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A season-ending sports injury can happen in the blink of an eye. In recent years, more and more athletes have ended their seasons, or even their careers, after seemingly tripping on thin air. To some, it can look like a car blowing out a tire; an athlete sprinting at full speed collapses under their own weight without anyone nearby.

Frustrated athletes are quick to blame the surface beneath them, and one common culprit in particular: artificial turf. According to Mark Cote, PT, DPT, MSCTR, a Mass General Brigham Sports Medicine researcher, these athletes make a compelling argument.

Mostly.

"I think they're right - they have good reason to blame artificial surfaces - but there are a number of reasons why injuries occur, and turf isn't the only one," says Cote. "It's a misconception to say natural grass is uniformly better than artificial surfaces for preventing injury, or vice versa."

Cote serves as director of Outcomes Research for Sports Medicine & Orthopaedic Surgery at Massachusetts General Hospital. He explains the differences between turf and grass playing surfaces, the risks of playing on each, and how athletes can best protect themselves from non-contact injuries.

Is turf better than grass? It's complicated.

Non-contact lower body injuries are common in sports like football, soccer, field hockey, and lacrosse. Each sport involves sudden movements on indoor fields with artificial turf or on outdoor grass fields. Those sudden movements, which include running, jumping, or cutting, place great stress on a player's joints.

How that stress affects the joints, and the rest of the lower body, often depends on the surface beneath.

Cote uses a yardstick as an example. Imagine jamming the yardstick into the ground, he says, like an athlete planting their leg mid-sprint. If jabbed into soft dirt, the bottom of the stick bends without breaking. Rather, it moves the dirt. Now, imagine jamming the stick into cement so it doesn't move.

"That flimsy yardstick becomes so stuck in the earth that, when you push or run into it hard enough, you break it," he says. "There is no wiggle room against the cement."

Grass surfaces

Whenever an athlete plants their cleats into the ground, they expose muscles, tendons, and ligaments in their legs to similar forces affecting the yardstick. On a natural grass surface, their cleats disrupt dirt beneath the grass, creating a divot.

Those divots allow the foot to break free from the ground, reducing the force from sharp movements. However, natural grass can expose players to several hazards:

Poor weather: Cold or snowy weather can harden dirt. The harder the surface, the less cushion for sharp movements.

Poor maintenance: Too many divots create uneven, chunky, or lumpy surfaces, which can lead to slipping or tripping.

According to Cote, injuries can occur from slipping on natural grass. A player who loses their balance moving side to side can overextend muscles in the inner thigh, leading to a groin injury.

Artificial surfaces: Turf and artificial grass

Artificial surfaces, such as turf and artificial grass, offer an even playing field - literally. They mimic the appearance of natural grass without the uneven bumps and holes created by divots. Some athletes credit turf for helping them run faster; they claim the surface feels easier to grip with their cleat, allowing them to accelerate.

Despite their durability and consistency, artificial surfaces act more like cement against Cote's figurative yardstick. A cleat may fix itself into the surface without room to latch free.

"A natural surface accommodates the cleat; its ability to allow the cleat to move and break free decreases built-up force trying to leave the leg," Cote says. "On a turf surface, the cleat can't move as well, so that force has nowhere else to go, except back up the leg."

Depending on which direction and how fast the cleat lands, several injuries to ligaments, tendons, and muscles can occur. These include straining or tearing the:

Why does turf cause more injuries?

Not enough data exists to confirm whether turf alone definitively causes more non-contact injuries than natural grass. Many variables affect an injury, such as:

Weather conditions

Personal fitness

Pre-existing injuries

Hamstring and quadricep size and strength

Often, players simply end up at the wrong place at the wrong time. That said, he does believe the materials used to create artificial grass or turf increase the likelihood of a non-contact injury occurring.

The devil lies in the details, he says, especially when examining two common types of turf:

1. Monofilament turf: The faux surface resembles a chunky blade of regular grass. Except, these blades do not bend or move in the same natural manner.

2. Slit-film synthetic turf: Shaped more like a double-helix than regular grass, these fake blades easily clump together. The blades, while more durable than monofilament turf, may catch the spikes of cleats when clustered.

# data[].attributes.attachment_link.title
Turf vs. Grass Injuries | Mass General Brigham

# data[].attributes.attachment_link.description
Is turf bad for athletes? Learn the difference between turf and grass injuries and whether turf causes injuries.

# data[].attributes.attachment_link.readable_text
Kevin Seifert, ESPN Staff WriterApr 20, 2023, 09:58 AM ET

Close
Kevin Seifert is a staff writer who covers the Minnesota Vikings and the NFL at ESPN. Kevin has covered the NFL for over 20 years, joining ESPN in 2008. He was previously a beat reporter for the Minneapolis Star Tribune and Washington Times. He is a graduate of the University of Virginia. You can follow him via Twitter @SeifertESPN.

Noncontact injuries for NFL players occurred at a higher rate on artificial turf compared to grass during the 2022 regular season, according to data released this week by the NFL Players Association.

The gap arose one year after the league moved to neutralize the debate about the two types of playing surfaces based on 2021 numbers.

Players have long said they prefer grass over artificial turf, arguing it was not only safer but also that it feels better to play on. In an essay posted to the NFLPA website Wednesday, union president J.C. Tretter noted that the injury rate on grass surfaces was lower from 2012 to 2020. Although the rates were essentially the same in 2021, Tretter termed that outcome an "outlier."

"Instead of following the long-term data (which is clear on this issue), listening to players and making the game safer," Tretter wrote, "the NFL used an outlier year to engage in a PR campaign to convince everyone that the problem doesn't actually exist."

Editor's Picks

"In short, last year, the gap -- much like the NFL's credibility with players on this issue -- was as wide as it has ever been," Tretter continued, "proving that (as the NFLPA suspected) 2021 was in fact an outlier. Now, 10 of the previous 11 years show the same exact thing -- grass is a significantly safer surface than turf."

