Turf Leads to More ACL Injuries: Fact or Fiction? | Curovate (2024)

ACL

A hot topic of discussion surrounding ACL injuries involves the increased risk of injury in athletes playing on artificial turf compared to natural grass. In this blog, we are going to talk about whether this increased risk is a fact, or simply a myth!

Corey Grunberg - Physical Therapist

3 min read

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What is an ACL and how does it become injured?

The ACL (anterior cruciate ligament) is an important ligament that helps to stabilize the knee. Injury to the ACL can affect anyone, and is especially common in athletes. Whether from a direct impact with another person in sport or a sudden twist of the knee, the ligament can tear, often requiring surgery and physiotherapy.[1] There is also a high risk of reinjury of the ACL following repair[2] - one of the main focuses of physiotherapy following an ACL injury is to reduce this risk and to help people return to their own optimal function.

Artificial Turf & ACL Injuries

The use of artificial turf in sport has become increasingly common with the introduction of third-generation and hybrid turf types, which aim to provide a more similar athlete experience to natural grass.[4] Third-generation turf is the most common type of artificial grass, made of long, grass-like synthetic fibres with sand and rubber infill between the fibres.[4] Hybrid turf systems include natural grass that is reinforced with additional synthetic fibres to make the field more durable.[4] Both types of artificial turf are now used in professional sports, including football and soccer,[3][4] which happen to be two sports where ACL injuries are quite common. This leads to the question we are going to answer today - does activity on turf lead to more ACL injuries?

In short, it seems that the answer is YES.

Studies looking at the risk of ACL injuries in collegiate and professional football and soccer players have found an increased risk of ACL injury in practice and competition when play occurs on artificial turf compared to natural grass.[1][3] These injuries on artificial turf often happen due to the increased frictional force between your shoes and the artificial grass[3] — when you plant your foot on the ground, it is more strongly stuck in that spot. As such, any twisting of your upper body will put a greater stress on the ACL, leading to a higher chance of tearing the ligament.[1] With natural grass, the planted foot would more easily be able to move, preventing the high forces put on the knee and reducing the risk of injury. Additionally, the increased risk of ACL injury associated with activity on artificial turf is made worse by hot or dry weather conditions, with increased injury rates in the summer months.[1] Due to the high risk of reinjury associated with ACL tears, aim to prevent any damage to the knee through strengthening, consciously avoiding twisting movements of the knee (i.e. through being mindful that the knee is bending toward the direction of the toes), and avoiding sport participation on artificial turf, especially when conditions are very dry.[1][2]

Unfortunately, athletes do not often get to choose what surface they play on, so it is very important to keep up with ACL rehabilitation and strengthening exercises following an injury to allow a safe return to sport and to prevent reinjury. Read more strategies to help you keep up with your ACL rehab here.

Curovate is a physical therapy exercise app with daily video guided exercises for recovery after a knee replacement, ACL injury or ACL surgery, hip replacement or anyone who is interested in strengthening their knee or hip with safe and effective physical therapy exercises. For more information on ACL, knee replacement, or hip replacement recovery, download the Curovate app for guided exercises, rehab reminders, progress tracking, and more, all from the convenience of your phone. See the links below!

If you need further customized assistance during your surgery or injury recovery check out our Virtual Physical Therapy page to book your 1-on-1 video session with a physical therapist.


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Turf Leads to More ACL Injuries: Fact or Fiction? | Curovate (2024)

FAQs

Turf Leads to More ACL Injuries: Fact or Fiction? | Curovate? ›

That research found 16% more injuries per play on artificial turf compared to grass. The authors concluded that if all games had been played on grass during that period there would have been 319 fewer foot and leg injuries. Looking only at non-contact injuries the risk was even higher, about 20% more injuries per play.

Does turf cause more ACL injuries? ›

This is particularly relevant in sports such as football and soccer, where approximately 62% of ACL injuries in soccer occurred on artificial turf without any physical contact with another athlete. Athletes playing on artificial turf were about 1.6 times more likely to injure their ACL compared to playing on grass.

Does playing on turf cause more injuries? ›

It found that, had every game been played on a grass surface, at least 300 fewer foot and leg injuries would have been expected. Turf fields also appeared to significantly increase the likelihood of non-contact injuries. About 20% more non-contact injuries occurred per play on a turf surface than a grass surface.

