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Helmet safety, Dizziness/Balance/Vertigo

By July 7, 2016July 11th, 2016Body Balance Quarterly

Body Balance Quarterly #2

Head Injury, Helmets and How to Treat Brain and Vestibular Problems

In this Issue:

  1. Helmet Safety
  2. Dizziness, Balance and Vertigo Treatment
  3. Body Balance Bursary


In our office, we are seeing more and more people for treatment following concussions and other head injuries. Whether this is because more injuries are occurring or whether health care practitioners and the public are better educated to recognize them, is still up for debate; however, the fact remains that head injury is a growing problem.

The best way to treat a head injury is to never have one in the first place. That is why proper helmet use is so important.

Here is a list of a few tips for getting the proper helmet.

  • Understanding How A Helmet Works

The purpose of the shell is to keep the shape of the helmet, distribute impact, protect against sharp objects penetrating the head and to help skid across the ground.

The foam on the inside is designed to “break”. When you hit the ground or surface, your head continues to move within the helmet and crushes the foam inside. The foam then absorbs the impact so the force of the impact on your head lessens.

  • Get the Proper Helmet for the Proper Use/Goal

Helmets have specific designs based on which sport you participate in. They vary in shape based on what part of the head needs protection (ie. Bike helmets are designed for protection from impact at the front and sides, whereas skateboarding helmets are designed to protect the head from impact on all sides.)

In addition, there are helmets designed specifically to protect from a high impact force – known as “single impact helmets” (ie. Skiing), versus ones designed to sustain repeated smaller forces – “multiple impact helmets” (ie. Hockey).

Keep these issues in mind when deciding which helmet to buy and use. HELMETS ARE NOT INTERCHANGEABLE BETWEEN SPORTS.

  • Replace the Helmet as Recommended/Required

Single impact helmets should always be replaced after one crash.

Multiple impact helmets are designed to take smaller, repetitive impacts before needing to be replaced.

Even without a crash, helmets are not designed to last forever. The poly-styrene liners should be replaced every 5 years and the crushable liners should be between 1.5 cm and 3.0 cm thick.

You should also consider temperature conditions and the amount of sweating because this affects the inside foam of the helmet and may be another deciding factor in replacing the helmet.

  • Get the Proper Fit

The Newfoundland and Labrador Brain Injury Association website suggests using the “2-V-1 Rule”:

  • The helmet should sit 2 fingers above brow line for children, 1 finger for adults
  • Straps should form a “V-shape” below each ear
  • 1 finger should fit snugly between the chin and helmet buckle (loose enough that it doesn’t pinch the chin and tight enough that the buckle touches the skin)

It is important to keep the straps firm and snug so the helmet doesn’t move or shift to expose the head.




  • Check inside the helmet for certification stickers, because not all helmets have the same legislated standards.
  • The most recognized association at this time is the Canadian Standards Association (CSA) certification.
  • Remember to wear and use the helmet as instructed by the manufacturer. For example, hockey helmets have an expiry date.


  • Use stickers, tape or paint on the helmet as it can hide cracks or dents, which are signs that the helmet must be replaced.
  • Don’t leave the helmet outside because weather and temperature can affect the materials.
  • Don’t toss helmets on the ground as that is an impact force and can damage or weaken the helmet.


  • Do I feel unsteady?
  • Do I feel as if the room is spinning around me?
  • Do I lose my balance and fall?
  • Do I feel as if I am falling?
  • Do I feel lightheaded or as if I might faint?
  • Do I have blurred vision?
  • Do I ever feel disoriented, such as losing my sense of time or where I am?


If you answered “yes” to any of these questions, you may have a disorder with your vestibular system. While it is not uncommon for everyone to experience some issues of dizziness; people who benefit from vestibular rehab experience these symptoms to a greater extent, which can severely impact on one’s quality of life and ability to perform in society.


What Is a Vestibular Disorder?

The vestibular system is what helps your body adjust to changes in your environment. Information about your environment from vision, proprioception (touch receptors) and the inner ear is sent to the brainstem. The brainstem collects this information, processes it, figures out what the body has to do to adjust, and then sends feedback to steady the vision, adjust muscle position/centre of gravity and balance. When it works properly, these adjustments are done at remarkable speed. If the vestibular system is not working, conflicting information between these components occurs and we end up with dizziness, vertigo or disequilibrium.



  • Dizziness – lightheadedness, faintness
  • Vertigo – sensation of the room spinning/moving
  • Disequilibrium – loss of steadiness

Some examples of what patients describe are the following:

  • Feeling like they drift to one side when walking
  • Uncomfortable in stores
  • Fatigue
  • Difficulty reading
  • Difficulty watching TV or using a computer


What Causes Vestibular Disorders?

Vestibular disorders can be as a result of:

  • Head injuries
  • Medication
  • Disease
  • Viral
  • Aging
  • Inner ear deficit

What can get confusing is that similar symptoms can also be produced by neurological injuries/disorders (Parkinson’s, stroke), circulation problems, eye problems, etc.


As mentioned previously, there can be a variety of causes for vestibular disorders and to make the situation more complex, sometimes the symptoms we experience may not be related to the vestibular system at all. That is why it is so important to have a qualified physiotherapist perform a comprehensive assessment. Specifically, a physiotherapist who has taken advanced level training and has experience in vestibular rehabilitation.

Because of how complex dizziness and vertigo treatment is, it is not possible to condense everything and everyone’s problems into this one article; but, the take home message is to make sure people are aware that, in a number of cases, there are options available to help you feel better and that these are not simply issues you have to “live with”.

For more detailed information, we suggest you visit the website

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