The Neck Brace Web Component

#

Intro and compiled by Pete Peterson

After the Dirt Rider feature story “The Neck Brace” (May 2013 issue) was completed it was shared with several companies and individuals and they were given the chance to make an official comment, whether to agree, challenge, expand upon, or offer different theories. The participants where asked not to make direct comparisons brand to brand. Those comments are below, “cut and pasted” directly from the source – they are speaking on their behalf (whether as a company or individual).

The magazine story had several endnotes, and those references are listed after the comments.

RESPONSE FROM DR. JOHN BODNAR

I want to applaud Pete Peterson and the staff of Dirt Rider for taking the effort to produce a very balanced report on a topic of major importance to the motorcycle community.  There are many misconceptions in the area of neck injuries and the issues of neck brace usage in our sport.  This article presents the facts as they stand today and hopefully will continue the discussion of protective gear in motorcycling, especially in off-road and motocross riders.  The topic of motorcycle safety is one that at times can seem to take a back seat to other issues, and Dirt Rider has performed a genuine service to all riders in bringing this article to the forefront.

John A. Bodnar, MD

Medical Director, Asterisk Mobile Medical Center

RESPONSE FROM JIMMY BUTTON

"I am happy to see someone finally presented a non bias story on it and just gave the facts."

RESPONSE FROM DR. STEPHEN SWISHER

I'm an emergency physician at Mammoth Hospital, in Mammoth Lakes, CA.  We treat motocross injuries every summer, particularly during the Mammoth Motocross.  An increasing number of our patients arrive wearing neck braces.  Often the brace was broken in the crash.  Many of these riders tell me they wouldn't have walked away from the crash without a neck brace.  Sounds promising.

Unfortunately, it's difficult to separate promise from reality.  Currently there's no large, randomized controlled trial to show that the braces have any effect.  In fact, there are few studies regarding neck braces.  Most neck brace research thus far is manufacturer-sponsored and potentially biased (bias can be unintentional--the desire for a study outcome can lead you to that very outcome).

Quality research takes time and large numbers of patients.  For example, it took years to establish that ski/snowboard helmets actually decrease the rate and severity of head injuries.  The medical literature is filled with promising therapies and interventions that never panned out.  It’s too early to say whether neck braces will be shown to be beneficial, like ski helmets, or of no benefit, like antibiotics for the common cold.

And here’s the counter-narrative.  In my practice, every patient who walked away from a crash wearing a neck brace was matched by a patient without a neck brace who also walked away from a crash.  Although I've treated several hundred motocross patients, it's unclear to me whether the neck braces make a difference.  My patient numbers are simply too small for a trend to be noticeable.

I want to believe in neck braces. The theory behind them seems sound.  They aren't cheap but they aren't expensive either.  It's unlikely that they increase the risk of other injuries such as clavicle fractures.  It’s up to you.

Stephen A. Swisher, MD

Mammoth Hospital

Mammoth Lakes, CA

RESPONSE FROM DR. ERIK SWARTZ

I was honored, and fortunate, to be contacted by Mr Peterson as he was developing this excellent article on the practice of wearing neck braces in motorcycle riding. My primary area of interest actually concerns the management of catastrophic head and neck injury in equipment intensive ‘collision’ sports, such as American Football. I conduct research on this topic and also serve on the National Football League’s Head, Neck, and Spine’s Subcommittee on Safety Equipment and Rules. Obviously motorcycle riding and American football are similar in that the participant typically wears protective equipment to prevent injury, such as a helmet. So, I was immediately intrigued with the concept of a protective neck brace to mitigate spine injury, primarily because of my lack of familiarity with the sport and its associated injury mechanisms. I was also keenly interested since my uncle is a long time participant in Enduro racing, and has had his share of crashes and injuries.

