Natural grass vs. artificial turf: which surface poses an increased injury risk?

A research review from the Performance Digest

Jordan August

By Dr. Jordan August
November 17th, 2019 | 4 min read

Contents of Research Review

  1. Background & Objective
  2. What They Did
  3. What They Found
  4. Practical Takeaways
  5. Reviewer’s Comments
  6. About the Reviewer

Background & Objective

Artificial turf (AT) has a number of benefits over natural grass (NG), such as decreased maintenance costs, and increased usability across the elements, making it more common in professional sports. However, many athletes prefer to play on natural grass due to factors including perceived injury rate, discomfort, and fatiguability. This study utilised the Injury Rate Ratio to evaluate data of injury occurrence on either artificial turf or natural grass playing surfaces.

What They Did

Injury data from pre-season, regular season, and post-season for two Major League Soccer (MLS) teams was recorded over the course of four seasons (2013-2016), along with the playing surface:
⇒ AT
⇒ NG
The injury incidence rate ratio was calculated as incidence rate AT/ incidence rate NG to determine which playing surface had a higher injury incidence rate.

What They Found

The key findings in this study were:
⇒ A total of 2174 in-game injuries were recorded during the study period, with 1.54 injuries per game occurring on AT and 1.49 occurring on NG.

⇒ Yearly injury incidence increased each year on both playing surfaces – 12.5% on NG and 26.3% on AT.

⇒ From 2013-2016, data analysis showed comparable injury incidence and overall injury rate between AT and NG surfaces, however, regarding specific injuries, a higher rate of Achilles injury and ankle fracture was found on AT.

Practical Takeaways

Despite what other sports may show and what MLS players beliefs are, this study shows us that there was no statistical difference in injury rates among MLS players playing on AT vs. NG. Over the last few years injuries rates have increased in all sports, so the question of playing surface has become a popular topic. Other variables such as strength and previous injury, should outweigh playing surface.

Since ankle injuries were found to be the only body part with increased injury occurrence on AT compared to NG, further research should investigate data and association with type of footwear as well as contact vs. non-contact injuries on playing surface.

Strengthening and proprioception training have been shown to decrease the overall risk of ankle-related injuries. When teams are in a situation where AT is the only playing surface at hand, it is imperative that players run through a sound dynamic warm-up for injury-risk reduction.

Reviewer’s Comments

“The biggest indicator of future injury is previous injury, and one major limiting factor in this study was the failure to include player’s injury history. This is important from an injury prevention and rehabilitation standpoint because if the initial injury was not fully rehabilitated and the player did not go through a proper return-to sport protocol, this could have skewed the rate of injury.

Other variables not included which impact the overall strength of this study was time missed and re-injury rates. However, it is important to note that a large amount of data was collected, all which showed comparable injury rates regardless of the playing surface.”

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    Jordan August

    Dr. Jordan August

    Jordan is a Physical Therapist and Strength Coach who currently practices in a Sports & Orthopedic clinic in Bergen County, New Jersey. He is passionate about educating athletes on ways to optimize performance while decreasing the risk of injury.

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