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High School Football Injuries:
The New Synthetic FieldTurf vs. Natural Grass

Craig Angle ME.d, ME.d, ATC, CSCS

Since the use of artificial turf became popular back in the 1980’s numerous studies have attributed a greater risk of injury to playing on artificial turf when compared to natural grass. In recent years, a new generation of synthetic surface called FieldTurf, which is composed of a polyethylene/polypropylene fiber blend stabilized with a graded silica sand and ground rubber infill, was developed to duplicate the playing characteristics of natural grass. Although FieldTurf has been recommended as a practical option to natural grass in the prevention of injuries, research into the long-term effects of FieldTurf on injuries, during actual game conditions over several seasons of competition, has not been published in the scientific literature. Recent reports have estimated that more than 1 million athletes are now playing high school football. The rising number and cost of knee surgeries and rehabilitation alone has reached more than $1 billion a year. 1 If you combine the cost of injury with the psychological trauma to the athletes and setbacks in training typically experienced by athletes after a significant injury, efforts to address ways to minimize injury risk are necessary. 2

Researchers from the Human Performance Research Center at West Texas A&M University and Panhandle Sports Medicine Associates in Amarillo, Texas assessed football injuries sustained by athletes from eight Texas high schools over a five year period. The purpose of their study was to quantify incidence, causes, and severity of game-related high school injuries on FieldTurf versus natural grass. A total of 240 games were studied over the 5 year period. Out of the 240 games, 150 games were played on FieldTurf and 90 games were played on natural grass. During the study the researchers observed 353 injuries. Out of the 353 injuries, 228 injuries (64.6%) occurred on FieldTurf and 125 injuries (35.4%) occurred on natural grass. When calculated those figures come out to be 1.52 injuries per game per team on FieldTurf and 1.39 injuries per game per team on natural grass. 2

Injuries where then classified as minor, substantial, or severe based on the loss of playing time due to injury. FieldTurf had the least amount of injuries that resulted in a loss of play, whereas there were a larger number of injuries that caused a loss of play due to activity over natural grass. Higher incidences of skin injuries, muscle strains, and spasms occurred over field turf. This may have resulted from the players increased speed over the artificial surface and the accompanying risk for muscle fatigue. Players on natural grass sustained more concussions and ligament tears which researchers speculated may have occurred due to shoe-playing surface traction over hard dry ground. The following table illustrates some of the injuries observed and the surface in which they were observed over.

Variable

FieldTurf Number of Injuries

Natural Grass Number of Injuries

Injury Category

 

 

Player to Player Collision

114

69

Player to Turf Collision

32

12

Shoe Surface Contact

61

40

Shoe Surface Non-contact

5

1

Muscle Tendon Overload

16

3

Time of Injury

 

 

Pregame

4

0

First Quarter

34

23

Second Quarter

72

34

Third Quarter

58

38

Fourth Quarter

60

30

Injury Time Loss

 

 

0 Days

97

37

1-2 Days

44

36

3-6 Days

39

22

7-9 Days

7

5

10-21 Days

23

7

22 Days or More

18

18

Position Played at Time of Injury

 

 

Offense

112

54

Defense

96

66

Special Teams

20

5

Injury Mechanism

 

 

Blocked Below Waist

26

14

Blocked Above Waist

10

10

Tackling

46

35

Tackled Below Waist

25

13

Tackled Above Waist

20

20

Blocking

41

14

Impact with Playing Surface

26

13

Stepped On/Fallen/Kicked

19

3

No Contact/Sprints/Running

15

3

Blocking a Kick/Punt

1

0

The researchers concluded that the greater rate of overall injury documented on FieldTurf may be attributed to the high number of minor injuries (eg, abrasions, muscle strains, non-contact trauma) or influenced by the greater number of games or potential exposure to injury on FieldTurf over 5 competitive seasons. Despite the lower number of games played on natural grass, findings still clearly indicate a similar incidence of substantial injury cases documented on natural grass. In addition, the researchers also stated that although similarities did exist between FieldTurf and natural grass over a 5-year period of competitive play, there were significant differences in injury time loss, injury mechanism, anatomical location of injury, and type of tissue injured between playing surfaces.Both surfaces, from a clinical standpoint, also showed signs of unique injury causes that need to be addressed to reduce the number of game-related, high school football injuries. The researchers noted that the findings of this study may only be generalizable to this level of competition. 2Much more research needs to be conducted to determine which surface is safer.

References

1. Griffin LY, Agel J, Albohm MJ, et al. Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg. 2000;8:141–150.

2. Myers, M. C. & Barnhill, B. S. Incidence, causes, and severity of high school football injuries on FieldTurf versus natural grass: a 5-year prospective study. Am J of Sports Med. 2004; 32(7):1626-1638