When first confronted with a new protective device or design I tend to be of a skeptical mindset until I am convinced of its merit. After reviewing materials that were provided to me I was immediately impressed with the detailed work that one of the neck brace companies had already undertaken to produce validity and reliability data for their product. These efforts are commendable, and clearly are critical, in manufacturing a device that not only does what it is designed to do, but equally important, doesn’t do anything it’s not supposed to do. These efforts should not be halted, however. Rather, companies should be willing to accept that validity, reliability, and effectiveness of a product designed to prevent (or minimize) injury is essentially a never-ending pursuit and empirical data should be reproduced externally, and independently wherever possible. Internally produced data and anecdotal claims are of a lower level of evidence in the medical and scientific communities.

Another element I was pleased to see with one of the company’s materials, and also reflected in the article, is that the manufacturer of a neck brace is careful with the claims they make regarding its products’ protective capabilities. For example, when I first looked at the device my initial conclusion was that it would not help prevent spine injuries due to an axial load mechanism, (when an impact is directed at the crown of the head and compresses the cervical spine) the most common mechanism for serious spine injury in American football. It was refreshing to see that the company states from the outset that their product is, indeed, not designed to prevent injury from this mechanism. The tempered claims of the protective equipment a manufacturer enhances the confidence in the claims the manufacturer makes about what the product can do. We have recently seen the US Federal Trade Commission investigate and charge companies regarding deceptive claims made about the health benefits of their products, most notably with products that claim to reduce the risk of concussion. A cautious marketing strategy for any manufacturer of protective equipment is warranted.

Finally, I would like to comment on a side effect, sort of speak, inherent to the introduction of new protective equipment into any sport or activity. Namely, a phenomenon described by others as ‘risk compensation’ means that individuals may increase their threshold of risk if they feel more protected. An easy example I tend to use to describe this is with sky-diving. Most people’s threshold for risk is such that if standing at an open door of an airplane in flight, thousands of feet off the ground, most would probably not elect to jump out of the plane. However, give a person a parachute that will protect them from harm, and their threshold for risk is now elevated so much that they feel safe enough to change their behavior and accept the risk of jumping from the airplane. American football experienced an unfortunate outcome of this risk compensation in the late 60’s and 70’s when helmet designs moved to incorporating a hard outer shell and a facemask. Players began to use their heads during tackling (spearing), a behavior that previously was avoided because their helmets did not afford much protection; and the rate of catastrophic neck injuries sky rocketed. Therefore, we navigate a fine line between protecting participants of sport from injury, and avoiding the unintended consequences that might come from them gaining a false sense of security. Honestly, from my perspective its hard to imagine motorcycle riders doing anything more risky than they already are, but I’m always mindful of the individual that assumes higher risk because they feel more protected.

Erik E Swartz, PhD, ATC, FNATA

Associate Professor, Clinical Coordinator

Athletic Training Education Program

University of New Hampshire

RESPONSE FROM ATLAS BRACE

OUR DESIGN

Atlas is extremely unique when it comes to neck brace technology. Every Atlas Brace is based our patented flexible technology. By incorporating flex into the neck brace, our goal is to not only reduce the forces on the head and neck, but also for the brace itself to dissipate and possibly reduce those impact forces before they are transferred to other areas of the body. By sitting around the spine and sternum, and using dual chest and back supports we increase the surface area that the brace rests on the body, which can help to spread out the impact forces rather than concentrate them in small areas. This flexible technology creates many unique characteristics that are not possible to achieve with rigid designs, and which is why we believe so strongly in our products.

OUR MISSION

Atlas’ mission was to create a testing method that could get as close to mimicking real life as possible. We use a 3rd party team of experts to perform our testing, so we are able to obtain un-bias results that are not under our own influence or design. The bulk of Atlas’ impact testing is performed by Dynamic Research, Inc. (DRI) in Torrance, CA by their extremely knowledgeable staff of Bio-Mechanical Engineers and Doctors, who are regular off road motorcycle riders themselves that understand what kind of dangerous scenarios they may be faced with.

DRI has previous experience testing braces, and had multiple ideas on how to not only better the technology, and the testing performed on them. Their team started from scratch to come up with something radically different that would provide us with useful repeatable tests, and more accurate data from scenarios which we see in real life.

