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Does artificial turf increase number of injuries ?

Previous studies evaluating injury patterns on the first two generations of artificial turf reported a higher incidence of overuse injuries. As a result one particular feature of third generation artificial surfaces is improved shock absorption. Even though a causal relationship between this intervention and a reduction in overuse injury is difficult to establish using our study design, the artificial turf cohort did not show a higher injury incidence than the control cohort. Wounds, burns and friction injuries have been reported to be more common on artificial turf. Knowing that low costs and ease of maintenance offered by artificial turf are quite important for sports clubs, UEFA currently supports the development of artificial turf technologies.
Grass is the traditional surface for football matches and training, but many regions in the world have a climate that makes development of adequate natural grass pitches difficult. Furthermore, modern specially designed football stadiums have a roof under which grass pitches do not thrive.

The use of artificial football pitches has been put forward as a solution to these problems. A comparison between first generation artificial turf and natural grass pitches revealed that the utility of artificial pitches was 12 times greater than grass pitches and the maintenance costs only 15%.  However, playing football on first and second generation artificial turf has the disadvantage of a distorted bounce and roll of the ball and a there was concern that the risk of injury was greater. Results from a the studies in Sweden when the first artificial surface was introduced. They observed that football played on artificial turf in created boots increased the rate of injury. Two Norwegian physicians analyzed 16 teams in the 1980s. They found 30 injuries/1000 match hours on artificial turf compared with 20 injuries/1000 hours on grass; the difference was not statistically significant probably because of small numbers.

Similar results were reported in another study conducted in the 1970s: more overuse injuries were found when football was played on artificial turf compared with natural grass. However, these two studies were too small for the results to reach statistical significance. In 1991, the risk of injury in Icelandic elite football was investigated. They found a significantly higher injury risk on artificial turf than on natural grass (25 v 10 injuries/1000 hours of exposure,). The relationship between artificial surfaces and a greater risk of injury, however, is poorly documented because the few studies reported have been small with methodological limitations.

The negative experience with first-generation artificial surfaces led to the development of improved artificial turf especially designed for football with playing characteristics similar to natural grass. Third-generation artificial turf pitches were introduced in the late 1990s, made of long (40 mm) and much more widely spread fibers of polypropylene or polyethylene filled with rubber granules. The use of the term ‘‘football turf’’ instead of ‘‘artificial or synthetic turf of the 3rd generation’’ is the official terminology chosen by FIFA and UEFA for artificial turf most suitable for football based on test criteria identical with those of the best natural turf.

Positive preliminary experience from youth tournaments encouraged FIFA to allow international matches to be played on these new surfaces. However, no studies have evaluated injury risk when elite football is played on football turf. The aim of this study was to examine the injury risk associated with playing elite football on artificial turf compared with natural grass. On the basis of experience from studies on previous generation artificial turfs, our hypothesis was that injury risk is higher when football is played on artificial turf than when it is played on natural grass.

A prospective two-cohort design was used for the study. Male players from 10 elite European football clubs that had reported the installation of football turf (third generation artificial turf) to UEFA during the 2003–2004 season constituted the study cohort. UEFA defines elite level as the two highest national football league divisions. Intra-cohort differences in injury incidence on football turf and grass were used to assess the effect of the playing surface. To adjust for any home ground effect and to further evaluate the impact of the playing surface, the Swedish teams in the artificial turf cohort were also compared with a control cohort consisting of the players from Swedish Premier League clubs playing their home matches on grass.

A recordable injury was defined as an injury resulting from football training or match play leading to a player being unable to take full part in training or match play at any time after the injury. A player was considered injured until cleared by the team medical officer for full participation in team training and match play. Injuries were divided into four categories of severity according to the length of absence from training sessions and matches: slight (1–3 days); minor (4–7 days); moderate (8–28 days); severe (longer than 28 days).

A total of 90 191 hours of football exposure were recorded during the study period in the artificial turf cohort; 65% of training and match exposure was on artificial turf, 27% on grass, and 8% on other surfaces. A total of 775 injuries was recorded, of which 455 (59%) were traumatic (5.04/1000 hours) and 320 (41%) overuse injuries (3.54/1000 hours). This analysis showed no difference between surfaces in overall injury incidence during training or match play. Ligament sprain (n = 151), contusion (n = 134) and muscle strain (n = 127) were the most common traumatic injury types. No abrasions or lacerations were recorded. The intra-cohort analysis showed an increased risk of ankle sprain on artificial turf, reaching significant levels in match play. In contrast, the rate of lower extremity strains was lower on artificial turf.

There was no difference in incidence of severe injuries between surfaces, although the tendency was that fewer severe injuries occurred on grass in training. However, results obtained through these studies should not be considered as definite results, since the number of samples was not high enough. Especially the claim that injury rates are lower for trainings made on natural grass should be analyzed in detail.

Previous studies evaluating injury patterns on the first two generations of artificial turf reported a higher incidence of overuse injuries. As a result one particular feature of third generation artificial surfaces is improved shock absorption. Even though a causal relationship between this intervention and a reduction in overuse injury is difficult to establish using our study design, the artificial turf cohort did not show a higher injury incidence than the control cohort. Wounds, burns and friction injuries have been reported to be more common on artificial turf.

The relative exposure to training and match play on artificial turf compared with natural grass was high in November to February, probably because of poor climate and grass pitch condition at that time of the year. The rate of traumatic match injuries was also high during these months, both on artificial turf and grass. This may imply that the rate ratio between injuries sustained on artificial turf and natural grass observed during matches in this study may be somewhat overestimated. Had exposure on artificial turf and grass been more evenly distributed during these two months of the year when the risk of injury is high, the rate ratio would probably have been even lower. This would further support the conclusion that the overall risk of injury on artificial turf is no higher than on grass.

The most obvious result of the study was that sprains are experienced more during matches on artificial turf, while low intensity muscle contraction is less frequent.

Knowing that low costs and ease of maintenance offered by artificial turf are quite important for sports clubs, UEFA currently supports the development of artificial turf technologies.

 
 
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