Fact vs. Fiction: Artificial Turf Injuries

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Recently, there has been a lot of negative press focused on artificial turf and those of us working in and around this industry have noticed that media seem to be latching on to the alleged safety issues surrounding rubber crumb. There are other concerns as well (and a lot of misinformation), but in this article, I will focus on shedding light between the facts and myths surrounding artificial turf injuries.

Splash or Skin Friction

Probably the most frustrating issue that tends to confuse both media and football pundits alike is the misconception that artificial turf is causing more injuries than natural turf. Given the condition of elite stadium natural turf in Scotland, this suggestion is consigned to a joke. In a recent study of Pro Player plying their trade in the Scottish Leagues, three artificial pitches ranked in the top half of the acceptability ratings with one being top 10.

There is no doubt that the player interaction and ball interaction on an artificial turf field are different. However, modern-day artificial turf is a high-tech, high-performing platform and with proper maintenance, it can receive exceptionally high player ratings. Humans, after all, are adaptable and we can adapt to different playing surfaces very quickly, especially with conditioning pre-game.

In this interesting article in the Glasgow Herald, one of Scotland’s top orthopaedic surgeons provides his view on injuries on artificial turf. It was revealed by one of Scotland’s leading knee specialists that there is no compelling scientific evidence to suggest footballers are at increased risk of serious injuries while playing on an artificial surface. Studies have also shown that clubs can, by more than half, reduce the chances of players being side-lined by altering pre-match warm-up routines and embracing the FIFA 11+ programme.

Rangers confirmed recently that their winger Jamie Murphy has been ruled out for the remainder of the season after sustaining an Anterior Cruciate Ligament (ACL) injury during the Betfred Cup game against Kilmarnock at Rugby Park, which is an artificial pitch. Both Steven Gerrard, the Ibrox club’s manager, and James Tavernier, their captain, have suggested the synthetic pitch at the Ayrshire ground was responsible.

In the wake of the Murphy incident, the Scottish Professional Football League (SPFL) have come under increased pressure to review their long-standing policy on their member clubs having artificial surfaces. However, Jon Dearing, a consultant orthopaedic surgeon based at Ross Hall Hospital in Glasgow, stressed that extensive medical research has shown that players are just as likely to suffer serious knee injuries when playing on natural grass.

Dearing, who is one of only two surgeons in the country who holds a specialist qualification in sport and exercise medicine, explained that clubs can significantly reduce the risk of injury on artificial turf by tailoring their pre-match warm-ups.

“There is no good evidence that with the current 3G pitches that there is any increased risk of injury,” he said. “There are number of studies which have looked at whether there is an increased risk of cruciate ligament injuries, ankle injuries and all injuries associated with artificial pitches. Overall, there is no good evidence that, with normal football boots versus blades, artificial pitches increase risk of lower limb injury. The footwear the player wears can be an influence. It used to be said that blades increase torsion of the knee and certainly in the older pitches that was true. But there isn’t such strong evidence that that is still the case with the new generation of artificial pitches.”

Dearing added, “People draw an association rather than causation. You see a professional athlete getting injured on an artificial surface and then, as was the case with Steven Gerrard, somebody states it is because of the pitch. Well, no, these things just happen. There are lots and lots of professional football and rugby players who get cruciate ligament injuries and they are not playing on artificial turf. Some studies have shown that if you are playing on a slightly hard uneven surface, that is a greater risk than playing on artificial pitches. It isn’t cut and dried.”

Dearing feels more football clubs in Scotland should be following the lead of their rugby counterparts by taking simple measures to prevent players from suffering serious injuries.

“Clubs should be doing more to mitigate against lower limb injury,” he said. “For the last five or six years there has been really, really strong evidence that doing specific warm-up drills reduces lower limb injury by between 30 and 60 per cent. FIFA have something called the FIFA 11+ drill. As far back as 10 years ago, there was a programme in America called PEP, Preventing Injury and Enhance Performance. Rugby players have really taken this on board. The SRU now has a programme based on that. It is not really that clear how well that has been taken up by footballers. But I see a lot of lower league and junior players who just don’t do this."

