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Thread: Do neck braces significantly reduce severe injury or death?

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    Default Re: Do neck braces significantly reduce severe injury or death?


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    Quote Originally Posted by Yorick View Post
    Wayne Rainey might disagree.
    Wayne Rooney might not.

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    Default Re: Do neck braces significantly reduce severe injury or death?

    Quote Originally Posted by The Spin Doctor View Post
    I assume racing is more dangerous than road riding but I have no figures.
    If by 'dangerous' you mean 'risk of death' it seems obvious to me that it's less dangerous. You've already said that racing deaths are very rare, and we all know that road deaths are not rare. Here are some figures https://assets.publishing.service.go...-2013-data.pdf
    https://bjsm.bmj.com/content/39/8/508

    Racing feels more dangerous because you spend so much time close to the limit of tyre grip, and because in the rain you can hardly see anything but you barely slow down. But your risk of death is much lower than it would be if you were commuting through a city.

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    Default Re: Do neck braces significantly reduce severe injury or death?

    Quote Originally Posted by nick h. View Post
    If by 'dangerous' you mean 'risk of death' it seems obvious to me that it's less dangerous. You've already said that racing deaths are very rare, and we all know that road deaths are not rare. Here are some figures https://assets.publishing.service.go...-2013-data.pdf
    https://bjsm.bmj.com/content/39/8/508


    Racing feels more dangerous because you spend so much time close to the limit of tyre grip, and because in the rain you can hardly see anything but you barely slow down. But your risk of death is much lower than it would be if you were commuting through a city.
    Is it so surprising that none of the racers who filled in the questionnaire reported their own death?

    If this report leads you to the conclusion that motorcycle sport is safe, you may be an optimist.

    Quote Originally Posted by BMJ
    A total of 117 elite motorcycle competitors including 36 road racers, 60 motocross racers, and 21 trial bike riders completed a questionnaire about injuries.

    Results: Sixty major injuries (25 in road racing, 32 in motocross, and three in trial bike riding) were reported. The most common injuries were fractures (45), followed by ligament injuries (, dislocations (5), and soft tissue injuries (2). The overall injury rate was 22.4 per 1000 hours....

    Conclusions: Injury rates in competitions such as road racing and motocross are high, and therefore additional safety measures are needed to protect competitors from injury.

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    Default Re: Do neck braces significantly reduce severe injury or death?

    The forces involved can't just be magicked away, so if you're wearing a neck brace (restricting head movement), is there a possibility of higher forces acting on the brain, resulting in greater injury?

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    Default Re: Do neck braces significantly reduce severe injury or death?

    Quote Originally Posted by Horse View Post
    The forces involved can't just be magicked away, so if you're wearing a neck brace (restricting head movement), is there a possibility of higher forces acting on the brain, resulting in greater injury?
    That's the real problem
    Braces, air bags, armour, none of them change the laws of physics. High energy crash = high probability of injury.

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    Default Re: Do neck braces significantly reduce severe injury or death?

    Quote Originally Posted by Cousin Jack View Post
    That's the real problem
    Braces, air bags, armour, none of them change the laws of physics. High energy crash = high probability of injury.
    It's more how the forces are managed. A car steering wheel airbag is timed so that it's deflating as the person 'meets' it, so cushioning the impact, slowing - for example - the head's change from moving to static.

    An airbag jacket with neck roll will stay inflated, but may 'give', whilst (presumably) a brace will have little or no 'give', so the head and brain may have high, sudden, forces.

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    Default Re: Do neck braces significantly reduce severe injury or death?

    Quote Originally Posted by Horse View Post
    It's more how the forces are managed. A car steering wheel airbag is timed so that it's deflating as the person 'meets' it, so cushioning the impact, slowing - for example - the head's change from moving to static.

    An airbag jacket with neck roll will stay inflated, but may 'give', whilst (presumably) a brace will have little or no 'give', so the head and brain may have high, sudden, forces.
    On a similar theme but, as always, suggesting that 'It's not quite that simple':

    https://academic.oup.com/brain/artic.../2/333/2770746

    We simulated three brain injury cases. These had very different head kinematics. Distinct patterns of brain deformation were predicted. The American football case involved a helmet-to-helmet impact. This resulted in acceleration pulses with smaller magnitudes but longer duration due to the compliance properties of both players. In contrast, the fall case involved head impact onto a rigid surface, resulting in head accelerations with larger magnitudes over a much shorter time. In the motorcycle accident, the helmeted head impact onto a rigid surface resulted in head accelerations with magnitudes similar to the American football impact but durations shorter than the American football impact and longer than the fall. The strains produced by head impact were largest in the American football case, which is consistent with previous studies demonstrating that acceleration pulses with longer duration generate larger strains within the brain (Margulies and Thibault, 1992; Kleiven, 2006). In contrast, strain rates were larger in the road traffic accident case and intermediate in the American football case. This might be related to the differences between the magnitude and duration of the acceleration pulse in these cases leading to variable responses of the brain due to its viscoelastic nature (Donnelly and Medige, 1997). The viscoelastic characteristic of neurons makes them more brittle when the rate of deformation increases, leading to their lower damage threshold to strain at higher strain rates (Elkin and Morrison, 2007; Tang-Schomer et al., 2010). Hence, high strain rates might produce more injury, and so our model results would predict that the road traffic and American football cases would be more likely to produce pathology in the sulci. This comparison indicates that nature of the initial head impact can have a significant influence on the pattern of brain injury parameters, which is likely to influence the likelihood of the development of long-term brain damage.

