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Partner robdotcalm


May 2, 2009, 5:24 PM
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Helmets increase neck injuries?
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This started at a party a couple of nights ago, when I was talking to a retired orthopedic surgeon I’ve known for many years both as an acquaintance and as a patient. About a year ago, he had a serious bicycle accident about the same time as I had a climbing accident in a gym
http://www.rockclimbing.com/...ead] stupid accident

Last summer after we had recovered somewhat, we had e-mailed each other about our accidents. His injuries were more serious than mine with an extended period of unconsciousness and required fusion of most of his cervical vertebrae.

At the party, he told me that his wearing a bicycle helmet increased the severity of his injuries, since the helmet increased the lever arm as his head was pushed aside and so maximized the damage to his cervical vertebrae. The weight of the helmet also would increase this effect. He said there were well documented studies regarding this. There’s a certain irony in his statement, since he was formerly the team physician for a college rodeo team. At that time he told me, it was shameful that the rodeo riders did not wear helmets and showed me some x-rays of closed head brain injuries the riders had sustained.

I had always wondered about the possibility of helmet wearing increasing the leverage at the base of the neck in a crash (bicycle or climbing) but had never given it any serious thought. So on this rainy Saturday, I did a modest web search. At the end, I’ll list the urls for some of the literature I looked at and will briefly summarize my conclusions here. I searched for “neck injuries” and “motorcycle helmets” and for “neck injuries” and “bicycle helmets”. The search for such injuries and climbing helmets did not produce any useful results.

The issue of increased lever arm and weight of the helmet promoting both brain and spinal cord injury has been discussed for motorcycles for a long time. The weight of a motorcycle helmet and the increased lever arm associated with its design probably don’t make the discussion especially relevant to climbing with its lighter weight and smaller helmets. However, practically all studies show a sharp decrease in serious cervical spinal and brain injuries when compulsory helmet laws are enacted. These studies don’t present the definiteness that would come from a controlled clinic study, but the trends are all the in same direction. These are better than population studies which show that people wearing helmets have fewer severe injuries than people not wearing helmets since the population wearing the helmets might engage in less risky behavior, e.g., driving at lower speeds.

On the other hand, there seems to be no evidence that wearing a bicycle helmet reduces serious injuries. In fact, from the Australian data injuries seemed to increase after the introduction of compulsory helmet laws. A common explanation was that wearing helmets made riders feel safer and so they rode more recklessly. While plausible, this is conjecture. I read some time ago that a similar phenomenon occurred in England after the introduction of compulsory seatbelt laws, viz., there was an increase in injuries to front seat passengers, who were now riding in cars driven by those who felt immune to the danger of going fast.

Practically all climbing helmets are hard on the outside so this reduces a risk found with older bicycle helmets that were soft on the outside. They caused the head to slide more slowly than the rest of the body leading to compression injuries in the upper spine. On the other hand, there is a risk that large ventilation holes in climbing helmets can cause a similar effect if they were to hook on the rock.

The bicycle literature is full of debate and for each scientist there is an equal and opposite scientist. I was discomfited by what I read, since I thought with the newer design helmets a definitive conclusion would have been reached that they make bike riding safer. I don’t see any definite conclusion that can be drawn. For the most part, one can go along with common sense as to whether or not helmets are mitigate or increase dangers in specific situations. But I did not find anything in the literature that would support or refute what the good orthopedist had to say. The ongoing argument often relates to the distinction between injuries caused by linear motions of the skull and rotational motions. The argument is made that helmets for various activities are designed (and tested) to protect against linear motion and not rotation, which many argue is the more common cause of injury.

After reading this material, my opinion (based on intuition and not any definitive studies) is pretty much what is was earlier. Helmets provide useful protection in non-severe falls and for light objects falling on the head helping to prevent severe injury in these cases. There is a possibility of helmets increasing rotational damage but that does not appear to be that important. But it sure would be nice to have some data on this last assertion. Finally, if helmets lead you to take greater risks than you would without a helmet, you’ve lost any putative advantage a helmet might provide.

