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 CD, Hershman EB, Anderson RB, Coughlin MJ, McNitt AS, Sendor RR, Kent RW
The American journal of sports medicine · 28 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Cohort study (classified by our AI screen)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
Who paid for it
- Funding
- Funding not disclosed
Publication
- Published
- 2018-11-19 · Am J Sports Med · vol. 47 · issue 1 · pp. 189–196
- Publisher
- SAGE Publishing
- Cited
- 60 citations · more than 92% of similar papers · 3.4× the field average
- Impact
- Top 10% most cited in its field
- References
- 40 works
- Access
- Free to read
- Research areas
- Sports injuries and prevention · Knee injuries and reconstruction techniques · Shoulder Injury and Treatment
- Keywords
- Football, Athletes, Medicine, League, Ankle, Physical therapy, Poison control, Rate ratio, Surgery, Emergency medicine, Population, Geography, Environmental health
- MeSH
- lower extremity, humans, poaceae, athletic injuries, incidence, retrospective studies, football, floors and floorcoverings, male, biomechanical phenomena
7 authors
From US
- Christina DeFilippo Mack · correspondingTriangle; IQVIA (United States)
- Elliott B. HershmanNorthwell Health; Lenox Hill Hospital
- Robert B. AndersonBellin College
- Michael J. CoughlinUniversity of California, San Francisco; Saint Alphonsus Medical Center
- Andrew Scott McNittPennsylvania State University
- Rachel R. SendorTriangle; IQVIA (United States)
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.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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