By Dev K. Mishra, M.D., President, Sideline Sports Doc
One of the most common questions I’m asked by parents at the start of high school football and fall club soccer seasons is “do you see more injuries on artificial turf compared to natural grass”? Many of the high schools in the San Francisco Bay Area where I live have installed artificial turf fields and the same is true for prominent soccer complexes. From the standpoint of field maintenance, the cost-benefit analysis seems to favor the artificial turf. You can get many years of excellent function from a turf field, whereas grass takes a lot of money and effort to keep up especially in wet weather.
The quality of the artificial turf has improved tremendously over the past several years. The “blades of grass” are much softer and cause far fewer abrasions on sliding than older versions; the rubberized undersurface seems to be forgiving; and the roll is true and reliable. For these and some other reasons I happen to like the newer varieties of artificial turf a lot.
But the question of injury rates is not fully answered. I revisited a study presented at a prominent orthopedic meeting in 2010. The study has not been published in the medical literature but it did have some alarming statistics that should have us asking more questions.
The study has a somewhat confusing title: “American professionalfootball games played on FieldTurf have higher lower extremityinjury rates.” If you stare at it a while you’ll figure it out. The NFL Injury Surveillance System was used to compile statistics on injuries primarily to the knee and ankle from the 2002 through 2008 seasons. The particular type of artificial turf used was a brand called FieldTurf. Some NFL teams started using FieldTurf in 2000 and by 2008 there were 10 NFL stadiums with this surface. (I believe 13 stadiums have artificial turf fields in 2011, and several brands of turf are used.)
The injury rates on FieldTurf were dramatically higher than the authors found for games played on natural grass. The injury rate overall per team-game was 27% higher on FieldTurf, the ACL injury rate was an amazing 88% higher, and the lateral ankle sprain rate was 48% higher. All of those differences were statistically significant.
So what can we take away from this study, and does it help to answer the question I get asked? First of all, this was a highly select group of elite professional athletes and it’s difficult to apply the results to youth sports. Other factors besides the surface may have contributed, such as the type of shoe. The type of turf used in 2011 is quite a bit different than that used in 2002, which could also change the results. So this is just one study and we can’t get the answer to our question from it. But at the very least a study like this should cause sports medicine professionals to ask additional tough questions.
My opinion is that from a practical standpoint it’s the quality of the field that counts most. There’s nothing better than a perfectly manicured grass field as a playing surface for most outdoor team sports- but that’s incredibly expensive. I can’t imagine there are many youth leagues or high schools with the kind of budget an NFL team has to maintain a beautiful grass field. If the typical youth field gets soggy and ripped up by cleats it resembles a city of gopher holes. It’s an injury-creating nightmare. If that’s our option I would favor one of the newer varieties of artificial turf without question.