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I enjoyed this article with its survey of helmets back to ancient warriors. Historical survey of helmet design.

http://www.mcnews.com/...e06Helmetfeature.pdf

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References studies showing that helmets decrease head injuries, but increase neck injuries. Author is not convinced of the validity of these studies. Non-technical article with references to published studies

http://www.whybike.com/motorcycle202.htm
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CONCLUSIONS: Motorcycle helmets reduce the risk of death and head injury in motorcycle riders who crash.
http://www.safetylit.org/...rnalarticle_84573_19

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Moto-helmet guy refutes the following argument

The reasoning of this urban legend tends to go along the lines of “wearing a motorcycle helmet increases the odds of a broken neck” then citing such reasons as “the size of a helmet creates more leverage against your neck in a crash” or “the helmet adds weight that makes your neck break more easily, like an orange on a toothpick.” Most people who tell this also cite some personal experience like “I knew a guy who had a motorcycle helmet and broke his neck.”

http://motorcycle-helmets-guide.blogspot.com/...elmets-types-of.html

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Supports argument that motorcycle helmets do not increase neck injury while preventing brain injury.

http://aapgrandrounds.aappublications.org/...tent/extract/19/5/51

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The testing of bicycle helmets approved by either the American National Standards Institute (ANSI) or the Snell Memorial Foundation indicated that using any helmet will protect the brain and neck during a crash more effectively than not using any helmet at all (18). However, these tests identified potential problems with helmet design, including a tendency for all helmets to slip out of proper position with the unequal application of force; a tendency for hard-shell helmets to slide on concrete, potentially increasing the risk for facial injury in a crash; and a likelihood for soft or no-shell helmets to catch or drag on concrete surfaces, causing the head to decelerate at a faster rate than the rest of the body, which potentially increases the risk for neck injuries (18). Subsequent tests indicated that helmets covered with a hard shell or a micro-shell (i.e., a very thin plastic covering) were least likely to cause injury to the head and neck region (19).

http://www.cdc.gov/...mwrhtml/00036941.htm

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Minor head injuries are usually as a result of linear acceleration of the skull by impact with another object. Cycle helmets may produce benefit by reducing and spreading this force.More serious injuries, on the other hand, are often as a result of angular or rotational acceleration, which leads to diffuse axonal injury (DAI) and subdural haematoma (SDH). These are the most common brain injuries sustained by road crash victims that result in death or chronic intellectual disablement.
Cycle helmets are not designed to mitigate rotational injuries, and research has not shown them to be effective in doing so.
To the contrary, some doctors have expressed concern that cycle helmets might make some injuries worse by converting direct (linear) forces to rotational ones. These injuries will normally form a very small proportion of the injuries suffered by cyclists, but they are likely to form a large proportion of the injuries with serious long-term consequences. In this way helmets may be harmful in a crash, but this harm may not be detected by small-scale research studies.
Thorough treatment of this subject, with comprehensive references, is to be found in the following article: (2nd url is for the referenced article)
http://www.cyclehelmets.org/1039.html

http://www.sciencedirect.com/...48aa0282ca3a47cbe852

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Cheers,
Rob.calm


Adk


May 2, 2009, 5:30 PM
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I'll make sure next time I put on my kevlar I think about this post.Crazy
Interesting might I add. Thanks.


bill413


May 2, 2009, 5:49 PM
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R.C - very interesting subject. I'll throw an anectdotal point out first:

A number of years ago I was learning to lead on friable rock (sans helmet). A foothold broke off, and I was swung into the rock. After my face met the rock, and I downclimbed out of the situation, and visited the hospital, I reflected on helmets.
I went out & bought one. I don't think that a helmet would have prevented all injury. I'm sure that it would have changed the injury. I'm not sure it would have made it better, or worse (by forcing my jaw into the rock). Just saying.

I recall a statement that wearing (mortorcycle or driving) helmets in cars would actually lead to an increase in cervical injuries UNLESS the cars were provided with head restraints; such as is done in NASCAR, etc.


petsfed


May 2, 2009, 6:13 PM
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I'd always wondered about a helmet's influence on neck injuries. Thanks for digging this stuff up Rob.

