Higher rates of lower extremity injury on synthetic turf compared with natural turf among National Football League athletes.

Mack CD, Hershman EB, Anderson RB, Coughlin MJ, McNitt AS, Sendor RR, and Kent RW. Am J Sports Med. 2018. [Epub Ahead of Print].


Take Home Message: Injury rates on synthetic turf surfaces are 16% higher than on natural playing surfaces among National Football League (NFL) athletes.

Synthetic turf surfaces are increasingly common at sporting venues. These surfaces may increase injury risk. However, it is hard to incorporate this concern into clinical practice because there are many factors that affect playing surface and risk of injury (e.g., care of the playing surface, reporting of injuries, selection bias). Therefore, Mack and colleagues completed a cohort study to assess the incidence of lower body injuries among NFL athletes on modern generation synthetic turf surfaces and natural grass. The researchers used electronic medical records from all 32 NFL teams from 2014 through 2016. This data was cross-referenced with the NFL Game Statistics and Information System (e.g., playing surface type, number of plays per game) and measurements of field surface hardness provided by the NFL Taskforce for Gameday Surfaces Recommended Practice. The authors included injuries to the lower body that occurred during a game and resulted in time loss from football-related activities. Playing surface was classified as either natural or synthetic for each NFL field. The number of distinct plays per game were 167.6 on synthetic surfaces and 166.8 on natural surfaces. Overall, injury rates were 16% higher on synthetic turf surfaces than on natural surfaces. The authors found consistent evidence of a higher injury rate on synthetic turf surface for injuries resulting in more than a week missed from play, knee injuries, foot/ankle injuries, and noncontact/surface contact injuries. Over the study period average surface impact hardness per game were similar between synthetic and natural turf surfaces.

Ultimately, clinicians and administrators should be interested in these findings. Clinicians should be aware that injury rates on synthetic turf surfaces are higher than natural surfaces. This agrees with earlier findings from the NFL and National Collegiate Athletic Association. This supports the notion that these findings may apply to collegiate athletes. However, it is still unclear if this finding will translate to high school athletes or athletes in other sports. Clinicians may also benefit from staying up to-date on future studies, which may examine injury prevention strategies designed for synthetic turf surfaces. Clinicians should also ensure that administrators are aware of this research because these findings should be considered before deciding to install synthetic turf surfaces.

Questions for Discussion: Are you a clinician whose institution has gone from a natural to
synthetic playing surface? If so, have you noticed any change in injury rates?

Written by: Kyle Harris

Reviewed by: Jeffrey Driban

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