Jeff Miller, the NFL's executive vice president of communications, public affairs and policy, said in a statement released Thursday that "there are no simple answers" to this discussion.

"The NFL and the NFLPA have access to the same injury information, which is collected by independent experts and shared at the CBA-mandated Joint Field Surface Safety and Performance Committee meetings," Miller said in the statement. "The committee, including the NFLPA's experts, believe that simply playing on natural grass is not the answer to this complex challenge. Some artificial turf surfaces have a lower injury rate than some grass fields -- and some grass fields have a lower injury rate than some artificial surfaces.

"Our goal is to decrease injuries on all surfaces. There are no simple answers, but we are committed to the substantial, ongoing work with the players and their expert advisors to make the game safer."

That NFL/NFLPA committee uses a third-party company, IQIVA, to compile and analyze injury data. Addressing a public push last fall from players, coaches and agents to convert all stadiums to grass fields, Dallas Cowboys owner Jerry Jones dismissed the idea based on IQIVA data.

"Our league stats don't see issues with the type [of] surface that we have [at AT&T Stadium] as opposed to natural grass," Jones said. "We don't see issues. No facts bear that out."

The surfaces committee pays particular attention to lower-extremity injuries that occur without contact and could potentially be attributed to the surface itself, specifically to the knees, ankles and feet.

As recently as 2019, the rate of such injuries was notably higher on artificial turf fields than grass. But the difference began narrowing in 2020, and by 2021, the numbers were almost the same. Artificial surfaces had an incident rate of .042 per 100 in 2021, while the rate for natural surfaces was .041 per 100. That ratio "replicated" during the 2022 preseason, Miller said last fall.

That trend meant that "the discussion between synthetic surfaces and natural grass surfaces isn't really the argument," Miller said then. Instead, he said, the NFL and NFLPA should try to "decrease injuries on both."

But the full data in 2022 returned to previous norms. The rate for noncontact lower-extremity injuries on artificial turf rose to a rate of .048 per 100. The corresponding rate on grass was 0.035.

In the post, Tretter also accused the NFL of allowing the Carolina Panthers to host a Week 16 game last season even after the artificial turf at Bank of America Stadium failed the league's standard pregame test. According to Tretter, the league informed the NFLPA that the field reached acceptable conditions late in the first half.

"But the fact remains that the players in that game had to play on a field that the league acknowledges was not safe," Tretter said. "That is beyond frustrating to players and unacceptable in the eyes of our union."

The sides are headed to arbitration on the issue.

"The union's assertions are incorrect," Miller said in Thursday's statement. "But we will make our arguments in the appropriate CBA-mandated grievance process, which is ongoing."

Asked if they had any plans to change surfaces or otherwise respond to the NFLPA's claims, the Panthers issued a statement from a spokesman of Tepper Sports Entertainment: "We are still discussing our options internally and have no further update at this time."
ESPN Panthers reporter David Newton contributed to this story.

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Latest NFL injury data fuels grass vs. turf debate

# data[].attributes.attachment_link.description
With the NFL saying "there are no simple answers," the NFLPA maintains the latest data on noncontact injuries shows grass is "significantly safer" than turf.

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( Beyond Pesticides, November 1, 2023) As communities consider maintenance and renovation of their playing fields, it is not uncommon for synthetic (or artificial) turf to come up as an alternative to natural grass. Promoters of synthetic turf argue that it provides a solution to climate change, reduces water use and maintenance costs, and allows for year-round play. But is this true? Is synthetic turf an environmentally responsible alternative to its organic grass counterpart? An established and growing body of scientific evidence is demonstrating environmental and health risks with synthetic turf. In addition, there is growing concern for the safety of those playing on artificial grass, which has led to a call from the National Football League's (NFL) Players Association to utilize natural grass on all 30 NFL stadiums after New York Jets quarterback Aaron Rodgers suffered a season-ending Achilles tear in September and Kansas City Chiefs tight end Travis Kelce's mid-game ankle injury.

Synthetic turf playing fields are reliant on polluting plastic (can contain perfluoroalkyl and polyfluoroalkyl substances-PFAS) and toxic pesticides for managing bacteria, mold and fungus, create contaminated water runoff, and cover over the natural environment, which is critical to preserving health and biodiversity, and averting climate disasters. Artificial fields can cost over $1 million for both the field installation, drainage system, and any additional costs for water treatment for an approximately ten-year lifespan, not including the game-day and ongoing maintenance costs. Manufacturers also recommend watering the synthetic field during the hottest time period because of the heat generated by the artificial material. The National Recreation and Park Association (NRPA) writes on synthetic turf: "[T]he high surface-level temperatures recorded on these fields compared to natural turf have been well-documented. Since grass leaves release water vapor (or transpire) and the evaporation of that water vapor leads to cooling, grass fields rarely get above 100° F. [Synthetic] Turf fields, in comparison, regularly rise well above 100° F. Penn State University's Center for Sports Surface Research conducted studies comparing surface temperatures of synthetic turfs composed of various fiber and infill colors/materials and found that the maximum surface temperatures during hot, sunny conditions averaged from 140° F to 170° F. The high surface-level temperatures on synthetic fields can lead to dehydration, burns and blisters if exposed skin comes into contact with the hot surface, as well as heat stroke." Restricted play is advised when temperatures exceed 80° F.

Synthetic turf is widespread across the United States. According to a multi-federal-agency presentation, there were 12,000-13,000 synthetic turf fields in the U.S. in 2019, with 1,200 - 1,500 new installations each year. Based on estimates, the global artificial turf market was valued at $8.1 billion in 2021, and it is expected to reach over $12 billion by 2027. Many of these fields have recycled tire crumb rubber, and a small fraction use coconut-based alternatives. According to Dan Bond, the president and CEO of the Synthetic Turf Council, "Over 90 percent of those fields have crumb rubber infill, and the other infills - the coconut, the EPDM, the virgin rubber, thermoplastics - are 1 to 2 percent." Mr. Bond elaborated in an article by Athletic Business, "It's a very small market share. It's growing, but it certainly is not going to overtake crumb rubber in five years." Typically produced from discarded tires, crumb rubber has been shown to contain carcinogens and heavy metals.

