Every few years, I hear a story about someone who fell while skating and injured themselves, or didn't. Those stories normally end with an exhortation for all of us to wear helmets. Wearing a helmet is an acknowledgement that we are mortal, that we can fall and hurt ourselves. The question of whether helmets actually achieve their goal of reducing injuries is rarely discussed - it's taken as gospel truth.
This page will examine that question. As you can guess, I'm not so sure that helmets actually do reduce injuries, and I'll present my evidence below.
But before we start, I want to focus you on what we're discussing. We're not discussing why people do or don't wear helmets, or whether people might or might not fall, or whether helmets ever prevent any injuries. We're talking about one simple question: whether wearing a helmet reduces your chance of being injured while skating.
I also want to restrict the discussion to recreational skating, alone or in groups, on trails or the streets. I can't talk knowledgeably about aggro, freestyle, slalom, hockey, roller dance, downhill or racing in any format from marathon to short-track, nor about skateboarding or kick scooters. However, I think it is useful to compare skating to cycling and skiing, since those activities have much better statistics than skating does.
You would think that, if helmets made us safer, all the studies would show a dramatic effect, like helmets while motorcycling, or seat belts in cars. But they don't - the results are mixed. Worse, most of the studies are based on data from emergency rooms, so they only look at skaters who have already fallen. That answers a different question: Do helmets make you safer while falling?
To help you understand the difference, let's look at a typical study, Patterns and Protective Equipment Used, Renata J. Frankovich, MD; Robert J. Petrella, MD, PhD; Chastity N. Lattanzio, MSc, Canada 2001. The study authors conclude by recommending greater use of helmets, which they note were worn by only 18.6% of the injured skaters they counted. But they also note that their observed use of helmets by skaters was under 10%. Do you see the problem? The <10% of skaters wearing helmets suffered 18.6% of the injuries, twice the injury rate of non-helmeted skaters!
Some people just don't believe statistics. And maybe skating just isn't popular enough or financially important enough to attract better studies. But the same phenomenon also seems to be at work in the world of bicycles, which are very well-studied.
The page www.cyclehelmets.org collects many articles on this subject, and scanning the headlines on their Home page gives you an idea of the typical content:
As a result of these studies, the European Cycling Federation recommends against mandatory helmet laws (ECF link).
Finally, the world of skiing has noticed the same effect: "We are up to 40 percent usage [this is the percentage of people on the slopes wearing helmets, a number that has increased about 5 percent a year for several years] but there has been no change in fatalities in a 10-year period." People who ski into trees used to die from head injuries; now they die from internal injuries.
How can it be possible that helmets don't make you safer? After all, they're designed to make you safer - isn't that the same thing? Well, no. I have no doubt that the makers of helmets and the many people who recommend them, especially instructors, have the best of intentions and really believe what they're saying. That doesn't make it true, though.
Let me give you an analogy that may make this easier to understand. As many of you know, the central part of the United States (the "red states") is crazy about guns. People there honestly believe that carrying guns makes them safer, and in fact this seems so obvious to them that you would have to be an idiot not to agree! If someone tries to force their way into your home, and they have a gun, you are going to be a victim. But if you have a gun, you can defend yourself. And in fact there are many stories bearing out that scenario, and they get wide press in that region.
But from a public health perspective, a region with lots of guns is a much more dangerous place! Just look at Latin America or Eastern Europe; Honduras is more than 2000x more gun-dangerous than Hong Kong. If guns make you safer, how come regions with more guns are less safe?
The situation is similar for helmets and skating. Obviously, there are some falls where a helmet does prevent or reduce injury, but it turns out they aren't frequent. I estimate that about 90% of the skaters I skate with don't wear helmets, and the number of head injuries that have required hospitalization among them has been zero, as far as I know. And I spent 6 years as a skate first aid responder with the two largest organized skates in Paris. We sent many skaters to the hospitals on a backboard and wearing cervical collars, because that was our protocol, but as far as I know none of them turned out to be injured beyond superficial scalp wounds - bloody, but not a danger to your brain.
I recently saw a video online showing a guy dropping a watermelon from shoulder height, first with the watermelon sitting in a helmet and then without. The watermelon broke open with the second fall, "proving" that helmets work. But in fact, that's not how helmets work. The danger we face is not a fall that would split our skulls like a watermelon - our helmets aren't strong enough to protect us against that much force anyway (they're only certified by dropping them from 4 meters)!
The danger we face is the internal collision between our brains and our skulls, and the resulting cerebral hemorrhage - that's how Natasha Richardson died, after refusing medical care for the 3 hours following her fall. We also face a danger from having our necks broken by a severe twisting or jerking of the head. Thus the job of the helmet is to cushion our heads against sudden decelerations - it's the helmet lining that's saving your life, not the hard shell.
There are several theories as to why helmeted skaters are injured more, not less. Some people think skaters with helmets take more risks - I don't see that. Some people think that sweat or the extra weight reduce vision - I don't think that's a big effect. Some people think that only beginners wear helmets - I don't think that's true, nor do I think beginners get injured more.
I think it's an attitude thing: a skater who chooses to wear a helmet makes other decisions that make him more likely to fall, and much more likely to get hurt. For instance, those skaters are much more likely to try to brake when they feel they're going too fast, while less fearful skaters might choose to ride out the descent in the security position without braking. Skaters with helmets more often brake with heel brakes instead of T-braking, which is much easier and more effective.
Likewise, fearful skaters tend to slow down as a first response to anything: bad pavement, cobblestones, sand, water or whatever. Not only does slowing down rob them of the stability of speed - think how much easier it is to ride a bicycle faster rather than slower - but braking itself makes them less stable. So they fall more often, and get injured more often. Generally, it is far more worthwhile to try to prevent accidents than to try to survive them.
Wearing a helmet while you skate probably isn't going to kill you, but it probably won't save your life, either. More important is to master the basics of skating - skating on one skate, the security position, and T-braking - and to skate with confidence instead of fear. And telling people to wear helmets (and all the other roller-derby protections) doesn't make them more confident. Skating is not a dangerous sport - it's much safer than descending a staircase or sitting on a bar stool while drinking. So let's help people master their fear and become better skaters.
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