This document summarizes research on the interaction between players and artificial turf versus natural grass football pitches. It finds that artificial turf can place more pressure on players' feet and lead to higher energy expenditure than grass. However, there is little difference in running activities or technical standards between surfaces. Research does not clearly support artificial turf increasing injury risk overall, though some studies find higher risks of certain injuries like ankle sprains on artificial turf. More research is needed on muscle and knee injuries. Standardization of artificial turf quality is recommended.

1. Review of evidence:
3G artificial turf pitches
Undertaken by Evidence Based Insights Ltd as part of
a research project for The Welsh Football Trust
2012
info@evidencebasedinsights.org

2. Summary
Producers and governing bodies need to better understand the interaction between players
and different natural grass and artificial turf systems. Problematically, research often focuses
on mechanical tests that do not accurately reflect the interaction between players’ complex
movements and the playing surface1. Studies investigating effects on players have shown that
artificial turf can place more pressure on players’ feet2 and is associated with higher energy
expenditure when compared with grass,3 possibly due to pitches being faster. However, there
is little difference between artificial turf and natural grass in terms of running activities and
technical standards.5
Research does not support an association between artificial turf and increased risk of injury
although there are contrasting reports for risk of ankle sprain, back and spine, and shoulder
and collarbone injuries.6,7,8,9,12 More research into the effects of artificial surfaces on muscle
and knee injuries is needed because data concerning sport type, player, gender or match
versus training is, at present, inconsistent.10 It is also important to understand player
perceptions because although some players might prefer harder pitches or faster games4 it is
likely that perceptions will be related to the physiological demands of artificial turf.8
Standardization of artificial turf is recommended for new artificial turf grounds to ensure
consistent quality.11
For more details please refer to the slides that correspond with the numbers

3. 1
Title Football specific evaluation of player–surface interaction on
different football turf systems
Author(s) Potthast, W., Verhelst, R., Hughes, M., Stone, K. & De Clercq, D.
Year 2010
Journal Sports Technology, 3:1, 5-12
Although the interaction between players and different natural grass and artificial turf systems
is not well understood, the popularity of artificial turf means that producers and governing
bodies are required to bring the experience as close as possible to natural grass. To do this
developers focus on modifying fibres, infill and the elastic layer in order to optimize the
mechanical properties of the turf system. However, research shows that mechanical tests (i.e.
without player involvement) of artificial turf systems like 3G do not reflect the interaction
between players’ complex movements and the surface. Such is the nature of artificial turf that
changes in a single component e.g. infill, will make the differences between artificial turfs
greater than those between natural grass and an artificial system. The authors recommend
further research to improve current certification procedures and to optimize artificial turf
systems, particularly for football.

4. 2
Title Comparison of in-shoe foot loading patterns on natural grass and
synthetic turf
Author(s) Ford, K.R., Manson, N.A., Evans, et al.
Year 2006
Journal Journal of Science and Medicine in Sport, 9(6);433-440
The effects of rubber or sand infill synthetic playing surfaces on lower extremity
biomechanics are not well understood. The authors in this study examined effects of two
surfaces (natural grass versus turf) on in-shoe foot loading patterns during cutting in 17 male
players. An in-shoe pressure distribution measurement insole was used to measure peak
pressure and relative load on the right foot. Results showed that the artificial turf condition
had significantly higher peak pressures within the central forefoot compared to grass. In
contrast, the relative load within the medial forefoot and lateral midfoot were higher for
grass. The study demonstrates that playing surface significantly affects plantar loading during
sport related activities. The authors recommend further investigation to determine the
effects of playing surfaces on sport-specific injuries.

5. 3
Title Comparison of Physiological Responses to an Incremental Running Test on
Treadmill, Natural Grass, and Synthetic Turf in Young Soccer Players
Author(s) Di Michele, R., Di Renzo, A.M, Ammazzalorso, S. & Merni, F.
Year 2009
Journal Journal of Strength & Conditioning Research, 23(3);939-945
The authors compared physiological responses to a multistage running test assessing
lactate thresholds in 18 young football players (mean age 17.4 years) performed on a
treadmill, natural grass and synthetic turf. Blood lactate concentration and heart rate were
assessed. Results showed that blood lactate was higher for synthetic turf than treadmill
and natural grass whilst heart rate was higher for synthetic turf than grass. This
demonstrated that the running patterns on synthetic turf led overall to higher energy
expenditure when compared with grass.

6. 4
Title Human perceptions of artificial surfaces for field hockey
Author(s) Fleming, P. R., Young, C., Roberts, J. R., Jones R. & Dixon, N.
Year 2005
Journal Sports Engineering, 8(3);121-136
The authors argue that measuring the performance of a sports surface is typically derived
from field and laboratory tests that ignore player’s perspective of their own comfort and
confidence in the surface and its playing characteristics. The authors conducted a qualitative
analysis of 22 elite hockey players’ perceptions immediately after a competitive match in
order to develop a method for exploring player perceptions of field hockey pitches. Players
identified the key themes of player performance, playing environment, pitch properties, ball
interaction and player interaction. Responses suggested that players largely considered a
‘hard’ pitch with a ‘low’ ball bounce facilitating a ‘fast’ game speed as desirable and provides
useful evidence regarding the use of artificial surfaces for hockey.