A groundbreaking study, The dark side of artificial greening: Plastic turfs as widespread pollutants of aquatic environments, has unearthed some disturbing revelations on the use of artificial turf, which has become a pervasive fixture on sports fields and playgrounds. This comprehensive study, prominently featured in the Environmental Pollution (June 2023) journal, has cast a spotlight on the dire consequences of plastic fibers from artificial turf, which are wreaking havoc on marine ecosystems.

The study has uncovered multiple entry points, such as river transport and stormwater runoff, where plastics and microplastics can enter watersheds. Once they make their way into the water, these fibers pose a menacing threat to marine life, leading to a host of health issues and, tragically, even mortality. These fibers also accumulate in sediments, compromising the overall health of aquatic ecosystems.

The authors of the study call for immediate intervention to tackle artificial turf pollution. The study authors indicate that plastic fields require enhanced waste management practices to staunch the plastic fibers from entering aquatic habitats. The results of this study serve as a call to policymakers, sports organizations, and the general public.

Communities discussing synthetic versus natural turf are faced with a number of issues that go to safety, environmental health, and cost. The chemicals used to manage synthetic turf for bacteria, mold, and fungus raise serious health issues and represent a threat that does not exist in organic land management. A builder of sports facilities, American Athletic, states, "Beyond surface cleaning, the artificial turf should be sanitized weekly or monthly to protect the players' and coaches' health. This disinfection requires special solvents, cleansers, and anti-microbial products to remove invisible particles and bacterial growth. You should strive to sanitize the field after every game and throughout the school day if it's used for physical education classes."

When all the synthetic turf issues are considered, including chemical use, maintenance, heat effects, water contamination and treatment, playability and safety, organic turf offers an approach that checks all the critical boxes for protecting health and the environment at a competitive price. Organic management practices build soil health, cycle nutrients naturally, enhance turf resiliency, reduce water use, and do not use petrochemical pesticides or fertilizers. The organic alternative is central to a community's discussion about its residents commitment to both the elimination of practices and products that are petrochemical-based and the ability of organically managed soils to draw down (sequester) atmospheric carbon, which contributes to mitigating global warming and erratic temperatures.

Learn more about how easy it is to create non-plastic and organic turf care. Prevent plastics from entering your local community with toxic and unsafe astroturf and artificial grass. Sign up to be a Parks Advocate today to encourage your community to transition to organic land management. Plan on attending Session 3 of the National Forum, Transformative Community-Based Change from the Ground Up: Managing Parks and Playing Fields with Organic Practices and Policies, on November 29, 2023, at 2:00 pm Eastern. Speaker and registration information HERE. This session is for all who want beautiful landscapes, parks, and playing fields without the reliance on petrochemical pesticides and fertilizers. The subject matter is cross-cutting and will inform people concerned about their health and community health, elected officials (from town, city, county, regional, state to school boards) interested in effecting movement away from toxic chemical reliance, and land managers and landscapers who work in parks and on playing fields and other landscapes.
All unattributed positions and opinions in this piece are those of Beyond Pesticides.
Source: The dark side of artificial greening: Plastic turfs as widespread pollutants of aquatic environments

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NFL Players Association Calls for Stadiums to End Synthetic Turf Use - Beyond Pesticides Daily News Blog

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An established and growing body of scientific evidence is demonstrating environmental and health risks with synthetic turf.

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The Effect of Turf Toe Injuries on Player Performance in the National Football League

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“Turf toe” results from hyperdorsiflexion of the first metatarsophalangeal joint, injuring the plantar capsuloligamentous complex. We hypothesized that National Football League (NFL) player performance following turf toe injury would decrease in…

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A season-ending sports injury can happen in the blink of an eye. In recent years, more and more athletes have ended their seasons, or even their careers, after seemingly tripping on thin air. To some, it can look like a car blowing out a tire; an athlete sprinting at full speed collapses under their own weight without anyone nearby.

Frustrated athletes are quick to blame the surface beneath them, and one common culprit in particular: artificial turf. According to Mark Cote, PT, DPT, MSCTR, a Mass General Brigham Sports Medicine researcher, these athletes make a compelling argument.

Mostly.

"I think they're right - they have good reason to blame artificial surfaces - but there are a number of reasons why injuries occur, and turf isn't the only one," says Cote. "It's a misconception to say natural grass is uniformly better than artificial surfaces for preventing injury, or vice versa."

Cote serves as director of Outcomes Research for Sports Medicine & Orthopaedic Surgery at Massachusetts General Hospital. He explains the differences between turf and grass playing surfaces, the risks of playing on each, and how athletes can best protect themselves from non-contact injuries.

Is turf better than grass? It's complicated.

Non-contact lower body injuries are common in sports like football, soccer, field hockey, and lacrosse. Each sport involves sudden movements on indoor fields with artificial turf or on outdoor grass fields. Those sudden movements, which include running, jumping, or cutting, place great stress on a player's joints.

How that stress affects the joints, and the rest of the lower body, often depends on the surface beneath.

Cote uses a yardstick as an example. Imagine jamming the yardstick into the ground, he says, like an athlete planting their leg mid-sprint. If jabbed into soft dirt, the bottom of the stick bends without breaking. Rather, it moves the dirt. Now, imagine jamming the stick into cement so it doesn't move.

"That flimsy yardstick becomes so stuck in the earth that, when you push or run into it hard enough, you break it," he says. "There is no wiggle room against the cement."

Grass surfaces

Whenever an athlete plants their cleats into the ground, they expose muscles, tendons, and ligaments in their legs to similar forces affecting the yardstick. On a natural grass surface, their cleats disrupt dirt beneath the grass, creating a divot.

Those divots allow the foot to break free from the ground, reducing the force from sharp movements. However, natural grass can expose players to several hazards:

Poor weather: Cold or snowy weather can harden dirt. The harder the surface, the less cushion for sharp movements.

