Does artificial turf cause more injuries?

The Truth About Artificial Turf Injuries

The winter sun was shining. A morning of soccer beckoned. But the guys were butting heads.

“This grass is full of gopher holes. Why can’t we play on the turf?”

“Grass is so much better for my knees.”

The debate about artificial turf injuries crops up again and again. And not just in my weekend pickup soccer gang. Last week, a long list of top players reluctantly knuckled under to FIFA’s demand that they play the Women’s World Cup entirely on artificial turf.

Artificial Turf Wars

The players, including Abby Wambach and Nadine Angerer, had gathered 23,159 signatures on a petition to move the tournament to grass. They said they were afraid of artificial turf injuries. They filed a gender discrimination lawsuit because the men’s World Cup has always been on grass.

But FIFA refused to budge. Its officials insist the risk of injuries is no greater on the latest generations of artificial turf it certifies than on grass.

The research on artificial turf injuries in soccer seems to favor the FIFA position. But it suggests a bigger problem for rugby, American football and similar contact sports.

Concern about artificial turf injuries date back to 1966, when a Major League Baseball tournament took place in the Houston Astrodome. That surface consisted of a short pile carpet on top of padding over concrete. It spread like weeds throughout the world of sports.

But many soccer clubs found it too hard, hot and slippery. The entire English Premier League reverted to grass in 1994. And in 1996, an Icelandic study showed that “more injuries occurred on artificial turf than on grass or gravel.” Ouch.

A New Generation of Artificial Turf

Artificial turf injuries
A rubber pad beneath the carpet is intended to reduce artificial turf injuries. Photo courtesy of Soft Surfaces.

Second generation turf, developed in the late 1980s, had longer pile, a rubber base and a layer of sand under the turf. Players complained of abrasions from the sand.

The latest generation features a bottom layer of sand, a middle layer of rubber and sand, and a top layer of rubber bits mixed into longer fibers of fake grass. This turf has fared much better in injury research.

“Studies have provided strong evidence for comparable rates of injury between new generation artificial turfs and natural turfs,” the authors of a 2011 review of the research in Sports Medicine concluded.

Not so fast, wrote the authors of a 2013 review in the Journal of the American Academy of Orthopedic Surgeons. “Despite the increased popularity of third-generation artificial turf fields, the effect of this playing surface on athlete health and injury rates has yet to be fully elucidated.”

What can explain this difference of opinion? A lot depends on whether you’re looking at soccer, football, rugby or some other sport; weather; footwear; the age, gender and expertise of the player; and how you define an injury.

For example, a 2014 review, this one focused on anterior cruciate ligament (ACL) injuries in the knee, found an increased risk of artificial turf injuries in American football but not in soccer.

Anyone who plays on grass knows how much it can vary depending on whether it’s wet or muddy, and the height of the grass. The grass fields in North Carolina skinned my knees. The ones in California almost never do. (I’ve got a scrape right now on my knee from playing on artificial turf on Thursday.)

Artificial Turf Injuries: the Bottom Line

I’m confident from reading these reviews that adult soccer players can relax their fear of artificial turf injuries. I wouldn’t say the same for American football or rugby. (Some research suggests a problem with girls’ soccer on turf.) As for baseball, a search on “baseball” and “turf” in the National Library of Medicine didn’t turn up any hits at all.

I do advise wearing shoes with relatively flexible soles and minimal studs on artificial turf. This may reduce the joint injuries caused when you turn your leg but your foot remains fixed to the ground.

FIFA even claims that the ball bounces and rolls within the same parameters of speed and height on the artificial turf it certifies as on grass. I’d like to see these fields. The ball bounces higher and rolls faster on every kind of artificial turf I’ve seen. (I also just like playing on a living surface.)

A survey found that pros remain unconvinced as well. “The feeling of players is that they have more injuries with artificial turf,” one researcher, Alessandro Ciompi, MD, told me.

His team compared artificial turf injuries to injuries on grass within the same league and same climate. “We were surprised because we did not see any difference.”

A generation from now, will players still be grousing about artificial turf injuries? “I think it’s a generational issue,” said Jan Ekstrand, vice-chairman of the European soccer (UEFA) Medical Committee in a FIFA interview. “The new generation coming from the academies will be used to playing on football turf.”

We shall see.

The featured image on this page is by Andrea Desalve

5 thoughts on “The Truth About Artificial Turf Injuries”

  1. What about slide tackling? I think that if you get cut, an abrasion, or even skid when you fall are you more likely to get cut and turf pieces stuck in your legs?

    1. I didn’t see anything about slide tackling broken out in the research. Maybe abrasions were not considered important enough to record. I certainly have had enough of my own to say they’re worth thinking about. When I lived in North Carolina, I used to skin my knee in practically every game, and they were all on grass. There was something about the quality of the soil that made it harder, I guess. Overall, I’d much rather slide tackle on grass than on artificial turf. But that’s just based on my personal experience.

  2. I just have to say that when I play goalkeeper on turf I regularly come off the field with bleeding scratches all down either side of my body from diving. I was wondering which changes to the creation of the field would solve the probolem.

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