Editor's Note: This is the fourth installment in a series by Peter F. DeLuca, M.D., Head Team Physician for the Eagles, on increasing player safety in football.

It was a cold, damp December night in Seattle. The Eagles were playing the Seahawks on a special Thursday night game. On a punt, Colt Anderson, who was headed for the Pro Bowl as a Special Teams player tried to avoid a block and planted his foot and moved laterally. His foot got stuck in the FieldTurf and he felt a pop in his knee. His physical examination and MRI confirmed a rupture of his ACL. This was the end to a promising season and the beginning of a long, hard road to recovery for Colt.

The Injury and Safety Panel and the NFL recently published a study on specific lower extremity injury rates on Grass and FieldTurf surfaces. (The American Journal of Sports Medicine, 2012)  Infill surfaces generally consist of long polyethylene fibers woven on a mat with spaces between the fibers that are filled with rubber particles or a combination of rubber and sand. There are different brand names of these infill surfaces—FieldTurf is just one. There are other examples, like Momentum and AstroTurf.

The results showed that there was a 67% higher incidence of ACL tears while playing on FieldTurf compared to grass and a 31% higher incidence of high ankle sprains on FieldTurf as opposed to grass in these NFL players. The other infill surfaces were not studied. (And the Washington Redskins want to switch from grass to turf after RGIII’s knee injury?)

On that subject, the NFL is also attempting to decrease lower extremity injuries. The right safety equipment is crucial. Currently the wearing of thigh and knee pads is optional in the NFL. Next year all NFL players will be required to wear these protective devices. The Injury and Safety Panel is now looking into whether certain cleat wear leads to an increase in specific injuries and the Competition Committee is reviewing the rules on all blocks below the waist.

When competition is intertwined with millions of dollars there will be some athletes who will try to get that competitive edge as we have recently seen with Lance Armstrong. It is going to happen in every sport, not just football. Steroid testing was initiated by the players in the NFL, not because they were worried about the long-term deleterious effects of steroids on their health, but because the players who didn’t use steroids felt that they were not playing on a level playing field.

Now hGH has become the focus of attention in sports. The MLB has just passed testing for hGH. The new CBA, ratified last year, called for hGH testing but it has yet to be implemented in the NFL. The NFL Players Association has recently come out and said they want the testing started.

However, there is a controversy about the current tests available for hGH. hGH cannot be detected in the urine therefore a blood test has to be performed. Exogenous hGH has a very short half-life and cannot be detected if it was injected greater than 24 hours before the blood test was performed. Random testing for performance-enhancing drugs occurs on the day after a game. So a player can conceivably inject hGH on Friday before a game and it will not be detected on a test performed on Monday after a Sunday game. Therefore, the NFL is awaiting a test for hGH that will detect blood levels for longer periods of time.

Strategy, strength and speed are what make this game great. The NFL doesn’t want to take physical contact out of the game. But we must ensure that players follow rules designed to reduce the risk of injury.

-By Peter F. DeLuca, M.D.