Injuries in National Collegiate Athletic Association American Football
JL, Braun HJ, & Harris AHS. The Knee. 2012. Epub ahead of print
Grass and Field Turf Playing Surfaces in National Football League Games: 2000 –
EB, Anderson R, Bergfeld JA, Bradly JP, Coughlin MJ, Johnson RJ, Spindler KP,
Wojtys E, & Powell JW. American Journal of Sports Medicine. 2012,
Epub ahead of print. doi:
playing surfaces are frequently used in athletics due to their
cost-effectiveness and all-weather benefits.
However, the question remains whether or not these surfaces affect
injury rates. Several studies have demonstrated
an increased rate of injury on artificial turf, where others have shown that
there is no difference. These two papers
by Dragoo and Hershman investigate this concept, and pay particular attention
to “third generation” or infill artificial surfaces which have a mat of
artificial fibers that is filled with rubber particles. The Dragoo et al. study used the NCAA Injury
Surveillance System to gather anterior cruciate ligament (ACL) injury incidence
data in football players across divisions and various playing surfaces from the
2004-2005 to 2008-2009 seasons. This
study demonstrated significantly higher ACL injury incidence rate on artificial
turf (1.73 per 10,000 athletic exposures) when compared to natural grass (1.24 per
10,000). This incidence rate is even
higher when comparing infill surfaces (1.77 per 10,000) to either grass or
other artificial surfaces without fill (1.43 per 10,000). Most of these injuries were non-contact ACL
tears, however, the study did not report if they were first time ACL tears or
not. The Hershman et al. article examined lower extremity injury rates (i.e.,
knee and ankle sprains) on playing surface types in National Football League games
between 2000–2009. At the conclusion of
the 2009 season, of the 6612 games played, approximately 60% of all games were
played on natural grass, approximately 10% on older-generation turf, and 30%
were played on infill artificial turf.
This study found that the injury rate for ACL sprains was 67% higher on
infill artificial turf than on natural grass (injury rate was not normalized)
and that there were significantly greater rates of eversion ankle sprains on
infill artificial turf than on natural grass.
it appears that the artificial infill turf seems to have a higher ACL injury
incidence rate; however, it is difficult to determine the cause of the higher
injury rates. As the manufacturing of
artificial turf has evolved, it is important to look at the subdivisions and
specific types of artificial surfaces as these two articles have. The newer generation infill artificial turf
is intended to be more like natural grass, yet clearly has different injury
rates. Manufacturers of the artificial
turf will naturally combat this due to financial interests, yet two independent
groups are echoing that infill artificial turf has higher ACL injury incidence
rates. As health care professionals,
this may indicate a need to look closer at the possible reasons as to why ACL
injury rates are higher. Some people
think it may have to do with the shoe/surface interaction, possibly looking at
things like friction, torque, and stiffness.
Players likely wear cleats or spikes in natural grass, and wear some sort
of turf sneaker on artificial surfaces.
Do you think that the playing surface can affect injury rates, or do you
attribute these higher rates to other reasons?
Has anyone seen ACL injuries or any other injuries that seem to be more
prevalent with athletes on artificial infill turf?
by: Nicole Cattano
by: Stephen Thomas
Dragoo JL, Braun HJ, & Harris AH (2012). The effect of playing surface on the incidence of ACL injuries in National Collegiate Athletic Association American Football. The Knee PMID: 22920310
Hershman EB, Anderson R, Bergfeld JA, Bradley JP, Coughlin MJ, Johnson RJ, Spindler KP, Wojtys E, Powell JW, & for the National Football League Injury and Safety Panel (2012). An Analysis of Specific Lower Extremity Injury Rates on Grass and FieldTurf Playing Surfaces in National Football League Games: 2000-2009 Seasons. The American Journal of Sports Medicine, 40 (10), 2200-2205 PMID: 22972855