Are Synthetic Playing Surfaces As Safe as Natural Grass?

Synthetic playing surfaces were initially developed in the 1960’s with the reported advantages over natural surfaces of being a durable, versatile surface, less affected by weather conditions, allowing multi-sport use, having easier maintenance, and being more cost-effective. However, the early generation surfaces did not provide much shock absorption and allowed for increased traction between the surface and athletic shoes, predisposing athletes to more impact type injuries such as concussions and non-contact twisting injuries such as ACL tears.

The new generation surfaces such as Field Turf were developed to decrease the injury rates found in the early generation artificial surfaces. These newer surfaces more closely replicate natural grass in terms of consistency and are more compliant with greater shock absorption compared to the older surfaces.

Several studies have investigated whether Field Turf is as safe as natural grass. At the lower levels of football competition, including high school, it appears that Field Turf is as safe or, in some cases, safer than natural grass in terms of overall knee ligament injuries. Another study showed that even at the collegiate football level, Field Turf is just as safe. However, studies looking at the highest levels of competition, including professional football, have shown an increased rate of knee injuries, including ACL tears and overall knee injuries when playing on artificial services. In terms of knee injuries in soccer, investigations have shown that, at the collegiate level, Field Turf is as safe or safer than natural grass. Finally, the concussion rate and the severity of concussions appear to be the same on both surfaces, with the concussion rate actually being less on Field Turf at the high school level.

Overall, Field Turf does not seem to substantially increase an athlete’s risk of injury at the high school and collegiate level compared to natural grass. However, there does appear to be an increased risk of injury at the professional football level on Field Turf. More studies need to be performed to more completely evaluate the safety of Field Turf at the highest

levels of competition.

References

1.. Hershman EB, Anderson R, Bergfeld JA, Bradley JP,

Coughlin MJ, Johnson RJ, Spindler KP, Wojtys E, Powell JW.

An analysis of specific lower extremity injury rates on

grass and FieldTurf playing surfaces in National Football

League Games: 2000–2009 seasons. Am J Sports Med. 2012.

40:2200-2205.

2.. Powell JW, Schootman M. A multivariate risk analysis of

selected playing surfaces in the National Football League:

1980 to 1989. Am J Sports Med. 1992. 20:686-694.

3. Orchard JW, Powell JW. Risk of knee and ankle sprains

under various weather conditions in American Football.

Med Sci Sports Exerc. 2003. 35:1118-1123.

4. Powell JW. Pattern of knee injuries associated with college

football 1975–1983. Athletic Training. 1985. 20:104-109.

5. Powell JW, Schootman M. A multivariate risk analysis of

natural grass and Astroturf playing surfaces in the National

Football League 1980–1989. International Turfgrass Society

Research Journal. 1993. 23:201-211.

6. Scranton PE Jr, Whitesel JP, Powell JW, et al. A review

of selected noncontact anterior cruciate ligament injuries

in the National Football League. Foot Ankle Int. 1997.

18:772-776.

7. Clarke KS, Powell JW. Football helmets and neurotrauma:

An epidemiological overview of three seasons. Med Sci

Sports. 1979. 11:138-145.

8. Guskiewicz KM, Weaver NL, Padua DA, Garrett WE Jr.

Epidemiology of concussion in collegiate and high school

football players. Am J Sports Med. 2000. 28:643-650.

9. Naunheim R, McGurren M, Standeven J, Fucetola R,

Lauryssen C, Deibert E. Does the use of artificial turf

contribute to head injuries? J Trauma. 2002. 53:691-694.

10. Meyers MC, Barnhill BS. Incidence, causes, and severity

of high school football injuries on FieldTurf versus natural

grass: A 5-year prospective study. Am J Sports Med. 2004.

32:1626-1638.

11. Meyers MC. Incidence, mechanisms, and severity of matchrelated collegiate men’s soccer injuries on FieldTurf

and natural grass surfaces: A 6-year prospective study.

Am J Sports Med. 2016. 45:708-718.

12. Orchard J. Is there a relationship between ground and

climatic conditions and injuries in football? Sports Med.

2002. 32:419-432.

13. Williams S, Hume PA, Kara S. A review of football injuries

on third and fourth generation artificial turfs compared

to natural turf. Sports Med. 2011. 41:903-923.

14. Dragoo JL, Braun HJ, Harris AH. The effect of playing

surface on the incidence of ACL injuries in National

Collegiate Athletic Association American football.

Knee. 2013.20:191-195.

15. Balazs GC, Pavey GJ, Brelin AM, Pickett A, Keblish DJ,

Rue JPH. Risk of anterior cruciate ligament injury in

athletes on synthetic playing surfaces. Am J Sports Med.

2014. 43:1798-1804.

16. Ekstrand J, Timpka T, Hagglund M. Risk of injury in elite

football played on artificial turf versus natural grass.

Br J Sports Med. 2006. 40:975-980.

17. Mechan WP III, d’Hemecourt P, Comstock RD. High school

concussions in the 2008–2009 academic year: Mechanism,

symptoms, and management. Am J Sports Med. 2010.