    DTI provided converging evidence about the presence of persisting sulcal damage following TBI. DTI provides an estimate of axonal injury after TBI (Mac Donald et al., 2007) of the type that can be produced by strain applied to individual nerves. For example, strains applied dynamically to the optic nerve caused accumulation of neurofilament proteins in axons 3 days post-injury leading to the formation of axonal swellings and retraction bulbs, which are hallmarks of axonal injury produced after TBI (Bain and Meaney, 2000). Significant changes in white-matter integrity were observed at the boundary of the grey–white matter within the sulci but not the gyri relative to controls. Hence, the locations were tau pathology accumulates are both exposed to large strain and strain rate and also show persisting evidence of structural damage. Further work is needed to explore the specificity and sensitivity of this imaging approach in predicting outcome following TBI, but our results suggest that diffusion imaging might be used to assess structural abnormalities at the grey–white matter interface in possible cases of CTE. Advances in the diffusion imaging, including improved spatial resolution, should make it easier to assess the impact of TBI on small white matter tracts and improve the assessment of abnormalities present at the grey-white matter boundary.

    We compared computational modelling predictions from a single fall, road traffic accident or sporting injury with neuroimaging results from a mix of different injury mechanisms. This is an informative comparison because CTE-type pathology is seen after injuries of different mechanisms and this is likely to reflect the underlying biomechanical forces produced at the time of injury, rather than distinct features specific to distinct injury mechanisms. CTE has most commonly been described in relation to repeated mild TBI, and has often been seen in a sporting context (McKee et al., 2009). However, there is little consensus about the frequency or severity of injuries that are required to produce CTE-type pathology. Smith et al. (2013) highlight that CTE-type pathology can be found years after just a single moderate-to-severe TBI. For example, in one neuropathological study 39 long-term survivors of single TBI were investigated (Johnson et al., 2012). Neurofibrillary tangles were exceptionally rare in the controls of this study, but were abundant and widespread in the around a third of TBI patients being commonly found in the depths of the sulci. This demonstrates that tau pathology is common after single TBI and is not confined to repetitive TBI. In addition, we have recently shown persistent amyloid pathology after a single TBI, which would be in keeping with CTE-type pathology present after single injuries (Scott et al., 2016). Therefore, understanding how the biomechanics of all types of TBI relate to CTE-type pathology is an important goal for TBI research broadly and not only repeated mild TBI.

    Future work will be necessary to clarify the links between distinct biomechanical patterns of injury, brain pathology and clinical features of post-traumatic dementia. We have demonstrated that various types of injury can produce high mechanical strains in brain regions that show tau pathology in cases of CTE defined at post-mortem. However, it is currently not possible to define CTE clinically with confidence. Hence, it is unclear whether cognitive impairment in our TBI group is due to post-traumatic neurodegeneration or other factors such as the direct effects of the initial injury. This uncertainty limits our ability to determine whether the type of injuries we have modelled are likely to lead to clinical problems as a result of the neurodegenerative pathology. Relatedly, although the neuropathological literature suggests that a significant proportion of survivors of single TBI will develop tau pathology (Johnson et al., 2012), it is unclear how pathology at these locations relates to clinical features or to the chance of developing overt dementia. Some of these issues are likely to be clarified in the near future by the use of molecular PET imaging of tau and amyloid pathology that will allow the presence and location of neurodegenerative pathology to be defined (Scott et al., 2016).

    Our results hold the promise of guiding improvements in protection from head injury, such as the development of novel helmet designs. Currently most TBI mitigation strategies are designed to reduce head translational acceleration. However, it is not clear that this is the optimal strategy for reducing the mechanical forces that lead to neurodegeneration following TBI (King et al., 2003). By using high fidelity computational models of brain injury, we have shown it is possible to map out the brain tissue response to head loading and this information could be used to focus the design of mitigation strategies on reducing the level of maximal strain and strain rate within the brain with particular attention to areas where pathology is observed.

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    Default Re: Do neck braces significantly reduce severe injury or death?