Poor maintenance: Too many divots create uneven, chunky, or lumpy surfaces, which can lead to slipping or tripping.

According to Cote, injuries can occur from slipping on natural grass. A player who loses their balance moving side to side can overextend muscles in the inner thigh, leading to a groin injury.

Artificial surfaces: Turf and artificial grass

Artificial surfaces, such as turf and artificial grass, offer an even playing field - literally. They mimic the appearance of natural grass without the uneven bumps and holes created by divots. Some athletes credit turf for helping them run faster; they claim the surface feels easier to grip with their cleat, allowing them to accelerate.

Despite their durability and consistency, artificial surfaces act more like cement against Cote's figurative yardstick. A cleat may fix itself into the surface without room to latch free.

"A natural surface accommodates the cleat; its ability to allow the cleat to move and break free decreases built-up force trying to leave the leg," Cote says. "On a turf surface, the cleat can't move as well, so that force has nowhere else to go, except back up the leg."

Depending on which direction and how fast the cleat lands, several injuries to ligaments, tendons, and muscles can occur. These include straining or tearing the:

Why does turf cause more injuries?

Not enough data exists to confirm whether turf alone definitively causes more non-contact injuries than natural grass. Many variables affect an injury, such as:

Weather conditions

Personal fitness

Pre-existing injuries

Hamstring and quadricep size and strength

Often, players simply end up at the wrong place at the wrong time. That said, he does believe the materials used to create artificial grass or turf increase the likelihood of a non-contact injury occurring.

The devil lies in the details, he says, especially when examining two common types of turf:

1. Monofilament turf: The faux surface resembles a chunky blade of regular grass. Except, these blades do not bend or move in the same natural manner.

2. Slit-film synthetic turf: Shaped more like a double-helix than regular grass, these fake blades easily clump together. The blades, while more durable than monofilament turf, may catch the spikes of cleats when clustered.

# data[].attributes.attachment_link.title
Turf vs. Grass Injuries | Mass General Brigham

# data[].attributes.attachment_link.description
Is turf bad for athletes? Learn the difference between turf and grass injuries and whether turf causes injuries.

# data[].attributes.attachment_link.readable_text
Kevin Seifert, ESPN Staff WriterApr 20, 2023, 09:58 AM ET

Close
Kevin Seifert is a staff writer who covers the Minnesota Vikings and the NFL at ESPN. Kevin has covered the NFL for over 20 years, joining ESPN in 2008. He was previously a beat reporter for the Minneapolis Star Tribune and Washington Times. He is a graduate of the University of Virginia. You can follow him via Twitter @SeifertESPN.

Noncontact injuries for NFL players occurred at a higher rate on artificial turf compared to grass during the 2022 regular season, according to data released this week by the NFL Players Association.

The gap arose one year after the league moved to neutralize the debate about the two types of playing surfaces based on 2021 numbers.

Players have long said they prefer grass over artificial turf, arguing it was not only safer but also that it feels better to play on. In an essay posted to the NFLPA website Wednesday, union president J.C. Tretter noted that the injury rate on grass surfaces was lower from 2012 to 2020. Although the rates were essentially the same in 2021, Tretter termed that outcome an "outlier."

"Instead of following the long-term data (which is clear on this issue), listening to players and making the game safer," Tretter wrote, "the NFL used an outlier year to engage in a PR campaign to convince everyone that the problem doesn't actually exist."

Editor's Picks

"In short, last year, the gap -- much like the NFL's credibility with players on this issue -- was as wide as it has ever been," Tretter continued, "proving that (as the NFLPA suspected) 2021 was in fact an outlier. Now, 10 of the previous 11 years show the same exact thing -- grass is a significantly safer surface than turf."

Jeff Miller, the NFL's executive vice president of communications, public affairs and policy, said in a statement released Thursday that "there are no simple answers" to this discussion.

"The NFL and the NFLPA have access to the same injury information, which is collected by independent experts and shared at the CBA-mandated Joint Field Surface Safety and Performance Committee meetings," Miller said in the statement. "The committee, including the NFLPA's experts, believe that simply playing on natural grass is not the answer to this complex challenge. Some artificial turf surfaces have a lower injury rate than some grass fields -- and some grass fields have a lower injury rate than some artificial surfaces.

"Our goal is to decrease injuries on all surfaces. There are no simple answers, but we are committed to the substantial, ongoing work with the players and their expert advisors to make the game safer."

That NFL/NFLPA committee uses a third-party company, IQIVA, to compile and analyze injury data. Addressing a public push last fall from players, coaches and agents to convert all stadiums to grass fields, Dallas Cowboys owner Jerry Jones dismissed the idea based on IQIVA data.

"Our league stats don't see issues with the type [of] surface that we have [at AT&T Stadium] as opposed to natural grass," Jones said. "We don't see issues. No facts bear that out."

The surfaces committee pays particular attention to lower-extremity injuries that occur without contact and could potentially be attributed to the surface itself, specifically to the knees, ankles and feet.

As recently as 2019, the rate of such injuries was notably higher on artificial turf fields than grass. But the difference began narrowing in 2020, and by 2021, the numbers were almost the same. Artificial surfaces had an incident rate of .042 per 100 in 2021, while the rate for natural surfaces was .041 per 100. That ratio "replicated" during the 2022 preseason, Miller said last fall.

That trend meant that "the discussion between synthetic surfaces and natural grass surfaces isn't really the argument," Miller said then. Instead, he said, the NFL and NFLPA should try to "decrease injuries on both."

But the full data in 2022 returned to previous norms. The rate for noncontact lower-extremity injuries on artificial turf rose to a rate of .048 per 100. The corresponding rate on grass was 0.035.

In the post, Tretter also accused the NFL of allowing the Carolina Panthers to host a Week 16 game last season even after the artificial turf at Bank of America Stadium failed the league's standard pregame test. According to Tretter, the league informed the NFLPA that the field reached acceptable conditions late in the first half.

