A case-control study conducted by students of the Department of Life and Health Sciences University of South Asia Lahore, Pakistan as a final year project to fulfill the requirement for the completion of the degree; Doctor of Physiotherapy.

1. RELATIVE ODDS OF NECK PAIN IN RELATION
TO HELMET USE AMONG MOTORCYCLISTS:
A CASE-CONTROL STUDY
Dr. Hafiz Rana Muhammad Arslan
(Presenter)
Authors
Hafiz Rana M. Arslan1, M. Salman Butt2, Hafiz M. Jamshaid Badar3
Faculty of Life & Health Sciences University of South Asia Lahore, Pakistan
Tel: +923360703557, E-mail: arslan.physio@gmail.com

2. Background
■ Neck pain is one of the commonly encountered problem by
helmet users that is not discussed often.
■ Relatively the existence of this pain on motorcyclist’s neck can
be related to ergonomically poor interaction of human and
motorcycle during the riding process. (1)
■ Motorcycle helmets have been proven to prevent head injury
and reduce fatality in road crashes. Certain studies indicate that
the helmet increases the mass to the head, and thus the chances
of neck discomfort also increases. (2,3)
■ In a motorcycle, neck pain can be related to the biomechanical
aspect of the riders seating condition. (4)

3. Literature Review
1. Evaluation of the Helmet use and reasons for not using the
helmet by Motorcyclists admitted to emergency ward of Shahid
Bahonar Hospital in Kerman, Iran.
Javad Faryabi et al. 2014
■ Procedure: This study was carried out by recoding the opinions of motorcyclists
who had been transferred to the emergency ward of Shahid Bahonar Hospital
(Kerman/Iran).
■ Intervention: A researcher-made questionnaire
■ Comparison: This study aimed to evaluate the use and reasons for not using a
helmet by motorcyclists admitted to an emergency ward of a trauma hospital due
to accident in Kerman, Iran.
■ Outcome: pain in the neck (69.4%), limitation of head and neck movements
(59.6%)
■ Study Design: cross-sectional
(7)

4. Literature Review
2. A Study on Motorcyclists Riding experience in Malaysia.
ConclusionK.Karmegama,c , M.Y. et al. 2009
■ Procedure: The current study was carried out using 957 students representing 481
males and 476 females ranging from the age of 18 to 24 years. It attempts to find
out the overall discomfort score, the discomfort symptom score and the statistically
significant differences on discomfort score among the male and female
motorcyclists.
■ Intervention: A questionnaire survey
■ Comparison: the discomfort symptom score and the statistically significant
differences on discomfort score among the male and female motorcyclists.
■ Outcome: The male and female motorcyclists have reported of having experienced
discomfort in the neck or head (male: 51.35%; female: 50.21%),
■ Study design: Survey Study. (8)

5. Literature Review
3. Factors Associated with Helmet Use among Motorcycle
Users in Karachi, Pakistan
Abdullah Khan et. al 2008
■ Procedure: This was a cross-sectional survey of motorcyclists in three
large randomly selected public-access parking spaces across Karachi,
Pakistan's largest city. Questions covered personal demographics,
frequency of helmet use, reasons for use or nonuse, and knowledge of
local helmet laws. Analysis was based on frequencies and group
comparisons using chi-square test or independent sample t-test.
■ Intervention: Interview
■ Comparison: compares the two groups in terms of several variables.
■ Outcome: physical discomfort (44%) and limited vision (25%) as the
leading reasons for noncompliance.
■ Study design: self-reported, cross-sectional survey.
(9)

6. Objectives
■ The aim of this study is to determine the
prevalence and to see the relative odds of neck
pain among motorcyclists.

7. Methodology
■ A case-control study design was opted to measure the relative odds
of neck pain in relation to the helmet use as an exposure. A total of
260 (Age mean 22.58 ± S.D 1.95 years) undergraduate students
were selected as a purposive sampling.
■ Case to control ratio was 1:4 (54 Cases and 206 Controls) where
cases were defined as the motorcyclists had neck pain with a riding
experience of more than 1 year.
■ Neck pain and disability scale was used as a self administered
questionnaire. Chi-square and Binary logistic regression was used
to calculate the significant relationship and odds of neck pain
among motorcyclists with and without a helmet use with the help of
SPSS version 17.0.

8. Inclusion criteria:
■ Undergraduate
university students.
■ Age range from 18 to 28
years
■ Should be a regular
motorcycle at least 10
Kilometers per day
■ Riding experience
should be more than one
year.
Exclusion criteria:
■ Neck pain secondary to
any systemic disease or
trauma.
■ Any musculoskeletal
disorder.
■ Helmet users whose
duration of the helmet is
less than one month.