    And continuing the cheery theme:

    http://content.tfl.gov.uk/ppr621-mot...les-report.pdf

    For the post event:
    • The majority (80, 85%) of motorcyclists died on the same day as the collision;
    • The most common body regions with life-threatening injuries were the thorax (78%) or the head (63%);
    • Although there were cases with life-threatening injuries to limbs, in all cases other life-threatening injuries were also present;
    • There were 17 (18%) fatalities whose helmets were displaced by the collision;
    • 17 (18%) drivers of other vehicles in the collision were convicted for an offence following the collision, most commonly ‘careless driving’; and
    • 13 (14%) fatalities had injury levels that were classed as ‘untreatable’.


    Post mortems were available and coded for 86 motorcyclist fatalities. In total 1,240 injuries were coded, of which 339 were ‘life threatening’ (AIS >=3). Figure 5-6 shows the percentage of motorcyclists with life threatening injuries for each body region. ‘Head’ includes neck and face.

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    Post Re: Do neck braces significantly reduce severe injury or death?

    Quote Originally Posted by Cousin Jack View Post
    High energy crash = high probability of injury.
    I agree.

    Though things like airbags should help in lower speed crashes, which are common on the road:
    Quote Originally Posted by Liz de Rome et al
    over half the crashes (57.1%) involved estimated impact speeds less than 40 Km/h with only 16.5% over 60 Km/h
    Source: de Rome, L., Ivers, R., Fitzharris, M., Du, W., Haworth, N., Heritier, S., & Richardson, D. (2011). Motorcycle protective clothing: protection from injury or just the weather? Accident Analysis and Prevention, 43, 1893 - 1900

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    Default Re: Do neck braces significantly reduce severe injury or death?

    Quote Originally Posted by Zebedee View Post
    Quote Originally Posted by Cousin Jack

    High energy crash = high probability of injury.
    I agree.
    Not necessarily. It's down to 'mechanism'. Or, to quote from a London Helimed Dr on TV a while ago, when arriving at the scene of a bike Vs car, "It's always bad when the rider is still close to the car." Or, as the old parachuting saying goes: "It's not the drop, it's the stop".

    As far as bike crashes go, there are so many variables involved, with biggies such as Crunch or Slide or Tumble . . .

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    Default Re: Do neck braces significantly reduce severe injury or death?

    Quote Originally Posted by nick h. View Post
    If by 'dangerous' you mean 'risk of death'
    The OP asked "Do neck braces significantly reduce severe injury or death?", so I was thinking in those terms, not just fatalities.


    it seems obvious to me that it's less dangerous. You've already said that racing deaths are very rare, and we all know that road deaths are not rare. [/url]
    It's not just gross numbers, it's exposure rate. You'd need to know something like fatalities per thousand hours (or some other measure that's equivalent across both road and race environments).

    And if you look at the fatalities in terms of population and exposure rather than simply counting the gross numbers, road deaths ARE rare. Around 350 per annum out of the entire biking population which is somewhere between 1 and 2 million.

    Racing feels more dangerous because you spend so much time close to the limit of tyre grip, and because in the rain you can hardly see anything but you barely slow down. But your risk of death is much lower than it would be if you were commuting through a city.
    Actually, urban crashes contribute relatively less to the fatality total than do out-of-town junction collisions, cornering crashes and overtakes that go wrong. The higher extra-urban speeds have a lot to do with that.

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    Default Re: Do neck braces significantly reduce severe injury or death?

    The worst racing injuries are when you hit the track furniture, or highsides.

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    Default Re: Do neck braces significantly reduce severe injury or death?

    Quote Originally Posted by Yorick View Post
    The worst racing injuries are when you hit the track furniture, or highsides.
    The sort of speeds you travel at, I'd die of fright (or from clinical shock due to sudden loss of body fluid, because I'd suddenly gone very badly incontinent)

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    Default Re: Do neck braces significantly reduce severe injury or death?

    Quote Originally Posted by Yorick View Post
    The worst racing injuries are when you hit the track furniture, or highsides.
    Which is why so much effort has been made to remove track furniture.

    Mind you, I did like the tree in the middle of the loop at Mallory. Gave it a nice 'park' feeling

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    Default Re: Do neck braces significantly reduce severe injury or death?

    Quote Originally Posted by Horse View Post
    The forces involved can't just be magicked away, so if you're wearing a neck brace (restricting head movement), is there a possibility of higher forces acting on the brain, resulting in greater injury?
    I guess another way of asking this is, do you increase some failure modes by reducing others? In risk mitigation you always take the strategy of reducing the biggest risks first, in this case the relatively weak area of the cervical vertebrae which have a heavy weight bobbing round at the end of them. Going back to the last thing I posted I'm inclined to think the risks of spinal or cranial injury are more influenced by the type of crash and terrain. Motocross, where you have a higher risk of landing on your head but on relatively soft terrain, is more likely to produce a neck injury. On tarmac the big issue is hitting your head on something hard and possibly angled. One is about reducing the risk of neck hyperextension, the other is about reducing the high deceleration forces from hitting a solid object.

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