No One Kind Fits All

Experts Say Different Sports Require Different Helmets

"Don't forget to wear your helmet," parents tell their kids now that warmer temperatures are luring them outside to cycle, skateboard, rock climb, kayak and ride horses. And with good reason. "Helmets basically keep your skull from cracking," says pediatric neuropsychologist Gerard Gioia, director of the Safe Concussion Outcome, Recovery & Education Program at Children's National Medical Center.

But as the number of outdoor activities continues to add up, so do the helmets meant to protect against head injuries. My family of two adults and two children owns four bike helmets, three horseback riding helmets, three ice hockey helmets and two skateboarding/scootering helmets. We have rented ski helmets, and I will need to send my son to lacrosse camp with a lacrosse helmet this summer. Twelve helmets sure feels like a lot.

Can't one all-purpose helmet suffice?

In a word, no, say medical experts. That's because different sports subject the body to different forces from different directions -- and sport-specific helmets are designed accordingly.

"If you think about riding a bicycle, people tend to fall off front first, so they are more at risk for the front of their head hitting the ground, or a wall, because they are moving forward," Gioia says. A bike helmet has frontal protection to guard against this.

"But then you have kids that are on skateboards, and the more typical thing for a skateboard is the skateboard zipping out, and you fall backwards and hit the back of your head." Skateboard helmets typically cover more of the skull and the back of the neck than bike helmets.

Head trauma is dangerous because it can cause bleeding, concussion (a jarring brain injury) and seizures, says Gholam Motamedi, an associate professor of neurology and director of the epilepsy program at Georgetown University Hospital. "In fact, if there is a piece of bone breaking into the brain, the chances of epilepsy would be as high as 30 to 50 percent," he says.

Hard-shell, foam-lined sport helmets reduce the risk of injury by absorbing much of the force that, in a fall or collision, would otherwise go directly to the head. The problem has been getting people to use them.

For the 900 or so people killed each year in bike-related crashes, head injury is the leading cause of death. Bike helmets have been shown to reduce the risk of head and brain injury by 85 percent or more. But of the more than 80 million bike riders in this country, approximately 43 percent never use helmets, according to the American Academy of Orthopaedic Surgeons. Children 5 to 14 are most at risk of bike accidents.

Safe Kids USA, a national coalition working to reduce childhood deaths from accidental injury -- the leading killer of children ages 1 to 14 -- released a report yesterday showing progress since 1987. A 10-step safety checklist published with the report, available at http://usa.safekids.org, reminds parents to make sure "children wear a helmet and other protective gear every time they bike, skate, skateboard, or ride a scooter."

Since the 1990s, helmet use has become increasingly common in all sports. Twenty-one states (including Maryland) plus the District require cyclists to wear a helmet, according to Safe Kids USA; Virginia has never passed a bike helmet law, but several Northern Virginia counties, including Fairfax, Arlington and Prince William, require their use by children younger than 15, according to the Bicycle Helmet Safety Institute. At least six states plus the District also require children to wear helmets while using scooters, skates and skateboards. But in some sports, lenient policies still compromise safety.

Drusilla Malavase, a horseback riding helmet expert, is critical of ice skating rinks and riding academies that sometimes let students take introductory lessons in bike helmets because most people already have them at home.

"It is not okay for anyone, especially beginners, to ride horses in bike helmets," says Malavase, who co-chairs the Equestrian Helmet Subcommittee of the American Society for Testing and Materials, which publishes standards for athletics. "Many of the lower-priced equestrian sport helmets look enough like bike helmets that it isn't easy to tell the difference from a distance." However, equestrian helmets have much better mechanisms such as harnesses and chin straps to keep the helmet on and closely fitted to the head, she says.

As demand grows for better protection, helmet design is evolving. For example, says Motamedi, study authors who reported on a cheekbone fracture suffered in alpine canoeing suggested that kayak helmet designers might want to incorporate facial protection in their products.

Materials are constantly changing, too. Leather football helmets long ago gave way to lighter, stronger polycarbonate shells. The old equestrian velvet "hard hats" are being replaced by high-tech foam versions. Designers and biomechanical engineers are working on helmets with thermoplastic shock absorbers, Gioia says. On impact, these air-based devices may provide more protection by taking more of the force away from the brain.

For now, however, anyone participating in a sport with a risk of head trauma needs to find the best helmet out there for that particular sport. It may mean that you will end up with an entire shelf dedicated to helmets, but the increased safety is worthwhile.

"We parents are paying money for different applications, because there are different risk profiles with different activities," Gioia says. "It doesn't matter whether it is a recreational kid or a high-level athlete, it is force to the head. I would say to any parent, I would not cross sports with helmets."

Eliza McGraw is a Washington area freelance writer. Comments:health@washpost.com.