HOW WE TEST

Since most crashes riders experience are very violent and can include multi-directional forces, a better real-world testing method was needed. DRI was able to create a custom built, forward/downward pendulum test rig (think Superman in flying position) that not only measures deflection in the direction of our choice, but also compression to the head and neck caused by the body’s weight crashing down behind the head as it typically does in various motorcycle crashes. With our one of a kind test rig we are able to repeat multiple controlled impacts into a custom built adjustable-angle surface. These mimic various scenarios of common crashes, including the “lawn dart” scenario of a rider going over the bars, and impacting head first into the ground, or an upcoming obstacle. This type of testing gives us extremely useful, and repeatable data that we can use to further develop our products.

Our Dummy is made up of an instrumented upper torso surrogate fitted with a Hybrid III head-form and a Motorcycle Anthropometric Test Device (MATD) neck, which was specifically developed (and certified) by DRI to be more realistic for data acquisition during motorcycle crash scenarios than a standard car crash type neck. Instrumentation on the surrogate includes a 9 accelerometer array mounted inside the Hybrid III head-form for measurement of linear and angular accelerations as well as a 6-degree-of- freedom upper neck load cell that monitors three dimensional forces and moments. A digital high speed video camera collecting data at 1000 frames per second is used to capture all impacts. The complete upper torso fixture is illustrated in

Fig. 1, and the MATD neck is shown in Fig. 2.

In all our testing, each test scenario was performed with, and without an Atlas Brace to provide comparative results. We were very pleased to find positive results in every impact scenario we performed, and that in each situation wearing an Atlas Brace was successful in reducing the forces to the head and neck, comparative to not wearing a brace in the same impacts. Although this does not in any way guarantee an injury will prevented or reduced, it does give us extremely valuable data related to our products positive performance while helping to further the development and understanding of impacts that riders may experience and how we can better control these forces. While our testing is unique and not directly comparative to some of our competitors testing, we still feel very strongly that neck braces are a vital component of rider safety, and should be highly considered as part of every riders’ program.

CERTIFICATION

In addition to our lab testing performed in the USA, the Atlas Brace is lab tested in Europe to meet various CE standards. The Atlas Brace conforms with the requirements of the European Directive 89/686/EEC concerning Personal Protective Equipment (PPE). CE is the only current certification for neck braces, and Atlas is proud to meet these requirements.

THE REAL WORLD

Often times devices which perform extremely well in Lab scenarios pose multiple challenges in the real world. During the initial design phase of the Atlas Brace we found this to be a very difficult to overcome, and searched for the best way to combine mobility and comfort, with safety and protection. Since the development was lead by a former professional motocross racer, we were able to carefully develop this mix over a 3 year period. We credit a huge portion of this to our real world rider testing, input, and feedback, as well as the developmental input from DRI who had a big influence on how to create a controlled flexible design that would provide the safety results we were looking for. The results are exactly what we hoped for, and we believe that having former Champions Ryan Villopoto and Jake Weimer choose to wear our product shows that we have created a great product. When asked about riders who choose to wear, or not wear a neck brace, this is what Ryan Villopoto had to say: “For me, it’s a choice I make, and even if a neck brace only helped me one percent, that’s a one percent advantage I have and it’s only going to help.”

RESPONSE FROM LEATT CORPORATION

In our history there have been many articles written about our neck braces and neck braces in general. No journalist has ever before gone into such detail and found so many independent, qualified resources for information and opinions. All we have ever tried to do, here at Leatt, is make a business out of helping protect riders and for this detailed article we owe thanks to Dirt Rider for effort, investment and integrity to publish this.

Leatt has a open door policy on our science, technology, testing and test results. It has been this way for many years now and even our legal team has said that full disclosure reduces liability and promotes informed decisions by riders. Sadly, in my 36 years of motorcycle industry experience, most legal advice about safety products is “say nothing”. In our opinion that advice just leads to confusion, misunderstandings and more injured riders. It concerns us that some other safety product companies either don’t have the test procedures and test results or choose not to share them. I just don’t see how that policy benefits the riders or the companies and we can only hope they change their policies.

