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Dr. Charles TatorJENNIFER ROBERTS/The Globe and Mail

Health Advisor is a regular column where contributors share their knowledge in fields ranging from fitness to psychology, pediatrics to aging. Follow us @Globe_Health.

Warm weather is great for cycling. But did you know that according to the data, cycling is the second riskiest activity in Ontario in terms of the number of catastrophic injuries for every 100,000 Ontarians? Better news is that cycling is only No. 27 in terms of personal risk – which is the number of injuries for every 100,000 participants.

In other words, lots of people in Ontario get injured cycling because of the large number of cyclists, but with proper precautions your actual personal risk is low.

We don't have as clear data on other "wheeled" street activities such as in-line skates, roller skates, scooters and skateboards, but the risks to the individual are probably similar.

My advice? Get out there, but be careful. As a practising neurosurgeon, I am very aware of the ravages of brain and spinal cord injuries in these street activities. In fact, Canada ranks poorly in comparison with many countries of comparable wealth and education. Many Canadians sustain fatal and non-fatal injuries through cycling and other wheeled activities, and almost all are preventable.

How? A number of strategies are required, but first is helmets and helmet legislation. Helmets provide huge protection against head injury as proven by so many studies. But who is required to wear a helmet differs greatly across our country. Some provinces have minimal legislation in effect; some have very restricted legislation that only applies to those under 18 years of age and only to cyclists; others have comprehensive legislation that applies to all ages and to cyclists, boarders and those participating in other wheeled street activities.

Both British Columbia and Nova Scotia – where wearing a helmet is the law – have excellent, comprehensive legislation that should be emulated by all provinces and territories. Enforcement is also required because the effect of legislation is weakened without it.

Not enough cyclists are wearing helmets or being compelled to do so. What really makes me crazy is that I see families of cyclists with the kids wearing helmets but the parents without. What an example to set. Helmets save lives.

Last year, I was involved in a research project covering two areas of Ontario, and enforcement of bike helmet legislation was almost zero in both. Out of curiosity, I recently counted the number of helmeted and unhelmeted adult cyclists on College Street not far from the Toronto Western Hospital where I work, and the helmeted group was only about 55 per cent. Two weeks ago, I was in San Francisco at a meeting of North American neurosurgeons and found that almost all the adult cyclists on San Francisco streets were helmeted. Wake up, Toronto!

A neurosurgery colleague of mine was "doored" by an unthinking driver who abruptly opened his car door without checking and failed to see my colleague riding by on his bicycle. The neurosurgeon was thrown off his bike and struck his head on the pavement, but thankfully, no brain injury. When he showed me the crack in the helmet, he said it so clearly: "The helmet saved my life."

This leads me to the issue of "bike awareness." In the Netherlands, there is no helmet legislation but the incidence of brain injury among cyclists is low because motorists are "bike aware." Maybe it's because almost everyone in that country bikes so they are brought up to share the road. Canada could no doubt do better on the creation of more bike lanes. And while we will probably never develop the degree of bike awareness the Dutch possess, we do need to establish some bike awareness. Motorists must respect the cyclist, but this of course works both ways.

In the meantime, when you hop on your bicycle (or skateboard, or put on your in-line skates), remember these tips:

  • Don’t drink and cycle.
  • Don’t text and cycle.
  • Use lights and bright reflective clothing at night.
  • Protect your eyes.
  • Maintain bikes and keep other wheeled devices in good repair.
  • Use judgment about biking in inclement weather and heavy traffic.
  • Children on bikes need supervision until proficient and old enough to make good decisions, and should avoid high-traffic streets.
  • All cyclists should be educated about road safety including signalling, speed, gauging road conditions and bylaws.
  • Wear a helmet. Make sure the strap is tight enough so that the helmet does not pop off after the first impact (there are often two or more impacts to the head). Tight enough means that only one finger can fit between the strap and your chin.
  • Message to lawmakers: Bring in comprehensive laws and enforce them.

Now isn't that easy? Smart cyclists, smart drivers, and smart societies keep the doctor away.

Dr. Charles Tator is a neurosurgeon at the Krembil Neuroscience Centre of Toronto Western Hospital. He is also the founder of ThinkFirst, now part of Parachute Canada, a national non-profit organization dedicated to the prevention of brain and spinal cord injuries, and the research lead for the Canadian Sports Concussion Project which is studying the long-term effects of repetitive concussion.