Artificial turf and injury incidence: what the data show for turf and landscape professionals

The question whether artificial turf surfaces increase the risk of injury compared to natural grass has been examined in multiple contexts. A 2023 systematic review titled "Lower Extremity Injury Rates on Artificial Turf Versus Natural Grass Playing Surfaces" found that across 53 peer-reviewed studies, the most consistent finding was a higher rate of foot and ankle injuries on artificial turf compared with natural grass, for both older‐generation and newer turf systems. Knee and hip injury rates were more commonly reported as similar between surfaces, although in some high-level football cohorts the knee injury risk on artificial turf appeared elevated.

In a study of elite European football clubs (male players) published in 2006 ("Risk of injury in elite football played on artificial turf versus natural grass: a prospective two-cohort study"), researchers compared injury incidence among clubs playing on third-generation artificial turf and clubs on natural grass. They reported no statistically significant difference in overall injury incidence between surfaces (for training or matches), but did observe a significantly higher incidence of ankle sprains during matches on artificial turf (4.83 vs 2.66 injuries per 1,000 match hours; rate ratio 1.81, 95% CI 1.00-3.28).

Additional review material - an "Injury Research Review - Natural Grass and Synthetic Turf Playing Surfaces" (published by the Sports Turf Managers Association) states that while traumatic (acute contact) injury rates did not differ significantly between artificial turf and grass in many cases, artificial turf "seems to be a risk factor for overuse injuries." In one cited study of NCAA athletes (3,009,205 exposures, 2,460 knee injuries from 2004-2014), athletes playing competitions on artificial turf experienced PCL injuries at nearly 2.94 times the rate of those on grass; for Division II/III athletes the ACL injury rate was 1.63 ?- and PCL 3.13 ?- higher on turf.

From a mechanistic perspective the material and functional differences between artificial turf and natural grass are seen as contributing factors. According to a publication from University of California, San Francisco, artificial turf generally does not absorb as much force at the knee and ankle as natural grass; the cleat-surface interaction is different, which may result in increased torque or shear on the lower extremities. The National Football League Players Association (NFLPA) cites internal data showing that players had a 28% higher rate of non-contact lower extremity injuries when playing on artificial turf vs grass, including a 69% higher rate of non-contact foot/ankle injuries.

Nevertheless, the literature also notes important caveats. The quality of turf (infills, shock-absorption, installation, maintenance) varies widely; many older-generation artificial surfaces had very different characteristics than modern third-generation surfaces. A meta-analysis published in "Clinical Journal of Sport Medicine" reported that in some professional football settings injury incidence was actually lower on modern artificial turf than on grass, suggesting context, sport, level, and surface quality matter. The article "Sports field surface and injury risks: Grass vs. turf is just the beginning" emphasises that player characteristics, footwear, surface maintenance, athlete fatigue and type of sport all influence injury outcomes, and that differences are not always large or consistent across studies.

For turf and landscape professionals involved in selecting, installing or maintaining playing surfaces, these findings have practical implications. First, surface choice is not purely a matter of cost or durability: the data suggest that the risk of foot, ankle and some knee injuries may be higher on artificial turf, particularly older or less-well-maintained systems. Second, maintenance protocols (e.g., ensuring proper infill depth, shock pad performance, surface evenness, cleat interface) and regular inspection matter to control for injury risk. Third, for facility owners, municipalities or clubs, surface decisions carry liability and insurance implications: the higher incidence of certain injuries may influence premium risk assessments or user safety policies. Fourth, for manufacturers and contractors of turf systems, the evolving research reinforces the importance of engineering surfaces to mimic natural grass in terms of traction, energy absorption and rotational resistance. Finally, from a lifecycle-cost perspective, the trade-off between artificial turf's durability, all-weather performance, and potential increased injury risk must be considered in business planning.

In conclusion, while artificial turf surfaces are widely used and continue to evolve, the body of peer-reviewed research suggests that certain classes of injury - especially foot and ankle, and to a lesser extent lower‐extremity knee and ligament injuries - tend to occur at higher rates on artificial turf compared with natural grass, all else equal. However, the effect is not uniform across all sports, levels of play or generations of turf, and better designed, installed and maintained systems may mitigate risk. For industry professionals in turf, landscape and construction sectors, the decision of surface type and the ongoing management of that surface remain key components in managing injury risk, asset value and user safety.