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; Hershman, Elliott B.; Anderson, Robert B.; Coughlin, Michael J.; McNitt, Andrew S.; Sendor, Rachel R.; Kent, Richard W.

doi:10.1177/0363546518808499

Cited by 40 publications

(78 citation statements)

References 38 publications

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“…Overall, choosing a shoe with lower rotational traction that results in no consequent detriment to performance (high translational traction) is recommended, assuming the injury risk from other sports extends to soccer [7–10, 29]. Table 2, S1 Fig, and Fig 3 can be used to help inform footwear selection for players in warm climate zones.…”

Section: Discussionmentioning

confidence: 99%

Six different football shoes, one playing surface and the weather; Assessing variation in shoe-surface traction over one season of elite football

et al. 2019

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Introduction An optimal range of shoe-surface traction (grip) exists to improve performance and minimise injury risk. Little information exists regarding the magnitude of traction forces at shoe-surface interface across a full season of elite football (soccer) using common football shoes. Objective To assess variation in shoe-surface traction of six different football shoe models throughout a full playing season in Qatar encompassing climatic and grass species variations. Methods Football shoes were loaded onto a portable shoe-surface traction testing machine at five individual testing time points to collect traction data (rotational and translational) on a soccer playing surface across one season. Surface mechanical properties (surface hardness, soil moisture) and climate data (temperature and humidity) were collected at each testing time point. Results Peak rotational traction was significantly different across shoe models (F = 218, df = 5, p <0.0001), shoe outsole groups (F = 316.2, df = 2, p < .0001), and grass species (F = 202.8, df = 4, p < 0.0001). No main effect for shoe model was found for translational traction (F = 2.392, p = 0.07). Conclusions The rotational (but not translational) traction varied substantially across different shoe types, outsole groups, and grass species. Highest rotational traction values were seen with soft ground outsole (screw-in metal studs) shoes tested on warm season grass. This objective data allows more informed footwear choices for football played in warm/hot climates on sand-based elite football playing surfaces. Further research is required to confirm if these findings extend across other football shoe brands.

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Section: Discussionmentioning

confidence: 99%

Six different football shoes, one playing surface and the weather; Assessing variation in shoe-surface traction over one season of elite football

et al. 2019

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“…13 American football also involves reactive cutting and is played on natural and synthetic turfs, with Mack et al recently reporting that synthetic turf resulted in 16% more lower extremity injuries than on natural turf. 14 That association became more pronounced as the authors focused on injuries located more distally, 14 supporting epidemiological observations in soccer. [7][8][9][10][11][12] Mack et al concluded that artificial turf has a causal impact on lower extremity injury, attributed to a biomechanical mechanism associated with the shoe-surface interaction and based on biomechanical testing of football cleats on a variety of playing surfaces.…”

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confidence: 71%

The Influence of Soccer Playing Surface on the Loading Response to Ankle (P)Rehabilitation Exercises

Jones¹,

Brogden²,

Page³

et al. 2021

Journal of Sport Rehabilitation

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Context: Contemporary synthetic playing surfaces have been associated with an increased risk of ankle injury in the various types of football. Triaxial accelerometers facilitate in vivo assessment of planar mechanical loading on the player. Objective: To quantify the influence of playing surface on the PlayerLoad elicited during footwork and plyometric drills focused on the mechanism of ankle injury. Design: Repeated-measures, field-based design. Setting: Regulation soccer pitches. Participants: A total of 15 amateur soccer players (22.1 [2.4] y), injury free with ≥6 years competitive experience. Interventions: Each player completed a test battery comprising 3 footwork drills (anterior, lateral, and diagonal) and 4 plyometric drills (anterior hop, inversion hop, eversion hop, and diagonal hop) on natural turf (NT), third-generation artificial turf (3G), and AstroTurf. Global positioning system sensors were located at C7 and the mid-tibia of each leg to measure triaxial acceleration (100 Hz). Main Outcome Measures: PlayerLoad in each axial plane was calculated for each drill on each surface and at each global positioning system location. Results: Analysis of variance revealed a significant main effect for sensor location in all drills, with PlayerLoad higher at mid-tibia than at C7 in all movement planes. AstroTurf elicited significantly higher PlayerLoad in the mediolateral and anteroposterior planes, with typically no difference between NT and 3G. In isolated inversion and eversion hopping trials, the 3G surface also elicited lower PlayerLoad than NT. Conclusions: PlayerLoad magnitude was sensitive to unit placement, advocating measurement with greater anatomical relevance when using microelectromechanical systems technology to monitor training or rehabilitation load. AstroTurf elicited higher PlayerLoad across all planes and drills and should be avoided for rehabilitative purposes, whereas 3G elicited a similar mechanical response to NT.

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“…Examples include an examination of the association between stadium surfaces-artificial turf versus natural grass-and injury occurrence, a critical question for NFL athletes and clubs. 9,12 Analyses found higher rates of lower extremity injuries on artificial surfaces. Examination of the unaffiliated neurotrauma consultant and athletic trainer spotter programs for concussion detection and epidemiologic descriptions of high-impact injuries are also in progress.…”

Section: Discussionmentioning

confidence: 96%

Lessons on Data Collection and Curation From the NFL Injury Surveillance Program

Dreyer

Mack

Anderson

et al. 2019

Sports Health: A Multidisciplinary Approach

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Background: “Research-ready” evidence platforms that link sports data with anonymized electronic health records (EHRs) or other data are important tools for evaluating injury occurrence in response to changes in games, training, rules, and other factors. While there is agreement that high-quality data are essential, there is little evidence to guide data curation. Hypothesis: We hypothesized that an EHR used in the course of clinical care and curated for research readiness can provide a robust evidence platform. Our purpose was to describe the data curation used for active injury surveillance by the National Football League (NFL). Study Design: Dynamic cohort study. Level of Evidence: Level 2. Methods: Players provide informed consent for research activities through the collective bargaining process. A league-wide EHR is used to record injuries that come to the attention of the teams’ athletic trainers and physicians, NFL medical spotters, or unaffiliated neurotrauma consultants. Information about football activities and injuries are linkable by player, setting, and event to other sports-related data, including game statistics and game-day stadium quality measures, using a unique player identification designed to protect player privacy. Ongoing data curation is used to review data completeness and accuracy and is adjusted over time in response to findings. Results: The core data curation activities include monthly injury summaries to team staff, queries to resolve incomplete reporting, and periodic external checks. Experiences derived from producing more than 100 reports per year on diverse topics are used to update coding training and related guidance documents in response to missing data or inconsistent coding that is observed. Roughly 20% more injuries were recorded for the same “reportable” injuries after switching from targeted reporting to an EHR. Conclusion: Research-ready databases need systematic curation for quality and completeness, along with related action plans. More injuries were reported through EHR than through targeted reporting. Clinical Relevance: Evidence-driven decision-making thrives on reliable data fine-tuned through systematic use, review, and ongoing adjustments to the curation process.

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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

Cited by 40 publications

References 38 publications

Six different football shoes, one playing surface and the weather; Assessing variation in shoe-surface traction over one season of elite football

Six different football shoes, one playing surface and the weather; Assessing variation in shoe-surface traction over one season of elite football

The Influence of Soccer Playing Surface on the Loading Response to Ankle (P)Rehabilitation Exercises

Lessons on Data Collection and Curation From the NFL Injury Surveillance Program

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