"But the fact remains that the players in that game had to play on a field that the league acknowledges was not safe," Tretter said. "That is beyond frustrating to players and unacceptable in the eyes of our union."

The sides are headed to arbitration on the issue.

"The union's assertions are incorrect," Miller said in Thursday's statement. "But we will make our arguments in the appropriate CBA-mandated grievance process, which is ongoing."

Asked if they had any plans to change surfaces or otherwise respond to the NFLPA's claims, the Panthers issued a statement from a spokesman of Tepper Sports Entertainment: "We are still discussing our options internally and have no further update at this time."
ESPN Panthers reporter David Newton contributed to this story.

# data[].attributes.attachment_link.title
Latest NFL injury data fuels grass vs. turf debate

# data[].attributes.attachment_link.description
With the NFL saying "there are no simple answers," the NFLPA maintains the latest data on noncontact injuries shows grass is "significantly safer" than turf.

# data[].attributes.attachment_link.description
Artificial turf has become an increasingly popular option for sports fields. However, artificial turf comes with its own set of harms.

# data[].attributes.attachment_link.readable_text
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Abstract

Football codes (rugby union, soccer, American football) train and play matches on natural and artificial turfs. A review of injuries on different turfs was needed to inform practitioners and sporting bodies on turf-related injury mechanisms and risk factors. Therefore, the aim of this review was to compare the incidence, nature and mechanisms of injuries sustained on newer generation artificial turfs and natural turfs. Electronic databases were searched using the keywords 'artificial turf', 'natural turf', 'grass' and 'inj*'. Delimitation of 120 articles sourced to those addressing injuries in football codes and those using third and fourth generation artificial turfs or natural turfs resulted in 11 experimental papers. These 11 papers provided 20 cohorts that could be assessed using magnitude-based inferences for injury incidence rate ratio calculations pertaining to differences between surfaces. Analysis showed that 16 of the 20 cohorts showed trivial effects for overall incidence rate ratios between surfaces. There was increased risk of ankle injury playing on artificial turf in eight cohorts, with incidence rate ratios from 0.7 to 5.2. Evidence concerning risk of knee injuries on the two surfaces was inconsistent, with incidence rate ratios from 0.4 to 2.8. Two cohorts showed beneficial inferences over the 90% likelihood value for effects of artificial surface on muscle injuries for soccer players; however, there were also two harmful, four unclear and five trivial inferences across the three football codes. Inferences relating to injury severity were inconsistent, with the exception that artificial turf was very likely to have harmful effects for minor injuries in rugby union training and severe injuries in young female soccer players. No clear differences between surfaces were evident in relation to training versus match injuries. Potential mechanisms for differing injury patterns on artificial turf compared with natural turf include increased peak torque and rotational stiffness properties of shoe-surface interfaces, decreased impact attenuation properties of surfaces, differing foot loading patterns and detrimental physiological responses. Changing between surfaces may be a precursor for injury in soccer. In conclusion, studies have provided strong evidence for comparable rates of injury between new generation artificial turfs and natural turfs. An exception is the likely increased risk of ankle injury on third and fourth generation artificial turfs. Therefore, ankle injury prevention strategies must be a priority for athletes who play on artificial turf regularly. Clarification of effects of artificial surfaces on muscle and knee injuries are required given inconsistencies in incidence rate ratios depending on the football code, athlete, gender or match versus training.

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national center for biotechnology information

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A review of football injuries on third and fourth generation artificial turfs compared with natural turf - PubMed

# data[].attributes.attachment_link.description
Football codes (rugby union, soccer, American football) train and play matches on natural and artificial turfs. A review of injuries on different turfs was needed to inform practitioners and sporting bodies on turf-related injury mechanisms and risk factors. Therefore, the aim of this review was to ...

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Injuries/Player Preference — Safe Healthy Playing Fields

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The rise of state-of-the art artificial turf fields at sporting facilities has eliminated the annoyance and cost of constant landscaping and watering to maintain real grass. From professional arenas and stadiums all the way down to local high school playing grounds, these synthetic surfaces have become commonplace. But under the shiny plastic surface, artificial turfs may be playing a more dangerous game with human health.

Recent studies reveal that athletes who practice and play on artificial turfs have higher injury risks compared to athletes who primarily play on natural grass. Sports medicine researchers studying the medical records of high schoolers in Ohio found that athletes who played football, soccer, and rugby were 58% more likely to sustain an injury on a turf field than a grass field.

Artificial turf fields have also caused a battery of non-contact injuries beyond the amateur level, including the eponymous " turf toe," a common injury where the big toe gets sprained. Professional athletes also see higher rates of feet, ankle, knee, and hip injuries on turf than on grass. One study of National Football League players found that turfs create a 16% increase in lower extremity injuries compared to natural surfaces. And in 2020, the president of the NFL's Player's Association officially recommended all turf fields be replaced with real grass.

Artificial turf fields might offer a pristine and bouncy place to play, but there are serious health risks rooted beneath the surface.

Currently, 15 of the 30 NFL stadiums remain turf. While most literature has shown that naturally grown fields help keep injuries down, several contradicting studies cite higher rates of injury on grass. However, these findings come from studies funded by the companies that manufacture turf materials, like Monsanto.

Beyond short-term injury, the chemicals intrinsic to artificial turf also threaten human health. Turfs are made from recycled tires and rubber to add bounce to the surface. Tests from these synthetic fields indicate they are filled with toxic substances known as "forever chemicals" like polyfluoroalkyl substances (PFAS), heavy metals, and volatile organic compounds. Some states, like Massachusetts and California, have imposed restrictions or bans on the sale or use of turfs containing PFAS because they have been linked to cancer and other chronic health problems.

The environmental impact of artificial fields brings an additional set of concerns. The life cycle of a turf field is about 8 to 10 years, which means there is a slow and steady rise of used and discarded turfs piling up. The Synthetic Turf Council estimates 1,500 new fields added and 700 replaced annually, resulting in up to 300 million pounds of plastic turf waste generated every year.

