Artificial turf and injury risk

Many people are of the opinion that football should be played on natural grass, and that artificial turf could potentially increase risk of injury. Quite often, and particularly in Scandinavia, is artificial turf beneficial as a pitch surface, due to lower cost of maintenance and that it can better tolerate a high usage. Hence, more and more pitches with artificial turf are being installed throughout the world.

An important question in regard to artificial turf is how injury risk in football is affected, both in terms of regular playing load on artificial turf, and frequent surface shifts between artificial turf and natural grass. This article will in short discuss the current literature in regard to artificial turf and injury risk.

Type of artificial turf

Artifical turf has been around for several decades, and the first generations that were introduced during the 1970s showed increased risk of injuries compared to natural grass (8). Since then, more modern turfs called third-generation artifical turfs have been developed to better replicate regular natural grass. These have shown to have better cushioning capabilities, and maintain softness over time (9). Since the early 2000s, these third-generation turfs have been the most widely used type of artificial turf.

Acute injuries on artificial turf vs. natural grass

Several studies have examined whether artificial turf (AT) results in more acute injuries compared to natural grass (NG). A study at elite level in Norway found no difference in injury risk, injury location or football-730418_640severity of injuries between AT and NG (1). This coincides with results from another Norwegian study on youth female football, where no difference in injury risk between AT and NG was found (2). In an international study on elite European football done between 2003 and 2005, the results also showed no difference between AT and NG on injury risk (3). The results from the aforementioned studies therefore concludes that the risk of acute injuries is similar between AT and NG.

Overuse injuries on artificial turf vs. natural grass

Compared to acute injuries, overuse injuries are more difficult to link to one single cause. This is due to the fact that is is difficult to determine for certain whether an overuse injury occured at one type of surface. Therefore, few studies have investigated if artificial turf can increase risk of overuse injuries.

A recent published study from the Norwegian and Swedish elite league showed that teams with AT at their home venue had higher acute training injuries and overuse injuries compared to teams that played home matches on NG (4). Some uncertainty exist for the results, because AT teams had increased injury rates when playing on both AT and NG. Thus, it is not necessarily that AT alone explains the increased injury risk.

A possible explanation for the increased rate of injuries on AT could be that most of the teams with AT at their home venue (67%) came from the northern parts of Norway and Sweden, with generally colder climate, compared to the northern clubs with NG (24%) (4). It has previously been shown that clubs from colder regions of Europe have higher injury rates compared to souhern Europe (5), thus, it could be that regularly playing in colder climates can affect the increased rates of overuse injuries for teams with AT at their home venue.

Frequent surface shifts between artificial turf and natural grass

In many parts of Europe more and more home venues have AT installed. Hence, a question that arise is if frequent surface shifts between AT and NG could increase injury rates. A recent study from elite Scandinavian football has examined how this could affect risk of injuries, and found that frequent surface shifts did not elicit increased injury rates (6). Thus, it seems that frequent change of playing surface is not a problem for modern football players.

In addition, the study found that teams normally playing their home games at NG, had fewer injuries when playing away matches on AT (6). A possible explanation for this could be that players with NG at their home venue plays with greater caution away at AT, as it has been shown that players might fear increased injury risk when playing on AT (7).

Hence, based on these studies, frequent surface shifts does not result in increased injury rates within elite football.

Summary

Third-generation artifical turfs are developed to better replicate natural grass, and many artificial turf surfaces can better maintain cushioning abilities over time. Hence, the qualities of these surfaces seems to be very high compared to natural grass. Based on the studies published on injury risk and artificial turf, artificial turf does not increase the risk of acute injuries in matches, or affects injury risk when frequent surface shifts are made between matches on artificial turf or natural grass.

However, in regard to overuse injuries, the results are more unclear. It does not seem that artificial turf alone can explain increased overuse injuries for teams with artificial turf at their home venue. Other factors such as colder climate could be a possible confounder. Still, it seems that teams with artificial turf at their home venue have higher risk of overuse injuries and risk of acute injuries during training. More studies are needed in order to fully explain the relationship between overuse injuries and artificial turf.

 

References
  1. Bjørneboe J, Bahr R, Andersen TE. Risk of injury on third-generation artificial turf in Norwegian professional football. British journal of sports medicine. 2010;44(11):794-8.
  2. Steffen K, Andersen TE, Bahr R. Risk of injury on artificial turf and natural grass in young female football players. British journal of sports medicine. 2007;41(Suppl 1):i33-i7.
  3. Ekstrand J, Timpka T, Hägglund M. Risk of injury in elite football played on artificial turf versus natural grass: a prospective two-cohort study. British journal of sports medicine. 2006;40(12):975-80.
  4. Kristenson K, Bjørneboe J, Waldén M, Andersen TE, Ekstrand J, Hägglund M. The Nordic Football Injury Audit: higher injury rates for professional football clubs with third-generation artificial turf at their home venue. British journal of sports medicine. 2013;47(12):775-81.
  5. Walden M, Hagglund M, Orchard J, Kristenson K, Ekstrand J. Regional differences in injury incidence in European professional football. Scandinavian journal of medicine & science in sports. 2013;23(4):424-30.
  6. Kristenson K, Bjørneboe J, Waldén M, Ekstrand J, Andersen TE, Hägglund M. No association between surface shifts and time-loss overuse injury risk in male professional football. Journal of Science and Medicine in Sport.
  7. Poulos CC, Gallucci J, Jr., Gage WH, Baker J, Buitrago S, Macpherson AK. The perceptions of professional soccer players on the risk of injury from competition and training on natural grass and 3rd generation artificial turf. BMC sports science, medicine and rehabilitation. 2014;6(1):11.
  8. Kristenson K. Obefogad rädsla för VM:s konstgräs. Centrum for Idrottsforskning
  9. http://www.klokavskade.no/no/Skadefri/ArtikelListing/Article-page/Kunstgress/Historie/

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