Yes, I work for Leatt. But I am also a rider and racer. I had a motorcycle shop owner I did business with who was tragically killed in a desert race crash from a neck injury. I was a supplier to that shop of protective equipment and remember how helpless I felt facing his wife and knowing that there was nothing made, at that time, to help protect from that injury. I don’t have to work at Leatt, I choose to. Dr. Leatt didn’t need to make neck braces, he already had a nice career. We all choose to do what we do for the riders.

Provided by Phil Davy, Leatt International Marketing manager and Leatt USA General Manager

END NOTES FOR MAGAZINE STORY

Below are the endnotes to the May 2013 Dirt Rider feature story “The Neck Brace.”

As the story pointed out under in the “The Trouble With Numbers” section, “It’s very difficult to find medical statistics on SCI from off-road and motocross crashes; too many of these statistics are from streetbike crashes, and many of those don’t even show if the rider was wearing a helmet.”

In nearly all cases the statistics are for general injuries and do not take neck brace effectiveness into account, since none of the studies cited here collected that data. These endnotes then should be thought of as information on injuries, in most cases from motorcycle crashes, but there is no conclusive “with a neck brace vs. without a neck brace” motorcycle crash injury statistics that could be found during the writing of this magazine story.

Another challenge is that these documents are not easily available for people outside the medical/research field. I have included a few helpful links for readers who want to read the full studies. The links will lead you to an Abstract (summary), and you will have to subscribe/pay to see the entire document.

These endnotes are supplied to assist you if you want to delve deeper into this topic of neck protection effectiveness. If you'd like to share insight or information with Dirt Rider please email to DRMail@sorc.com and cc pete.peterson@sorc.com.

I will use for this first endnote some AMA motocross statistics that are unpublished but were provided to the authors of the Leatt White Paper. For this data see Table 2-6 on page 17 of the Leatt White Paper ( http://www.leatt-brace.com/images/uploads/library/LEATT_WHITE_PAPER_FINAL_rev1.pdf ), or check their General Injury Statistics page ( http://www.leatt-brace.com/images/uploads/accident_form/Injury_Stats.pdf ) which reference some AMA Motocross statistics that shows that approximately 29% of spinal fracture injuries in the very small collection of motocross crash data resulted in spinal cord injury. This percentage is not very reliable since it was drawn from such a small body of date.

Drawing from a larger pool of data-

Robertson A, Giannoudis PV, Branfoot T, Barlow I, Matthews SJ, Smith RM. Spinal injuries in motorcycle crashes: Patterns and outcomes. The Journal of Trauma. 2002;53:5-8.

- shows approximately 20% of spinal injuries resulted in spinal cord injury (25 out of 126).

Here's a link to get access to this paper on a 'subscribe to read' site that hosts papers from many medical journals - http://journals.lww.com/jtrauma/Fulltext/2002/07000/Spinal_Injuries_in_Motorcycle_Crashes__Patterns.2.aspx

From Dr. Chris Leatt, “The incident of neurological deficit depends on the study group e.g. MVA vs. dirt bike accidents. The risk of spinal column injury may be 3 – 7%, of these approximately 20% plus may have a neurological deficit, but for the dirt bike group the study groups are relatively small and statistical significance difficult to prove. The white paper includes this topic.” A neurological deficit generally means full or partial loss of muscle groups and organ function, and that neurological deficit can be temporary, incomplete, or complete.

] –

These statistics are possibly misleading since so many motorcycle spinal cord injury statistics are gathered from motorcycle riding on streets (motorcycle or scooter), and it was pointed out to me during my research for the Dirt Rider story that in many of these studies the details surrounding the rider’s gear and the crash are not available. This is frustrating for the sake of researching the effectiveness of neck protection in motocross and off-road motorcycle crashes, but in the grand scope of things it is overall good news, as was pointed out to me, that these types of injuries are rare enough that gathering a large enough body of information is difficult. The references to the medical journals, however, are –

Robertson A, Giannoudis PV, Branfoot T, Barlow I, Matthews SJ, Smith RM. Spinal injuries in motorcycle crashes: Patterns and outcomes. The Journal of Trauma. 2002;53:5-8.

