Why You Should Always Wear a Helmet
By: Brian Hoeflinger, MD
February 8, 2026 | #75
Forwarded this email? Sign up here.
Disclaimer: Opinions are my own. Not medical advice.
Medical Trivia of the Week
By what percentage do helmets reduce the risk of severe traumatic brain injury in cyclists? (the correct answer is at the end of this email)
- A) 40-50%
- B) 30-40%
- C) 70-80%
- D) 50-60%
Let Me Show You What This Looks Like
In 26+ years as a neurosurgeon, I've seen and operated on hundreds of traumatic brain injuries. One of the biggest predictors of who walks out of the hospital, and who leaves with a life that will never be the same, is whether that person was wearing a helmet.
This applies whether you're on a bike, a motorcycle, skis, or a snowboard. The brain doesn't care what activity you were doing. The physics are the physics.
What This Looks Like in Real Life
I want to share two stories with you to get this point across. Same basic situation. Two completely different outcomes. Of note, these are generalized scenarios based on countless cases I've seen over the course of my career rather than any one individual's specific scenario.
Story 1: No Helmet
A person, let's call him Jake, heads out for what feels like a normal ride on his motorcycle. He isn't trying to be reckless, but he forgot his helmet. Jake isn't worried. He's ridden his motorcycle so many times before and never been in an accident. But then the unexpected happens. A car pulls out in front of him and he hits it head-on at high speed. He flies through the air and hits his head on the road, hard.
Someone calls 911 and an ambulance arrives at the scene. The paramedics check the basics: airway, breathing, and circulation. But it's clear Jake has a severe head injury. He's unconscious and unresponsive. By the time he reaches me in the ER, he is in a deep coma. His CT scan does not look good. His brain didn't just bruise where it hit the pavement; it rebounded and smashed into the opposite side of his skull. The impact caused massive bleeding and rapid swelling. Despite our best efforts in the operating room to relieve the pressure, the damage to the brain tissue is too extensive. After speaking with Jake's parents, life support is withdrawn and Jake's organs are donated to help save the lives of others. Jake made a mistake. He decided not to wear his helmet. And he ended up dying.
Story 2: Helmet
Now let's talk about another person, let's call him Josh. He is about to leave work to head home. Josh grabs his helmet, puts it on, and hops on his motorcycle after clocking out. Josh is listening to his favorite song on his headphones when a car suddenly pulls into the road from a side street. Josh hits the car at speed and flies through the air and then hits his helmet on the road, hard.
The paramedics find Josh dazed and confused, a clear concussion, but he is awake and talking. He's transported to the hospital where I evaluate him. His CT scan shows a few small spots of bruising, but no major bleeding and no skull fracture. The helmet took the brunt of the energy, cracking and compressing just as it was designed to do. Instead of a fatal blow, the force was dispersed. Josh spends one night in the hospital for observation and walks out the next morning. He has a long recovery from his concussion and broken bones ahead of him, but he is alive, and his personality and memory are intact.
Why Helmets Work
Your brain is soft tissue inside a hard skull. When your head stops suddenly, your brain keeps moving. It can bruise against the inside of the skull, tear blood vessels, and swell. Pressure rises because the skull can't expand, and high pressure is one of the fastest ways a head injury becomes life-threatening.
Helmets help by changing the force of impact. They spread that force over a slightly longer time and across a larger area, lowering the peak force that reaches your brain. It's like a crumple zone for your head.
No helmet makes you invincible. Helmets can't guarantee you won't get a concussion. But they can dramatically reduce the risk of catastrophic brain injury, and that difference is everything.
What To Do Today
Wear a helmet every time, even on short rides. Make sure it fits snugly, sits level, and is strapped correctly. Use a helmet designed for your activity, and avoid "novelty" helmets. If you take a significant hit, replace it, even if it looks fine , because it may be compromised.
Most life-changing crashes aren't planned. Helmets are for the unexpected. Don't gamble with your brain.
Want to Go Deeper on This?
I made a video walking through everything I covered in this newsletter but in more detail. I talk about what actually happens to the brain during impact, why the physics of helmets matter, and what I've learned after seeing these injuries firsthand for over 26 years. If this topic hit home for you, then I think you'll get a lot out of it.
π Watch the full video on YouTube: Click Hereβ
Impactful Quote of the Week
"Do the best you can until you know better. Then when you know better, do better."
- Maya Angelou
All my best,
Brian Hoeflinger
P.S. - if you enjoyed this newsletter, you may enjoy my podcast and/or my book that details my life as neurosurgeon and the loss of my oldest son, Brian (see below a synopsis).
Check out My Book
Life and Death . . . Two words with such opposite meaning and which inflict such contradictory emotions and yet are so closely intertwined in our lives. As parents, we bring meaning and life into this world through our children. Our lives become defined as a result. We learn the joy, hardship, and responsibility of shaping an innocent life. But a day will come when that life will be taken. For some, death will come too soon. This is the story of my son, Brian Nicholas Hoeflinger, who died unexpectedly at age 18.
βhttps://doctorhoeflinger.com/products/the-night-he-died-the-harsh-reality-of-teenage-drinkingβ
Check out My Podcast
The Dr. Hoeflinger Podcast is about more than medicine, itβs about living a fuller, healthier, and more meaningful life. My son, Kevin, and I discuss medicine, health, fitness, lessons learned from personal tragedy, family, and purpose. Along the way, we invite inspiring guests to bring fresh insights and perspectives. Watch or listen to the podcast below.
YouTube: Click hereβ
Apple Podcasts: Click hereβ
Spotify: Click hereβ
Please reply with any questions you may have or future topics that you want me to write about.
If you enjoyed this newsletter or previous editions, please share it with a friend. You can use this link: https://pages.doctorhoeflinger.com/postsβ
Medical Trivia Answer:β
The correct answer is D) 50-60%
*Disclaimer: This newsletter and blog is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this newsletter and blog or materials linked from this newsletter and blog is at the userβs own risk. The content of this newsletter and blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay seeking medical advice for any medical condition they may have and should consult their healthcare professionals for any such conditions.
β