My outlook on helmets remains unchanged however: if there is the kind of climbing where a helmet is likely to cause me to fall (offwidths and chimneys are the worst), and there isn't any loose rock, the helmet creates a greater hazard than it protects against.

Helmets are not meant as general head protection in all cases. They protect the head from smaller falling rocks, and the odd fall where the climber is in just the right place that the helmet does some good. To wear it all the time without carefully considering how the helmet affects and fits into your safety system is itself unsafe.


Partner robdotcalm


May 2, 2009, 7:20 PM
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petsfed wrote:
I'd always wondered about a helmet's influence on neck injuries. Thanks for digging this stuff up Rob.

My outlook on helmets remains unchanged however: if there is the kind of climbing where a helmet is likely to cause me to fall (offwidths and chimneys are the worst), and there isn't any loose rock, the helmet creates a greater hazard than it protects against.

I wear helmets most of the time on slabs, frequently on faces , and practically never on offwidths or chimneys.

Cheers,
Rob.calm


bradley3297


May 2, 2009, 9:17 PM
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if your head is smashed in and your neck is fine...... my main reason for wearing a helmet is flipping while falling. heard of quite a few of those deaths. i wonder if the new lightweight style helmets would lessen those effects anyway. my new helmet is quite light.


blondgecko
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May 2, 2009, 9:27 PM
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A good topic, this. I'm going to move it over to Injury Treatment and Prevention.


gwyn


May 2, 2009, 11:18 PM
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I found the information on this site http://www.helmets.org/ to be interesting, specifically this memo: http://www.helmets.org/hurtmemo.htm. Granted, it's all about bicycle helmets but it factored into my decision when I replaced my helmet. Of course, the bike shop clerks thought I was odd and didn't believe rotational injuries were a concern. Well, I didn't believe I required an aero helmet (yeah, as if I ride fast enough for it to make a difference!).

I've heard the argument regarding helmets causing people to take more risks and perhaps there is some truth to that. I know I'd rather have a helmet on if I'm skiing and wish to play with small jumps (I'm not that good). I believe a helmet would give some protection but I also know it is limited (a concussion is still possible and a helmet isn't going to protect the rest of me). I accept the limited protection.


meanandugly


May 3, 2009, 5:32 AM
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With the possibility of all this being true, my own experience with helmets has been very positive and when not wearing them has turned out, on some occations, negative.
I wear a helmet for many activities such as cycling, climbing (rock and ice), whitewater, firefighting, urban exploration, etc. There have been times when it was conducive to the activity to remove the helmet, but for the most part I felt it more prudent to keep it in place.
I have suffered a number of head and neck injuries, both while wearing and not wearing a helmet. I have found that head injuries were less in severity while wearing the helemt. As for neck injuries, my most severe was while not wearing a helmet (dislocation between C2 and C3). Other neck injuries have appeared to be equal whether wearing or not.
In my opinion the possible forces placed on the neck because of wearing a helmet are far outweighed by the possibility of brain injuries. These neck injuries due to additional rotional forces because of the helmet are very rare at best. With that being said, choose wisely and be prepared to live (or not) with your choices.

Take care

ps. Awesome post with great info.


(This post was edited by meanandugly on May 3, 2009, 5:41 AM)


bill413


May 3, 2009, 6:18 AM
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meanandugly wrote:
I have suffered a number of head and neck injuries, both while wearing and not wearing a helmet. I have found that head injuries were less in severity while wearing the helemt. As for neck injuries, my most severe was while not wearing a helmet
I think many of us appreciate your unselfishness in being a volunteer to explore such injuries. However, after "a number" (greater than 1) one wonders if perhaps you aren't actually a professional crash tester.


meanandugly


May 3, 2009, 6:37 AM
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Many people wonder the same thing about me.


onceahardman


May 3, 2009, 6:58 PM
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Nice post Rob.

Certainly there is a physical basis for an increase in neck injuries...more mass, farther out on the lever. Increased torque will be generated in rotation.