What sports cause the most ACL injuries? ›

Causes. ACL injury typically occurs during athletics where jumping, pivoting and rapid change of direction occurs. Football, basketball, lacrosse, soccer, and skiing are some sports known to have high ACL injury rates. Contrary to popular belief, the ACL can tear without contact.

Why are ACL injuries becoming more common? ›

As with any sport or activity, the more you practice and play it, the greater the risk of injury. Today's prevalence of ACL tears is partially attributable to increased training, practice, and playing time which places a far too heavy workload on an athlete's body.

Does artificial turf cause more knee injuries? ›

Normal studs (bigger ones) have been suggested to put significantly more pressure on the ACL when played on artificial turf. Artificial turf puts more general load through the knees, making the knee bend in more (valgus load and internal rotation). These are risk factors associated with knee injuries.

How many ACL tears happen on turf? ›

There were 74,620 estimated football-related ACL injuries on artificial turf and 122,654 on natural grass. Likewise, 71,877 of the estimated soccer-related ACL injuries occurred on artificial turf and 104,028 on natural grass.

Does turf cause more injuries then grass? ›

That research found 16% more injuries per play on artificial turf compared to grass. The authors concluded that if all games had been played on grass during that period there would have been 319 fewer foot and leg injuries. Looking only at non-contact injuries the risk was even higher, about 20% more injuries per play.

Why is turf worse than grass for football? ›

On synthetic surfaces, there is less give, meaning our feet, ankles and knees absorb the force, which makes injury more likely to follow. The data supports the anecdotes you'll hear from me and other players: artificial turf is significantly harder on the body than grass.

Why is turf bad for soccer? ›

Over time, infill layers of these turfs gets compressed and quality of their shockpads degrades, and these developments lead to increasing hardness of surface. These changes result in elongated artificial grass fibers and therefore increased friction between shoe and surface.

Who tears their ACL the most? ›

Why are ACL tears more common in female athletes? The structure of the knee joint in women plays a big role in putting them at a higher risk for an ACL tear. Women's joints — including the knee — generally have more looseness and range of motion than men's.

Who is most likely to get an ACL injury? ›

This higher stress can lead to either a chronic (overuse) or acute (sudden) injury. According to research, an ACL tear is one acute injury that female athletes are two to eight times more likely to experience than males.

How is the ACL most commonly injured? ›

History: One of the most common knee injuries is an ACL sprain or tear. Typically, injury occurs during activity/sports participation that involves sudden changes in the direction of movement, abrupt stopping or slowing down while running, or jumping and abnormal landing.

What is the number 1 cause of an ACL tear? ›

The ACL can be injured or torn in a number of different ways. The most common mechanism is that of a sudden pivoting or cutting maneuver during sporting activity, which is commonly seen in football, basketball and soccer. The ligament can also tear due to work injuries or automobile accidents.

Why are so many athletes tearing ACL? ›

Faulty landing mechanics are a major contributor to ACL injuries. Many athletes land with their knees collapsing inward and forward past their toes or without bending their knees at all. These postures stress the knees.

Why do so many NFL players tear ACL? ›

Most ACL injuries in NFL athletes are associated with contact, brisk deceleration, and shallow knee and hip flexion angles.

Are turf fields bad for knees? ›

Comparing turf and grass fields involves understanding their distinct effects on knee health. Turf Fields: Pros: Durability, low maintenance, consistent playing surface. Cons: Potential increased risk of knee injuries due to less give and higher traction, which may stress the ligaments.

Why are ACL tears so common in football? ›

What causes football ACL injuries? In football, motions such as cutting and pivoting can put a great amount of force on the knee. The positioning of the ACL makes it responsible for maintaining the integrity of the knee against that force.

What are ACL injuries most common in? ›

ACL injuries most commonly occur during sports that involve sudden stops or changes in direction, jumping and landing — such as soccer, basketball, football and downhill skiing.

Is playing on turf bad for you? ›

While the available research does not indicate a significant health risk, there are several ways to minimize any potential exposures to chemicals from synthetic turf fields. Always wash hands after playing on the field and before eating.

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