Higher Rates of Lower Extremity Injury on Synthetic Turf Compared With Natural Turf Among National Football League Athletes

Epidemiologic Confirmation of a Biomechanical Hypothesis

Christina D. Mack, Elliott B. Hershman, Robert B. Anderson, Michael J. Coughlin, Andrew Scott McNitt, Rachel R. Sendor, Richard W. Kent

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Biomechanical studies have shown that synthetic turf surfaces do not release cleats as readily as natural turf, and it has been hypothesized that concomitant increased loading on the foot contributes to the incidence of lower body injuries. This study evaluates this hypothesis from an epidemiologic perspective, examining whether the lower extremity injury rate in National Football League (NFL) games is greater on contemporary synthetic turfs as compared with natural surfaces. Hypothesis: Incidence of lower body injury is higher on synthetic turf than on natural turf among elite NFL athletes playing on modern-generation surfaces. Study Design: Cohort study; Level of evidence, 3. Methods: Lower extremity injuries reported during 2012-2016 regular season games were included, with all 32 NFL teams reporting injuries under mandated, consistent data collection guidelines. Poisson models were used to construct crude and adjusted incidence rate ratios (IRRs) to estimate the influence of surface type on lower body injury groupings (all lower extremity, knee, ankle/foot) for any injury reported as causing a player to miss football participation as well as injuries resulting in ≥8 days missed. A secondary analysis was performed on noncontact/surface contact injuries. Results: Play on synthetic turf resulted in a 16% increase in lower extremity injuries per play than that on natural turf (IRR, 1.16; 95% CI, 1.10-1.23). This association between synthetic turf and injury remained when injuries were restricted to those that resulted in ≥8 days missed, as well as when categorizations were narrowed to focus on distal injuries anatomically closer to the playing surface (knee, ankle/foot). The higher rate of injury on synthetic turf was notably stronger when injuries were restricted to noncontact/surface contact injuries (IRRs, 1.20-2.03; all statistically significant). Conclusion: These results support the biomechanical mechanism hypothesized and add confidence to the conclusion that synthetic turf surfaces have a causal impact on lower extremity injury.

Original languageEnglish (US)
Pages (from-to)189-196
Number of pages8
JournalAmerican Journal of Sports Medicine
Volume47
Issue number1
DOIs
StatePublished - Jan 1 2019

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Football
Athletes
Lower Extremity
Wounds and Injuries
Incidence
Ankle
Foot
Knee
Foot Injuries

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Mack, Christina D. ; Hershman, Elliott B. ; Anderson, Robert B. ; Coughlin, Michael J. ; McNitt, Andrew Scott ; Sendor, Rachel R. ; Kent, Richard W. / Higher Rates of Lower Extremity Injury on Synthetic Turf Compared With Natural Turf Among National Football League Athletes : Epidemiologic Confirmation of a Biomechanical Hypothesis. In: American Journal of Sports Medicine. 2019 ; Vol. 47, No. 1. pp. 189-196.
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abstract = "Background: Biomechanical studies have shown that synthetic turf surfaces do not release cleats as readily as natural turf, and it has been hypothesized that concomitant increased loading on the foot contributes to the incidence of lower body injuries. This study evaluates this hypothesis from an epidemiologic perspective, examining whether the lower extremity injury rate in National Football League (NFL) games is greater on contemporary synthetic turfs as compared with natural surfaces. Hypothesis: Incidence of lower body injury is higher on synthetic turf than on natural turf among elite NFL athletes playing on modern-generation surfaces. Study Design: Cohort study; Level of evidence, 3. Methods: Lower extremity injuries reported during 2012-2016 regular season games were included, with all 32 NFL teams reporting injuries under mandated, consistent data collection guidelines. Poisson models were used to construct crude and adjusted incidence rate ratios (IRRs) to estimate the influence of surface type on lower body injury groupings (all lower extremity, knee, ankle/foot) for any injury reported as causing a player to miss football participation as well as injuries resulting in ≥8 days missed. A secondary analysis was performed on noncontact/surface contact injuries. Results: Play on synthetic turf resulted in a 16{\%} increase in lower extremity injuries per play than that on natural turf (IRR, 1.16; 95{\%} CI, 1.10-1.23). This association between synthetic turf and injury remained when injuries were restricted to those that resulted in ≥8 days missed, as well as when categorizations were narrowed to focus on distal injuries anatomically closer to the playing surface (knee, ankle/foot). The higher rate of injury on synthetic turf was notably stronger when injuries were restricted to noncontact/surface contact injuries (IRRs, 1.20-2.03; all statistically significant). Conclusion: These results support the biomechanical mechanism hypothesized and add confidence to the conclusion that synthetic turf surfaces have a causal impact on lower extremity injury.",
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Higher Rates of Lower Extremity Injury on Synthetic Turf Compared With Natural Turf Among National Football League Athletes : Epidemiologic Confirmation of a Biomechanical Hypothesis. / Mack, Christina D.; Hershman, Elliott B.; Anderson, Robert B.; Coughlin, Michael J.; McNitt, Andrew Scott; Sendor, Rachel R.; Kent, Richard W.

In: American Journal of Sports Medicine, Vol. 47, No. 1, 01.01.2019, p. 189-196.

Research output: Contribution to journalArticle

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