There is also a physical basis for helmets protecting from axial loading.

Similarly, I'm sure some people have died in car wrecks because they were wearing seat belts, and were unable to extricate themselves in time.

My opinion is, it should be up to the individual to decide what types of protective devices are appropriate in different circumstances.


iron106


May 3, 2009, 7:50 PM
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To me it seems it might be one of those things that people who now survived something they should not have, ended up with a serious injury.

But they survived the injury.

If they were not been wearing a helmet they would not have a neck injury because they would be dead.

When people started wearing seat belts in cars they would always get whiplash. However if they did not wear seat belts they would have gotten killed. They just put headrests in cars to reduce the problem. They did not get rid or seat belts.


Partner angry


May 3, 2009, 8:11 PM
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Well there is a progression to safer and safer and safer.

I don't know where we are in the progression with helmets. I think it's a bit problematic to suggest that because old cars might have had dangerous seatbelt problems to say that a new car with seat belts, multiple air bags and crumple zones are unsafe.


petertherock


May 3, 2009, 8:14 PM
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The argument about helmets being unsafe due to people who wear helmets taking bigger risks than people who do not wear them is totally true and yet silly and senseless. How about shoes, belay gear, ropes? Of course, gear is improved so we can climb harder, more dangerous terrain with a "reasonable" degree of risk/safety. Would you climb that runout with a hemp rope?

This is is not to criticize the post - it is good people realize that helmets do not guarantee safety.

I personally use helmet against falling rocks and upside-down falls. I believe my helmet is helpful in those cases.


Terry2124


May 4, 2009, 11:05 AM
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petertherock wrote:
The argument about helmets being unsafe due to people who wear helmets taking bigger risks than people who do not wear them is totally true and yet silly and senseless. How about shoes, belay gear, ropes? Of course, gear is improved so we can climb harder, more dangerous terrain with a "reasonable" degree of risk/safety. Would you climb that runout with a hemp rope?

This is is not to criticize the post - it is good people realize that helmets do not guarantee safety.

I personally use helmet against falling rocks and upside-down falls. I believe my helmet is helpful in those cases.

It does help for sure, that's why I wear mine as well. The chances are low that the helmet can get caught and torque the neck but the chance is still there. Sometimes seat belts do more harm then good but again a lower chance of this happening. Its far better to go on the side of of wearing it then not wearing and thinking its going to hurt your neck. What about a rock falling on your head?

But as we all know shit happens and sometimes what we use as safety can screw us over.


Hammertoes


May 4, 2009, 11:11 AM
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We climb to "stare death in the face and scream our rage at the inevitability of it", mountaineers started wearing them, because some mountaineers where overly educated physics instructors and conservative by nature.

Sport climbers started wearing them because they were not as competent as the 'Trad climbers' of the day got scarred easily and thought 'they could be hurt'. Someone told them they could have 'fun' without committing to the challenge they had undertaken

Now, your mothers have taken over their job. When you were little it started with female hysteria her prodigy would not survive to procreate and spread her genes. So you were required to wear your helmets and safety protection for bicycles, skateboards, and roller skates.

Men, being men, did not take take these precautions, for us it is about the activity (who cares if you are going to die, it is living an empty life that is the tragedy). Like sperm,that gets one shot we take ours and the adrenalin rush that goes with it. That is why old climbers don't exist; we all embraced our angst and our activity as divine sport. What kind of man (climber) would give up that?

It is embracing that passion, not who is wearing a 'helmet' or why.Cool


GeneralZon


May 4, 2009, 11:30 AM
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Great report Rob.