Run-off from turfs, whether in current use or previously discarded, add to microplastics found in the soil and water. Preliminary research done in Sweden revealed synthetic sports fields as a significant contributor to microplastics in waterways, with hundreds of kilograms of microplastics coming from each field. Research in Norway confirmed microplastics in 85% of samples taken from streams near artificial turfs. For now, the Environmental Protection Agency has released Part 1 of a 2-part report on synthetic turf fields. So far, no risk assessments or advisories have been formalized.

In response to growing evidence of artificial turf harms, big-league sports teams, including the NFL, have moved closer to leaving artificial turf for good and returning to natural grass fields. This action is not only about preventing immediate injuries but also about safeguarding the long-term health of athletes. Some teams are now hiring epidemiologists to track professional athletes' causes of death.

Artificial turf fields might offer a pristine and bouncy place to play, but there are serious health risks rooted beneath the surface-the public health impacts of turf have become too deep to ignore.
Photo via Getty Images

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Artificial Turf Fields: Grass Is Always Greener

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From increased risk of injury to toxic chemical exposure, the public health consequences of artificial turf fields are too deep to ignore.

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NPR's Scott Simon talks with orthopedist Timothy Kremchekan about how artificial turf can exacerbate injuries among high school football players.

SCOTT SIMON, HOST:

There was much attention when Aaron Rodgers was injured, carted off the field Monday night about four minutes into his first season as a New York Jet and a quarterback they hoped would bring them to the Super Bowl. He tore his Achilles tendon. Aaron Rodgers will be out for the rest of the season. The game was on artificial turf. Forty-eight hours later, the NFL players union once again urged the league to switch all fields to natural grass, saying it's safer. Some experts also sound the alarm about what they see as the risk that artificial turf poses to high school football players. Dr. Tim Kremchek joins us now. He's an orthopedic surgeon at Beacon Sports Medicine in Cincinnati and former medical director for baseball's Cincinnati Reds. Dr. Kremchek, thanks so much for being with us.

TIMOTHY KREMCHEK: I'm glad to be on.

SIMON: From your medical standpoint, what's the difference between artificial turf versus natural grass?

KREMCHEK: Well, No. 1, the artificial turf - you know, it holds up season by season, sport by sport for the college and the high schools. But the problem is the footing. Your footing gets caught in the artificial turf, and it doesn't give. And when that doesn't give, then your body is twisting and/or people are falling on you. You're trying to make quick cuts. Then something has to give, whether it's your ankle sprained, broken, Achilles tendon, knee. And it's been a real problem with multiple sports at all levels for a lot of years. Even though the artificial-turf makers are trying to change it and make it as closely resemble grass as they can, they still haven't been able to do that.

SIMON: As I don't have to tell you, some of the pro teams who use artificial turf contend that actually they think that the risk of injury is less because the surface is uniform, and it's weather resistant, they say, so players don't slip and slide or get a foot or a toe caught in a divot like they might on natural grass. How do you answer that?

KREMCHEK: Well, that's true. And I think a lot of athletes like to play on artificial turf when you're running straight ahead. And in most instances, you're right. In inclement weather, it can be great. The problem is when you do cutting sports like soccer or football, and you have to - if you wear cleats and it gets caught in the seams of the artificial turf, the thing that gives is your body. And if you're on regular grass or mud, even, then the mud or the grass gives rather than your body.

SIMON: We should explain. When you say a cutting sport, you mean a sport where people run a lot and have to change direction. Yeah.

KREMCHEK: Yeah. And that's - I mean, that's soccer. That's being a tailback in football, defensive back. So it's your foot getting caught. And the guys would say, well, you know, the argument would be, well, why would you wear cleats? Well, if you don't wear cleats on artificial turf, you slide all over the place so you don't get your footing even if there's just a little wetness. So you've got to wear some type of a cleat. Yet the cleat that you wear gets caught inside of the turf. That can be dangerous. And they have to be more controlled when they're playing on artificial turf because they don't want to have that cutting injury. They don't want to have that uncontrollable fall or twist. It'll hurt them.

SIMON: Do you personally see more injuries on artificial turf?

KREMCHEK: I do. I see more injury. But the problem is a lot of the kids that we see with college and high school, they have artificial turf because financially it makes more sense. They play men's and women's sports pretty much year-round - lacrosse, soccer, football. And so I'm going to see more injuries on artificial turf because the volume of games are played on artificial turf in most areas of the country now.

SIMON: Do you have some concern that if the NFL doesn't go more to natural grass, that high school and colleges will say - will point to the NFL as an example, and young athletes might be injured before a career gets started?

KREMCHEK: Absolutely. I mean, I think the NFL has a huge responsibility here. The NFL makes a lot of money. And it's very visible, and it's becoming more and more popular every year. And so I think that whether you're a college or a high school or junior college, if the NFL can say that the entry rates are the same as regular grass, they're going to be able to justify and mostly for financial reasons, to be able to say, let's put artificial turf down because we can't afford, No. 1, to put natural turf and, No. 2, maintain natural turf for all the sports that we have to play year-round. So I think the NFL has a huge responsibility, as well as Major League Soccer. But I think they have a huge responsibility because you're right, everybody's going to hang their hat on what the NFL does.

SIMON: Dr. Tim Kremchek, orthopedic surgeon at Beacon Sports Medicine in Cincinnati, thanks so much for being with us.

KREMCHEK: It's my pleasure. I hope this helps. I think we're going to have to make a change soon.

Copyright © 2023 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR's programming is the audio record.

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After Aaron Rodgers' injury, experts sound the alarm about the risks of artificial turf

# data[].attributes.attachment_link.description
NPR's Scott Simon talks with orthopedist Timothy Kremchekan about how artificial turf can exacerbate injuries among high school football players.

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Christian McCaffrey non-contact PCL injury.

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Christian McCaffrey non-contact PCL injury.

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49ers’ McCaffrey injures PCL; season in jeopardy

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49ers RB Christian McCaffrey, playing in just his fourth game since returning from Achilles tendinitis, suffered a PCL injury Sunday night in Buffalo that coach Kyle Shanahan described as potentially season-ending.

