Grass vs turf: Does it affect injury rate?

Whenever I see a patient with an ACL tear, they always want to blame something or someone for their injury. The biggest culprit in the blame game seems to be turf fields.

If you’re old enough you might remember the original AstroTurf, and by all means plenty of blame can be placed on it for athletic injuries. But now we have new 3rd and 4th generation turf fields that are much more similar to natural grass. They are used in the NFL, MLB, MLS, and even international soccer matches are being played on them. People still love to blame turf for their injuries. But are there any facts behind these assumptions that more injuries occur on turf than grass?

Research has shown that as the coefficient of friction increases there is an increase in the rate of lower extremity injuries. This means that the more traction you get on the field or court, the higher the risk of injury. The common thought is that turf has more traction than grass and therefore we will see more injuries on turf.

Increased injury rate on artificial turf:

A study published in 2011 looking at football, rugby, and soccer injuries showed that there was a higher incidence of ankle injuries on artificial turf. In 2012, another study looking at NCAA football injuries showed an increased risk of ACL injuries on artificial turf. Lastly, a 2013 study looking at amateur soccer players in Portugal showed a greater rate of lower extremity injuries on turf during matches vs. training.

No difference in injury rates:

A 2010 study looking at collegiate football injuries showed that FieldTurf may actually be safer than natural grass for injuries in general. This study also found no significant difference in knee injuries between surfaces. Another study in 2013 looked at injury rates between grass and artificial turf in female collegiate soccer players. This study actually showed a significantly lower total injury incidence rate and a lower rate of substantial injuries on FieldTurf. This study also showed no significant difference in knee injury rates between the two surfaces.

Since the research doesn’t give us a definitive answer regarding injury rates and artificial turf, what is the best advice regarding artificial turf? We know that the greater the traction, the higher the rate of injury. Wearing cleats made specifically for artificial turf, or better yet turf shoes, may help to decrease traction and therefore reduce lower extremity injuries.

We can apply this same thought process to grass regarding increased traction and increased injury rates. Unfortunately, there may be a decrease in performance as shoes with less traction may cause players to slip.   

Previous sports doc blogs have discussed ACL reduction programs. For those at higher risk for ACL injuries, maybe the type of shoe you practice and play in should be part of an injury reduction program. So don’t just choose your cleats for the color, but instead pick the ones that are appropriate for the playing surface.


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