9. Results
Table 1. Demographic features of participants
age in
years
BMI
Helmet weight
in kilograms
Average
motorcycle use
in kilometers
Duration of
helmet use in
years
Mean 22.58 25.86 1.04 52.95 1.93
Std. Deviation 1.958 4.86 0.75 22.79 2.13
Minimum 18.00 15.05 0.25 10.00 0.10
Maximum 28.00 42.88 3.00 100.00 8.00

10. Inferential Statistics
Table 2. Odd Ratio 2x2 Table
Do you experience neck pain?
Totalyes no
Do you use a helmet
while riding a
motorcycle?
yes 54 (20.8%) 136 (52.3%) 190 (73.1%)
no 11 (4.2%) 59 (22.7%) 70 (26.9%)

11. Table 3. Relationship of Average motorcycle use per day with neck pain
Average Motorcycle use
per day in kilometers
Do you experience neck
pain?
Total
Sig.
(0.266) Exp (B)yes no
10-40
kilometers 21 (8.1%) 74 (28.5%) 95 (36.5%) 0.157 1.631
40-70
kilometers 19(7.3%) 67 (25.8%) 86 (33.1%) 0.167 1.633
70-100
kilometers 25 (9.6%) 54 (20.8%) 79 (30.4%) 0.001 2.160

12. Table 4. Relation of BMI with neck pain
BMI Categories
Do you experience neck pain?
Total
Sig.
(0.033) Exp(B)yes no
Underweight 6 (2.3%) 5 (1.9%) 11 (4.2%) 0.094 0.313
Normal Weight 31 (11.9%) 78 (30.0%) 109 (41.9%) 0.884 0.944
Overweight 16 (6.2%) 80 (30.8) 96 (36.9%) 0.149 1.875
Obese 12 (4.6%) 32 (12.3%) 44 (16.9%) 0.004 2.667

13. Table 5. Relation of Neck Pain with Duration of Helmet Use
Duration of Helmet
use
Do you experience neck
pain?
Total
Sig.
(0.035) Exp(B)yes no
non helmet user 11 (4.2%) 59 (22.7%) 70 (26.9%) 0.992 1.006
0.10-1.00 years 24 (9.2%) 46 (17.7%) 70 (26.9%) 0.045 0.359
1.00-4.00 years 24 (9.2%) 58 (22.3%) 82 (31.5%) 0.118 0.453
4.00-8.00 years 6 (2.3%) 32 (12.3%) 38 (14.6%) 0.000 5.333

14. Table 6. Relation of Neck Pain with Helmet Weight In Kilograms
Helmet Weight in
Kilograms
Do you experience neck
pain?
Total
Sig.
0.000 Exp(B)yes no
non helmet user 11 (4.2%) 59 (22.7%) 70 (26.9%) 0.808 0.858
0.25-1.25 31 (11.9%) 36 (13.8%) 67 (25.8%) 0.004 0.186
1.30-1.90 19 (7.3%) 75 (28.8%) 94 (36.2%) 0.441 0.632
2.00-3.00 4 (1.5%) 25 (9.6%) 29 (11.2%) 0.001 6.250

15. Receiver Operator Characteristic Curve.
0.904

16. Discussion
■ Neck pain is very neglected problem among motorcyclists.
Many studies are available on the prevalence of helmet use
but very little literature shed light on the relation of neck pain
with helmet use.
■ Previously no research was carried out on motorcyclists
which can evaluate the relationship between neck pain and
helmet use.

17. ■ This research showed out of 260 motorcyclists 190 (73.1%)
were helmet users and 54 (20.8%) had neck pain as compared
to the 70 (27.9%) non helmet users with a neck pain
prevalence of 11 (4.2%).
■ The relative odd to have neck pain was 2.13 times more
among the motorcyclists using helmet as compared to non-
helmet users. Logistic regression results showed significant
results (P < 0.05) with BMI, Helmet weight and duration of
helmet use but did not show significant relation with average
motorcycle use per day unless it exceeds 70 kilometers.

18. Conclusion
■ Use of helmet can be a potential cause of neck pain among
motorcyclist users but the odds to have neck pain increase
with the increase in motorcycle use per day. The protective
benefits are multifold for helmet use which outreaches the
negative impact including neck pain motorcyclist.

19. Limitations and Recommendations
■ This study was conducted particularly on undergraduate
university students so this can not be generalized on general
population.
■ There were many confounding variables such as poor posture
of individuals during the riding process.
■ Future researchers should consider other variables too to
evaluate any relation with neck pain.

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