Keep Your Brain Safe While Biking

By Tracie Bearden, MS, CCC-SLP, CBIST

Biking has become one of the most eco-friendly and popular methods of recreation and commuting in America. In 2022, the number of Americans who rode a bike reached 54.7 million, up from 51.4 million the year before. Biking is an excellent way to stay active, but it’s important to be safe, as biking is a common cause of brain injury.

Imagine this scenario: You ride your bike to work every day. One day, you wake up 20 minutes late, scramble to get ready, and realize that you forgot your helmet. You may think to yourself, “I’ve been riding a bike for 20 years, I’ll be fine this one time,” but the reality is, all it takes is one time to have a bike-related accident without a helmet to sustain a severe traumatic brain injury (TBI).

A TBI can result from a forceful impact, strike, or jolt to the head or body, or from an object that penetrates the skull and enters the brain. However, not every impact or jolt to the head leads to a TBI. Certain types of TBI can cause temporary or short-term issues with typical brain functions, affecting a person’s thought processes, comprehension, movement, communication, and behavior. More severe TBI can cause significant and lasting disability, and can even be fatal.

I have personally worked with the brain injury population for 14 years and have seen the ramifications of someone not wearing a helmet even one time on their bike. A severe traumatic brain injury can look like someone in a coma, a vegetative state, or minimally conscious. The individual may not be able to eat, move, breathe on their own, or be able to recognize familiar faces or objects. An individual with a moderate-severe TBI may experience short or long-term memory loss, visual impairments, physical impairments, and seizures.

Motor vehicle accidents, including those associated with bikes, are the third most common cause of TBI. This makes helmet usage more important than anything when riding any type of bike. Helmets reduce the likelihood of brain injuries by 65 percent to 88 percent, and they lower the risk of facial injuries to the upper and mid-face by 65 percent. They reduce the risk of severe brain injury by 75 percent. With the research showing these consistent statistics, it’s not hard to see the benefits of wearing a helmet while riding a bicycle.

Bicycling leads to the highest number of sport and recreation-related emergency department (ED) visits for traumatic brain injuries (TBIs) in the United States. The use of bicycle helmets was found to reduce head injury by 48 percent, serious head injury by 60 percent, traumatic brain injury by 53 percent, face injury by 23 percent, and the total number of killed or seriously injured cyclists by 34 percent.

Not only has the popularity of pedal biking risen, but the rise in usage of e-bikes and e-scooters – also known as MMPs– has significantly soared since the COVID-19 pandemic. A 2023 report released by the U.S. Consumer Product Safety Commission (CPSC), showed that injuries associated with all MMP devices increased by nearly 21 percent in 2022 from 2021. MMP-related injuries have trended upward since 2017, increasing by an estimated average 23 percent annually.

A JAMA Surgery study released in 2024 revealed that only 44 percent of hospitalized e-bike riders were wearing helmets. This same study showed that riders without a helmet were almost twice as likely to suffer head injuries than ones wearing a helmet. E-bikes can travel at speeds up to 20 miles per hour, making them more hazardous than traditional pedal bicycles. This speed makes e-bikes harder to control and more difficult to stop in the event of an accident. Additionally, some e-bikes can even reach speeds of up to 30 miles per hour, which is why it’s essential to wear a helmet when riding them.

Wearing a helmet on a pedal bicycle or an e-bike is essential to preventing a severe traumatic brain injury. Helmets are the best defense for preventing serious head injuries, lifelong disabilities, and even death when riding a bike of any kind. While you might be an experienced rider, the people and cars around you aren’t necessarily paying attention, adding an extra layer of danger when you’re on two wheels. A helmet is hard on the outside to absorb the impact of the crash and soft on the inside to protect your head.

And it’s not just about the helmet, it’s about a properly fitting helmet: your helmet should sit level on your head and low on your forehead—one or two finger-widths above your eyebrow. The helmet’s side straps should both form a V-shape under, and slightly in front of, the ears. Tighten the chin strap after snapping it together to ensure a snug fit that you can fit only two fingers between your chin and the strap. I recommend going to a qualified and trusted helmet store to have your helmet properly fitted before hitting the road.

There is no federal law for the use of helmets while riding a bicycle. Currently, 22 states – less than 50 percent of the country – have statewide helmet laws. Many of these statewide laws only apply to riders under the age of 16-18 years old, or e-bike riders. Not having proper safety protocols in place for high-risk activities and transportation puts riders at a high risk on the road.

Wearing a helmet decreases the risk of severe traumatic brain injuries, facial fractures, and skull fractures. The more we advocate for safety protocols including bike lanes, regulation of motorized bicycles and scooters, and universal helmet laws, the safer and less likely riders are to sustain severe traumatic brain injuries and facial fractures. This allows riders to enjoy these eco-friendly transportation methods and recreational activities without the added risks and dangers.

Tracie is a Denver-based Speech Language Pathologist and Certified Brain Injury Specialist Trainer. She has over 14 years of experience working with patients who have survived brain injuries in an acute care or intensive rehabilitation setting. She is the owner of TBI MedSLP, a non-profit organization that provides accessible and affordable brain injury education to speech pathologists and healthcare providers to improve patient outcomes and patient experiences.