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Visit ESPN for the 2024 NFL season injury status per team, with details on players that are out, day-to-day, or on the injured reserve.

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Rob Demovsky, ESPN Staff WriterJan 6, 2025, 01:05 PM ET

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Rob Demovsky is an NFL reporter at ESPN and covers the Green Bay Packers. He has covered the Packers since 1997 and joined ESPN in 2013. Demovsky is a two-time Wisconsin Sportswriter of the Year as selected by the NSSA. You can follow him on Twitter at @RobDemovsky.

GREEN BAY, Wis. -- Green Bay Packers receiver Christian Watson sustained a season-ending torn ACL in Sunday's loss to the Chicago Bears, coach Matt LaFleur said Monday.

"Yeah, it's not good," LaFleur said. "He'll be out for this season or the rest of the year."

As for quarterbacks Jordan Love and Malik Willis, both of whom sustained injuries in Sunday's game, LaFleur wasn't sure whether they would be limited in practice this week. Love left the game in the second quarter after landing on his right elbow, which caused numbness in his throwing hand. Willis played the rest of the game but banged his throwing hand on the helmet of a Bears player on the second-to-last series of the game.

"I talked to both of those guys," LaFleur said. "They seem to be doing all right, but as far as their limits, I think they're going to be OK, but we'll find out over the next two days."

Editor's Picks

Watson was coming off a bruised left knee that forced him to miss the previous week's game at Minnesota. It's unclear whether that had any impact on the injury to his right knee. The injury came on a noncontact play in which the ball went to Dontayvion Wicks across the field. Watson needed help getting off the field and was carted to the locker room.

"That's a tough one," Love said Sunday. "Obviously, I'm not sure the exact circumstances, but just seeing it on the field, him going down noncontact like that, it's tough. It's really tough, especially Christian trying to bounce back from what he's been dealing with and to be able to go out there and have that happen, it's tough. I feel for Christian."

Watson, a third-year pro who played in all but two games this season, led the Packers with a 21.4-yard average per catch. He caught 29 passes for 620 yards and two touchdowns and was the team's best deep-threat receiver.

The timing of his injury not only wiped him out of the playoffs, which the Packers begin Sunday at the Philadelphia Eagles, but also means he's likely to miss a large portion of next season, when he will be in the final year of his rookie contract.

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Packers' Watson has season-ending knee injury

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Packers receiver Christian Watson sustained a season-ending knee injury in Sunday's loss to the Chicago Bears.

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Dak Prescott season-ending non-contact injury on hamstring.

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Dak Prescott season-ending non-contact injury on hamstring.

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Cowboys QB Dak Prescott to undergo season-ending surgery on injured hamstring

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Dallas Cowboys quarterback Dak Prescott is scheduled to undergo surgery Wednesday on his injured hamstring and will miss the remainder of the 2024 season, owner Jerry Jones announced Tuesday on 105.3 The Fan.

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The Houston Texans’ win over the rival Indianapolis Colts on Sunday came at a significant cost. Veteran wide receiver Stefon Diggs will miss the rest of the 2024 season after suffering a torn ACL, head coach DeMeco RyansDeMeco RyansDeMeco Ryans (/dɪˈmiːkoʊ/ dih-MEE-koh; born July 28, 1984) is an American professional football coach and former linebacker who is the head coach of the Houston Texans of the National Football League (NFL).https://en.wikipedia.org › DeMeco_Ryans announced on Tuesday.Oct 29, 2024

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NPR's Scott Simon talks with orthopedist Timothy Kremchekan about how artificial turf can exacerbate injuries among high school football players.

SCOTT SIMON, HOST:

There was much attention when Aaron Rodgers was injured, carted off the field Monday night about four minutes into his first season as a New York Jet and a quarterback they hoped would bring them to the Super Bowl. He tore his Achilles tendon. Aaron Rodgers will be out for the rest of the season. The game was on artificial turf. Forty-eight hours later, the NFL players union once again urged the league to switch all fields to natural grass, saying it's safer. Some experts also sound the alarm about what they see as the risk that artificial turf poses to high school football players. Dr. Tim Kremchek joins us now. He's an orthopedic surgeon at Beacon Sports Medicine in Cincinnati and former medical director for baseball's Cincinnati Reds. Dr. Kremchek, thanks so much for being with us.

TIMOTHY KREMCHEK: I'm glad to be on.

SIMON: From your medical standpoint, what's the difference between artificial turf versus natural grass?

KREMCHEK: Well, No. 1, the artificial turf - you know, it holds up season by season, sport by sport for the college and the high schools. But the problem is the footing. Your footing gets caught in the artificial turf, and it doesn't give. And when that doesn't give, then your body is twisting and/or people are falling on you. You're trying to make quick cuts. Then something has to give, whether it's your ankle sprained, broken, Achilles tendon, knee. And it's been a real problem with multiple sports at all levels for a lot of years. Even though the artificial-turf makers are trying to change it and make it as closely resemble grass as they can, they still haven't been able to do that.

SIMON: As I don't have to tell you, some of the pro teams who use artificial turf contend that actually they think that the risk of injury is less because the surface is uniform, and it's weather resistant, they say, so players don't slip and slide or get a foot or a toe caught in a divot like they might on natural grass. How do you answer that?

KREMCHEK: Well, that's true. And I think a lot of athletes like to play on artificial turf when you're running straight ahead. And in most instances, you're right. In inclement weather, it can be great. The problem is when you do cutting sports like soccer or football, and you have to - if you wear cleats and it gets caught in the seams of the artificial turf, the thing that gives is your body. And if you're on regular grass or mud, even, then the mud or the grass gives rather than your body.

SIMON: We should explain. When you say a cutting sport, you mean a sport where people run a lot and have to change direction. Yeah.

