-hair sensation appears to be one of the attractions of cycling, and that forcing cyclists to wear protective headgear discourages them from using their bikes.

When cycle helmets were made compulsory in Australia, the number of people cycling plummeted by a third and, although the number of serious head injuries fell, too, it didn't match the drop in usage. In other words, the risk of injury actually rose among those who donned helmets and continued cycling.

Closer to home, the British Government admits that there is no convincing data linking increases in helmet use with improvements in cycling safety.

Part of the reason why helmets appear to have had negligible, if any, impact on serious injuries is that the overall risks of hitting your head while cycling (excluding mountain-biking and racing) are tiny. In more than 20 years of medicine I have never had to treat a cyclist with a life-threatening head injury.

Indeed, the Bicycle Helmet Research Foundation estimates that the average cyclist would have to pedal the roads for more than 3,000 years to suffer a serious head injury, let alone one that would be mitigated by a cycle helmet. And children are four times more likely to suffer a head injury as a pedestrian than when they are on their bikes (so why don't we make them wear helmets when they are walking along the pavement?). But it is the impact on behaviour that concerns me more than whether cycle helmets are needed, or provide as much protection as we think. Research suggests that the mere donning of helmets encourages cyclists to take more risks on the road, and therefore, paradoxically, increase their risk of serious injury. Moreover, the drop in the number of cyclists seen in Australia after helmet use was made compulsory could, if matched here, have serious implications for our fitness, waistlines and general health.

Put simply, driving your child to school, or putting him on the bus, is likely to have a bigger negative impact on his long-term well-being than his risk of being seriously injured riding to school – whether helmeted or not.

He's a strapping young man

EPIC final. Killer forehand. Great body. But why the trademark white tape under both knees? At first glance, Wimbledon champion Rafael Nadal's bandages look more like a fashion statement than a medical aid but there is science behind their use – they are patella straps, designed to take the load off the tendon that connects the kneecap to the lower leg. Physiotherapy involving special thigh exercises can help ease the stress on the knee but strapping to support the short tendon has become an increasingly popular way to ward off recurrent problems. It certainly seems to have worked for Rafa.