Anecdotally, I had a bike accident where i flipped over my handlebars and the top of my helmet it the corner of a curb. The helmet was busted up really good, but I got up and walked it off. However, I will add that there was no head roll with the impact, pretty much a linear force and the helmet took the entire impact. Without a doubt, if I didn't have that bike helmet on I would be effed-up or worse.


yodadave


May 4, 2009, 11:50 AM
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this is anecdotal and may be off topic but I have found in whitewater kayaking that helmets pose a significant threat to the neck. Specifically if you flip while playboating in a hole, they can act as a sail and start catching the force of the water and transferring it to the neck. Unfortunately the range of vented helmets that would prevent this scenario is slim. It is definitely a case of forces being increased by the helmet though


rocknice2


May 4, 2009, 12:42 PM
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yodadave wrote:
this is anecdotal and may be off topic but I have found in whitewater kayaking that helmets pose a significant threat to the neck. Specifically if you flip while playboating in a hole, they can act as a sail and start catching the force of the water and transferring it to the neck. Unfortunately the range of vented helmets that would prevent this scenario is slim. It is definitely a case of forces being increased by the helmet though
That's what you get when you stick your head in a washing machine


rhyang


May 4, 2009, 5:19 PM
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Interesting.

My neck was broken in a rollover car accident in August 2007. I ended up in a halo (broken C1) with my neck fused from T1 up to C5. On top of that I have an incomplete spinal cord injury -- permanent neurological damage.

SCI sucks, there is no doubt about it. But I cannot imagine having a traumatic brain injury. That's a whole other rehab ward.

Anyway, my neurosurgeon said that he wanted me to minimize axial force on my cervical spine .. I guess that means down the axis, like the roof of the car crushed in on my head. So when I'm climbing outside, I tend to wear a helmet, just in case of falling ice, rock or gear. Same when I'm riding a mountain bike (carefully).

YMMV of course.


king_rat


May 5, 2009, 5:40 AM
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Rob thanks for that its very interesting.

Like others I don’t think ill stop wearing a helmet, and suspected that while helmets may cause some risk of spinal injury they save far more people from head injury.

I know at least 2 people who have been saved by a helmet from either being killed or suffering serious brain damaged. One in particular convinced me to where a helmet. A climbing partner who I had climbed with a few times, fell while leading, he caught his foot on a small ledge and flipped upside down and struck his head on a protruding rock. His helmet was smashed and he fractured his skull. While his injury’s where serious, I’m fairly certain that the helmet saved his life.


syco


May 21, 2009, 4:38 PM
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I caved a motorcycle helmet in a crash a few years ago and slid about 100 feet on my face, bloody terrifying! I'm sure I'd be dead or eating through a tube without a full face helmet. I always wear one snowboarding now after too many close calls with trees. But I only sometimes wear a helmet climbing. I've been climbing since I was a kid and really only wear one on friable rock where the risk of being beaned by rockfall is high. I usually bring a helmet to make my belayer wear if there is loose rock. So many times I've been knocked off balance by my helmet hitting something, but then on the flip side I've smacked my head a few times too. On one very early trad lead in Llanattock, South Wales, I couldn't move into a groove past a small roof because my helmet kept jamming. It took a few desperate seconds to realize I had to lean way out to my get helmet round it. Me and climbing helmets fell out right there, it almost caused a very bad fall (my noob placements were mostly useless). If there are lots of ledges or ramps then I do consider wearing my helmet. If it's vertical or nearly so then I'm less likely to hit the rock when falling so could do without the distraction.

I'm also far less gung ho then when I was a kid so tend to reach for a bucket more than I used to just for security. The jury is still out for me.


skinner


May 22, 2009, 7:26 PM
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I've never really considered helmets, especially modern lightweight ones as anything more then protection from falling objects. But for this reason I always wear one.

I was hit by a rock once about the size of a sugar cube that some hikers kicked off of the ridge above (and no doubt had reached terminal velocity), which broke my
collar bone and left a nice deep hole in my shoulder. I'd hate to imagine what that would have done to a helmetless head.

I have no data to back this, but my personal experience tells me that, my chances are a lot higher of being spared serious head injury from falling rock/ice then
suffering a neck injury due to some off-chance weird kind of fall where my head even contacts the rock, let alone the helmet causes me neck injury.

If you are buying a helmet as falling object protection, make sure that it is rated as a true "impact" helmet and not just a "deflection" lid, as many of the popular
lightweight models tend to be.


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