Here's a link to get access to this paper on a 'subscribe to read' site that hosts papers from many medical journals - http://journals.lww.com/jtrauma/Fulltext/2002/07000/Spinal_Injuries_in_Motorcycle_Crashes__Patterns.2.aspx

Robertson A, Branfoot T, Barlow IF, Giannoudis PV.Spinal injury patterns resulting from car and motorcycle accidents. Spine. 2002; 27(24):2825-2830.

Here's a link to get access to this paper on a 'subscribe to read' site that hosts papers from many medical journals - http://journals.lww.com/spinejournal/Fulltext/2002/12150/Spinal_Injury_Patterns_Resulting_From_Car_and.19.aspx

Shrosbree RD. Spinal cord injuries of motorcycle accidents. Paraplegia. 1979; 16:102–12.

Kuppferschmid JP, Weaver ML, Raves JJ, Diamond DL. Thoracic spine injuries in victims of motorcycle accidents. Journal of Trauma.1989; 29:593–596.

Here’s a link to get access to this paper on a ‘subscribe to read’ site that hosts papers from many medical journals –

Gorski TF, Gorski YC, McLeod G, Suh D, Cordero R, Essien F, Berry D, Festus D. Patterns of injury and outcomes associated with motocross accidents. The American Surgeon. 2003; 69; 10: 895-98.

These are the specifications of the test dummy that the Leatt Laboratory uses –

Hybrid III 50th percentile Anthropomorphic Test Dummy with:

  • Chest Potentiometer

  • 3  x Uni-axial Head Accelerometers

  • 6-Axis Upper Neck Load Cell

  • 6-Axis Lower Neck Load Cell

  • 2 x 2-Axis Clavicle Load Cell

  • 3  x Uni-axial Chest Accelerometers

  • 2 x Tri-axial Head Gryometers

  • MATD & Hybrid III neck

Hydraulic Automotive Impact Pendulum – 6.5m vertical lift = ±40km/h impact

High Speed Camera - PhotronFastCAM SAE3 – 1000fps @ 1024x1024

Non-flicker lights – Dedo DLH 200D

Data Acquisition Unit - 28 measured channels – SoMateDAQ Lite

Post-Processing software – nCodeGlyphworks

HBM PACELine CMC 120kN piezoelectric force transducer

Various S Beam Load Cells

Shaft Encoder for shaft rotation measurement

Inverted Impact pendulum for unrestraint torso testing

Horizontal Impact pendulum for unrestraint torso testing

Helmet drop tower  to test according to various test standards – up to 10m/s impact

CE drop tower for PPE certification testing

Fatigue tester

Slow tension / compression testing equipment

6m Vertical Drop tower for dynamic material testing

Various temperature chambers

R &D workshop with the following capabilities:

  • Carbon Fibre / Kevlar / Fibre Glass Layup

  • Precision Drilling

  • Milling Machine

  • Grinding Room

  • Spray Painting

See endnote 3

SVEMO letter

Leatt looked into the Internet rumor of a rider in Sweden being cut with a shattered neck brace. Leatt couldn’t find any evidence of this rumor being true, and their search actually resulted in a letter from SVEMO (The Swedish Motorcycle and Snowmobile Federation) stating that none of the fatal injuries from that year were associated with head or neck trauma or with neck braces. You can read that letter, it’s posted on Leatt’s website, with this link –

The magazine feature story and this web story are, as has been mentioned before, not an end point, but just a discussion of information available today. Hopefully more information will becomes available, more advancements in protective gear will be made, and more discussion will help share all the facts, concerns, theories, and advice with motocross and off-road riders.