KREMCHEK: Yeah. And that's - I mean, that's soccer. That's being a tailback in football, defensive back. So it's your foot getting caught. And the guys would say, well, you know, the argument would be, well, why would you wear cleats? Well, if you don't wear cleats on artificial turf, you slide all over the place so you don't get your footing even if there's just a little wetness. So you've got to wear some type of a cleat. Yet the cleat that you wear gets caught inside of the turf. That can be dangerous. And they have to be more controlled when they're playing on artificial turf because they don't want to have that cutting injury. They don't want to have that uncontrollable fall or twist. It'll hurt them.

SIMON: Do you personally see more injuries on artificial turf?

KREMCHEK: I do. I see more injury. But the problem is a lot of the kids that we see with college and high school, they have artificial turf because financially it makes more sense. They play men's and women's sports pretty much year-round - lacrosse, soccer, football. And so I'm going to see more injuries on artificial turf because the volume of games are played on artificial turf in most areas of the country now.

SIMON: Do you have some concern that if the NFL doesn't go more to natural grass, that high school and colleges will say - will point to the NFL as an example, and young athletes might be injured before a career gets started?

KREMCHEK: Absolutely. I mean, I think the NFL has a huge responsibility here. The NFL makes a lot of money. And it's very visible, and it's becoming more and more popular every year. And so I think that whether you're a college or a high school or junior college, if the NFL can say that the entry rates are the same as regular grass, they're going to be able to justify and mostly for financial reasons, to be able to say, let's put artificial turf down because we can't afford, No. 1, to put natural turf and, No. 2, maintain natural turf for all the sports that we have to play year-round. So I think the NFL has a huge responsibility, as well as Major League Soccer. But I think they have a huge responsibility because you're right, everybody's going to hang their hat on what the NFL does.

SIMON: Dr. Tim Kremchek, orthopedic surgeon at Beacon Sports Medicine in Cincinnati, thanks so much for being with us.

KREMCHEK: It's my pleasure. I hope this helps. I think we're going to have to make a change soon.

Copyright © 2023 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR's programming is the audio record.

# data[].attributes.attachment_link.title
After Aaron Rodgers' injury, experts sound the alarm about the risks of artificial turf

# data[].attributes.attachment_link.description
NPR's Scott Simon talks with orthopedist Timothy Kremchekan about how artificial turf can exacerbate injuries among high school football players.

# data[].attributes.headline
Comparing stadiums with real grass vs artificial turf

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Comparing stadiums with real grass vs artificial turf

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NFL
Over the years, NFL stadiums have featured artificial turf, with more than half of the franchises still using it. Which NFL stadiums have natural grass?

Ed Mulholland

The high number of injuries had everyone debating about grass or artificial turf at the beginning of the season. The players want to play on natural grass because it's safer, but as of the 2023 season, 14 NFL teams out of 32 do not use natural grass. Two teams use Desso GrassMaster, a combination of artificial turf and grass.

Remember that the Giants and Jets share the MetLife Stadium, and the Rams and Chargers share the SoFi Stadium.

In comparison to the 90's, today's artificial turf is much safer than back then, but is still a long shot from natural grass, especially for NFL players' preference. In 2020, following numerous players suffering injuries off artificial turf, NFL Players Association president JC Tretter advocated against using artificial turf. In a survey conducted by NFLPA regarding turf vs. natural grass, nearly 93 percent of players listed artificial turf as an impediment to their careers. In comparison, 91 percent stated it made them feel more tired and sore. That demand was made again after Aaron Rodgers' torn Achilles injury on Sep. 10, 2023

Which NFL stadiums use natural grass?

The Cleveland Browns and Pittsburgh Steelers are two franchises that have stadiums in cold-weather climates but also cultivate natural grass fields in both Lambeau and Heinz Field. Arizona and Las Vegas also avoid artificial turf, even with their indoor stadiums, and use Bermuda grass.

Arizona's State Farm Stadium specifically has a retractable natural grass that can be removed whenever there are other events in the stadium, like soccer games or even concerts.

Other stadiums that use the same type of Bermuda grass are the Chiefs' Arrowhead Stadium, and Dolphins' Hard Rock Stadium. Tampa Bay Buccaneers, Tennessee Titans and Washington Commanders have also cultivated the same grass surface in all three stadiums, Raymond James Stadium, Nissan Stadium and FedExField.

Last but not least, there are a few other stadiums inhabiting perennial, cool-season lawn grass called Kentucky bluegrass: Bears' Soldier Field, Browns' FirstEnergy Stadium, and Broncos' Empower Field.

The Aaron Rodgers injury has reignited the NFL debate about natural grass vs. artificial turf fields.

But the data is clear - natural grass is safer.

Here's a breakdown of the data and an explanation of why NFL owners are still hesitant to make the change.

The irony here is... pic.twitter.com/7v9hjkTCkT
- Joe Pompliano (@JoePompliano) September 13, 2023

NFL stadiums with natural grass:

NFL stadiums with real grass

NFL stadiums with artificial turf

Stadiums with astro turf

NFL fields that use Desso GrassMaster

Desso Grassmaster is a hybrid grass sports playing field surface that is a mix of artificial fibers and natural grass. The combination was developed in 1993 by the Dutch company Desso Sports.

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NFL stadiums with real grass and artificial turf: Full list of field surfaces

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Over the years, NFL stadiums have featured artificial turf, with more than half of the franchises still using it. Which NFL stadiums have natural grass?

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What is CTE? | Traumatic Brain Injury | IU School of Medicine

# data[].attributes.attachment_link.description
Chronic Traumatic Encephalopathy, or CTE, is a progressive degenerative disease affecting people who have suffered repeated concussions and traumatic brain injuries, that may occur in some athletes and others who have been exposed to concussions and repetitive head impacts. One theory about the cause of CTE is that repeated injuries to the brain causes a buildup of an abnormal form of the tau protein which may interfere with the function of the brain’s neurons. Not everyone who has a brain injury or who has been exposed to repetitive head impacts develops CTE. In fact, at this time, research has not yet revealed how many or which individuals exposed to repetitive injuries will develop this condition.