Risk of injury in elite football played on artificial turf versus natural grass:​ a prospective two-cohort study

Ekstrand, J.; Timpka, T.; Hägglund, M.

Affiliations

¹Department of Social Medicine and Public Health Science, Linköping University, and the Sports Clinic, Linköping, Sweden

Abstract

Objective: To compare injury risk in elite football played on artificial turf compared with natural grass.

Design: Prospective two-cohort study.

Setting: Male European elite football leagues.

Participants: 290 players from 10 elite European clubs that had installed third-generation artificial turf surfaces in 2003–4, and 202 players from the Swedish Premier League acting as a control group.

Main outcome measure: Injury incidence.

Results: The incidence of injury during training and match play did not differ between surfaces for the teams in the artificial turf cohort: 2.42 v 2.94 injuries/1000 training hours and 19.60 v 21.48 injuries/1000 match hours for artificial turf and grass respectively. The risk of ankle sprain was increased in matches on artificial turf compared with grass (4.83 v 2.66 injuries/1000 match hours; rate ratio 1.81, 95% confidence interval 1.00 to 3.28). No difference in injury severity was seen between surfaces. Compared with the control cohort who played home games on natural grass, teams in the artificial turf cohort had a lower injury incidence during match play (15.26 v 23.08 injuries/1000 match hours; rate ratio 0.66, 95% confidence interval 0.48 to 0.91).

Conclusions: No evidence of a greater risk of injury was found when football was played on artificial turf compared with natural grass. The higher incidence of ankle sprain on artificial turf warrants further attention, although this result should be interpreted with caution as the number of ankle sprains was low.

Links

DOI: 10.1136/bjsm.2006.027623

PubMed: 16990444

WoS: 000242234700008

History

Accepted: 2006-09-03

Online: 2006-09-21

Cited Works (5)

Year	Entry
1999	Hawkins RD, Fuller CW. A prospective epidemiological study of injuries in four English professional football clubs. Br J Sports Med. June 1999;33(3):196-203.
1989	Ekstrand J, Nigg BM. Surface-related injuries in soccer. Sports Med. July 1989;8(1):56-62.
1996	Árnason Á, Gudmundsson Á, Dahl HA, Jóhannsson E. Soccer injuries in Iceland. Scand J Med Sci Sports. February 1996;6(1):40-45.
2004	Andersen TE, Tenga A, Engebretsen L, Bahr R. Video analysis of injuries and incidents in Norwegian professional football. Br J Sports Med. 2004;38(5):626-631.
1992	van Mechelen W, Hlobil H, Kemper HCG. Incidence, severity, aetiology and prevention of sports injuries: a review of concepts. Sports Med. August 1992;14(2):82-99.

Cited By (16)

Year	Entry
2016	Hotfiel T, Carl H-D, Grim C, Engelhardt M. Management of injured athletes at the field. In: Valderrabano V, Easley M, eds. Foot and Ankle Sports Orthopaedics. Cham, Switzerland: Springer International Publishing; 2016:81-87.
2010	Meyers MC. Incidence, mechanisms, and severity of game-related college football injuries on FieldTurf versus natural grass: a 3-year prospective study. Am J Sports Med. April 2010;38(4):687-697.
2012	Hershman EB, Anderson R, Bergfeld JA, Bradley JP, Coughlin MJ, Johnson RJ, Spindler KP, Wojtys E, Powell JW. An analysis of specific lower extremity injury rates on grass and FieldTrf playing surfaces in National Football League games: 2000-2009 seasons. Am J Sports Med. October 2012;40(10):2200-2205.
2012	Viano DC, Withnall C, Wonnacott M. Football helmet drop tests on different fields using an instrumented Hybrid III head. Ann Biomed Eng. January 2012;40(1):97-105.
2007	Fuller CW, Dick RW, Corlette J, Schmalz R. Comparison of the incidence, nature and cause of injuries sustained on grass and new generation artificial turf by male and female football players, II: training injuries. Br J Sports Med. August 2007;41(suppl 1):i27-i32.
2012	Smeets K, Jacobs P, Hertogs R, Luyckx J-P, Innocenti B, Corten K, Ekstrand J, Bellemans J. Torsional injuries of the lower limb: an analysis of the frictional torque between different types of football turf and the shoe outsole. Br J Sports Med. December 2012;46(15):1078-1083.
2012	Frimenko RE, Lievers WB, Coughlin MJ, Anderson RB, Crandall JR, Kent RW. Etiology and biomechanics of first metatarsophalangeal joint sprains (turf toe) in athletes. Crit Rev Biomed Eng. 2012;40(1):43-61.
2013	Drakos MC, Taylor SA, Fabricant PD, Haleem AM. Synthetic playing surfaces and athlete health. J Am Acad Orthop Surg. May 2013;21(5):293-302.
2013	Dragoo JL, Braun HJ, Harris AHS. The effect of playing surface on the incidence of ACL injuries in National Collegiate Athletic Association American football. Knee. June 2013;20(3):191-195.
2011	Fleming P. Artificial turf systems for sport surfaces: current knowledge and research needs. Proc Inst Mech Eng Part P-J Sports Eng Tech. June 2011;225(2):43-63.
2010	Müller C, Sterzing T, Lange J, Milani TL. Comprehensive evaluation of player-surface interaction on artificial soccer turf. Sports Biomech. September 2010;9(3):193-205.
2009	Stiles VH, James IT, Dixon SJ, Guisasola IN. Natural turf surfaces: the case for continued research. Sports Med. 2009;39(1):65-84.
2010	Dragoo JL, Braun HJ. The effect of playing surface on injury rate: a review of the current literature. Sports Med. 2010;40(11):981-990.
2011	Williams S, Hume PA, Kara S. A review of football injuries on third and fourth generation artificial turfs compared with natural turf. Sports Med. November 2011;41(11):903-923.
2012	Wannop JW. Footwear Traction and Lower Extremity Non-Contact Injury [PhD thesis]. Calgary, AB: University of Calgary; August 2012.
2017	Saxton KH. Descriptive Analysis of Lower Limb Injuries on Differently Aged Artificial Turf [Master's thesis]. Missoula, MT: University of Montana; May 2017.