"We don’t look after our athletes. In Scotland we can’t afford to haemorrhage talent at a young age," he continues. There are steps which can be taken to reduce the risk of lower limb injury. If you are doing that then it doesn’t matter what surface you are playing on. The difficulty is with people listening. Often older managers are of the opinion that we have always done it like this. So you say but you’ve always had injuries. The reason FIFA push this is if you have a player who is on £50,000 a week and he is out for a year that is a lot of money to be spending on somebody who isn’t doing anything. If you can reduce the risk of that happening by a third to two thirds that is a lot of money to be saved.”

Dearing admitted that artificial surfaces had been shown to increase ankle strains - which in turn can lead to serious knee injuries - but stressed that a bespoke warm-up can prevent that.

“The ACL injury that Michael Owen suffered at the 2006 World Cup was a nothing incident. He just kind of folded. But if you look back you will see that a minute or so earlier, he had just gone over on his ankle. His balance was impaired, and he suffered a failure as he was trying to push off. But the likelihood of suffering an ankle injury is also reduced by proper conditioning and the warm-up. All lower limbs injuries are reduced by doing that. So, you can mitigate against them.”

This is one expert's view which, of course, may suit the direction of this article. But more compelling evidence can be brought to the table and whilst John Dearing could be one man’s point of view. Then the results from the recent Women’s World Cup provides a detailed study on elite players and injuries on artificial turf.

WOMEN’S WORLD CUP 2015: The Fewest Injuries per Match in Almost a Decade

For the first time in its history, a FIFA World Cup was held on artificial turf. As a result, artificial turf was in the spotlight at the 2015 Women’s World Cup, and despite some initial concerns, the international governing body’s Technical Report and Statistics publication reveals that “there was no significant difference regarding injuries sustained there and those on the grass at previous editions.”

Initially, most complaints were targeted at the safety of artificial turf, stating that it is less forgiving than natural grass and therefore it impacts play because of concerns of injury. The data, however, told a different story.

According to the 232-page FIFA report released six weeks after the United States defeated Japan, 5-2 (one of football’s most memorable tournament finales ever) team doctors were asked to report all injuries incurred by their players during each match of the 2015 Women’s World Cup. This practice has been common for years.

Lower Injury Rate

The overall injury rate was 2.1% injuries per match — lower than the overall injury rate at both the 2007 (2.3%) and 2011 (2.3%) Women’s World Cups, which were each played on grass.

The 2.1 percent injury rate was also equal to or lower than injury rates during women’s football at the previous four Olympic Games, which were all played on natural grass.

Temperature Concerns?

As the international governing body did at the Men’s World Cup 2014 in Brazil, FIFA permitted cooling down/drinking breaks as needed during Women’s World Cup 2015 matches when the heat stress threshold was surpassed. This development was implemented, in part, out of concerns that the artificial turf would cause on-field temperatures to increase. FIFA’s Medical Committee recommended this stoppage in play whenever the Wet Bulb Globe Temperature (WBGT) index reached or exceeded 32 degrees Celsius (or 89.6 degrees Fahrenheit). No cooling breaks were needed as a result of high WBGT compared to one stoppage in Brazil.

The WBGT index, an effective way to assess heat stress, provides a composite temperature used to estimate the effect of actual temperature, humidity, wind speed and radiant heat on players.

A Resounding Success

The turf didn’t appear to bother fans either, as more than 1.35 million spectators attended matches at the six Canadian venues, and record-breaking television audiences tuned into coverage in 188 territories — confirming that World Cup is the world’s largest women’s single-sport event.

Conclusion

The study concludes that in terms of safety, artificial turf is as safe or safer than natural grass. And, as with all articles which are directing the reader to a point of view, one must provide a balanced view. These opinions and facts are not mine, and evidence-based results are not views, they are presented for anyone to analyse. Artificial turf, when well-maintained, does not cause more injuries than natural turf -- and that is a fact.