Revisiting the Artificial Turf vs. Natural Grass Injury Debate

November 6, 2018 | Sports Science

By Dev K. Mishra, M.D.

President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Debate continues regarding the safety of playing sports on artificial turf versus natural grass fields
  • There has been very little new published high quality evidence to solve the debate
  • The newer generation artificial turf fields are substantially safer than the older versions

I’ve written previously about injury rates on FieldTurf versus natural grass and in 2011 one well conducted study showed a

substantially higher injury rate on FieldTurf. I revisited this issue in 2013 when my partner at Stanford Dr. Jason Dragoo presented results of his study of NCAA athletes with ACL tears and found a substantially higher incidence of ACL tears in games played on FieldTurf. Is this still the case with the newer generation of artificial turf surfaces?

Manufacturers of artificial turf surfaces have made considerable changes to the composition of the turf and it is claimed that the newer generation surfaces are quite a bit safer than the ones played on in previous years. I performed a recent literature search and came across only three articles of interest.

First, this is an interesting six-year prospective comparative study of newer generation FieldTurf versus natural grass surfaces. The study actually revealed a lower injury rate overall for the athletes participating on FieldTurf versus natural grass in many injury types. While the study is well constructed overall, I do have one reservation in that the study was partially funded by the manufacturer.

Next,this study performed at a single Japanese university examined the injury rates of their male soccer team over a 12-year period. The first four years were played on natural grass, and the next eight years played on artificial turf. The authors noted that the quality of the artificial turf field changed considerably over the eight-year timeframe. There was a significant increase in the incidence of upper extremity trauma after initial conversion to artificial turf. After the refurbishing of the artificial turf with additional rubber chips in 2013, the incidence of lower extremity muscle strains significantly declined. This study supports the common notion that older generation artificial turf fields are not equivalent to the newer turf fields.

And finally, this published paper evaluated the risk of ACL tears on newer generation artificial turf fields versus natural grass. This was a systematic review of available high-quality published scientific studies in American tackle football and soccer. Their review supported an increased rate of ACL injury on synthetic playing surfaces in football, but there was no apparent increased risk in soccer.

So… There is not very much new evidence to settle this debate. Much has been learned in the decades since the introduction of the original Astroturf, and clearly the newer generation artificial surfaces are much safer than the original.

Until compelling evidence comes along to change my mind, my feeling is the same as it has been these past several decades: the best surface from a safety and performance standpoint is a pristine natural grass field. This would then be followed closely by the newest generation artificial turf surfaces, and finally the least safe field would be a pockmarked and poorly maintained grass field. Given how difficult and expensive it is to maintain a perfect grass field, I would expect that the artificial turf surfaces will continue to feature prominently, especially at the youth and high school levels.








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2 Responses to “Revisiting the Artificial Turf vs. Natural Grass Injury Debate”

  1. Rick Volbrecht says:

    I found your conclusion valuable

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