7. 5
Title: Elite football on artificial turf versus natural grass: Movement
patterns, technical standards, and player impressions
Author(s) Anderssona, H., Ekblomb, B. & Krustrupc, P.
Year 2008
Journal Journal of Sports Sciences, 26(2); 113-122
The study examined the movement patterns, ball skills, and the opinions of elite football
players during competitive games on artificial turf and natural grass. No differences were
observed between artificial turf and natural grass in terms of total distance covered, high-
intensity running, number of sprints, standing tackles or headers per game. Overall, there
were fewer sliding tackles on artificial turf than natural grass and there were more short
passes and midfield-to-midfield passes on artificial turf. Male players reported a negative
overall impression and greater physical effort on artificial turf than natural grass. The authors
conclude that running activities and technical standards were similar on artificial turf and
natural grass although there were subtle changes in playing style which could have explained
male players' negative impression of artificial turf.

8. 6
Title: Risk of injury in elite football played on artificial turf versus natural
grass: a prospective two-cohort study
Author(s) Ekstrand, J., Timpka, T. & Hägglund, M.
Year 2006
Journal British Journal of Sports Medicine, 40;975-980
The authors compared injury risk in 290 male elite football players using artificial turf and
natural grass using. Compared with the control cohort who played home games on natural
grass, teams in the artificial turf cohort had a lower injury incidence during match play. The
results showed that the risk of ankle sprain was increased in matches on artificial turf (it is
noted that number of ankle sprains was low) compared with grass, although no difference
in injury severity was seen between surfaces. Overall, no evidence of a greater risk of injury
was found when football was played on artificial turf compared with natural grass.

9. 7
Title: Injury risk on artificial turf and grass in youth tournament football
Author(s) Soligard, T., Bahr, R. & Andersen, T.E.
Year 2012
Journal Scandinavian Journal of Medicine & Science in Sports, 22(3);356-361
This study investigated the risk of acute injuries among youth male and female footballers
playing on 3G artificial turf compared with grass. Over 60,000 players between 13–19 years
old were followed in four consecutive Norway Cup tournaments between 2005 and 2008. The
results showed that there was no difference in the overall risk of injury or in the risk of time
loss injury between 3G and grass. There was a lower risk of ankle injuries and a higher risk of
back and spine and shoulder and collarbone injuries on 3G compared with grass. Overall,
there was no difference in the overall risk of acute injury in youth footballers playing on 3G
compared with grass.

10. 8
Title: Playing Field Issues in Sports Medicine
Author(s) Wright, J.M. & Webner, D.
Year 2010
Journal Current Sports Medicine Reports, 9(3);129-133
Overall injury incidence does not apparently differ between artificial turf and grass surfaces
but patterns of injury do. This might be down to differences in shoe-surface interface, foot
loading patterns and the nature of foot impact. Player perceptions of artificial turf also vary
and may be related to different physiological demands between the two surfaces. The
authors conclude that a better understanding of the differences between artificial turf and
natural grass will help doctors, sports professionals and coaches better care for and train
their athletes.

11. 9
Title: Risk of injury on artificial turf and natural grass in young female
football players
Author(s) Steffen, K., Andersen, T.E. & Bahr, R.
Year 2007
Journal British Journal of Sports Medicine, 41;i33-i37
The aim of this study was to investigate the risk of injury on artificial turf compared with
natural grass among 2020 young (mean age = 15.4 years) female football players. Time-
loss injuries and exposure data on different types of turf were recorded over an eight-
month period. The incidence of acute injuries on artificial turf and grass did not differ
significantly in relation to match injuries or training injuries. In matches, the incidence of
serious injuries was significantly higher on artificial turf with ankle sprain being the most
common type of injury although overall, the actual risk of acute injuries was very similar
between artificial turf and natural grass.

12. 10
Title: A Review of Football Injuries on Third and Fourth Generation Artificial
Turfs Compared with Natural Turf
Author(s) Williams, S., Hume, P.A. & Kara, S.
Year 2011
Journal Sports Medicine, 41(11); 903-923
This review compared the incidence, nature and mechanisms of injuries sustained on newer
generation artificial turfs and natural turfs. The authors found that studies provide strong
evidence for comparable rates of injury between new generation artificial turfs and natural
turfs i.e. there is little to distinguish the two different surfaces. An exception is the increased
risk of ankle injury on 3G and 4G turfs. Changing between surfaces may be a precursor for
injury in football. It is recommended that ankle injury prevention strategies are prioritised for
those who regularly use 3G and 4G. Further clarification of effects of artificial surfaces on
muscle and knee injuries is required because it is evident that data concerning sport type,
player, gender or match versus training is inconsistent.

13. 11
Title: Mechanical assessment of artificial turf football pitches: The
consequences of no quality certification
Author(s) Burillo, P., Gallardo, L., Felipe, J.L. & Gallardo, A.M.
Year 2012
Journal Scientific Research and Essays, 7(28);2457-2465
The study assessed the quality of a sample of 20 3G turf pitches in Spain using EN 15330-1:2007
and Fédération Internationale de Football Association (FIFA) rules. Results indicated that
none of the pitches examined passed the 7 field tests of the certification protocols. Only 1 of
the fields assessed passed 5 of the 7 tests in the EN protocol. Given that the type of fibre,
type of rubber infill or elastic base have an influence on the mechanical properties of the
pitch i.e. its quality and playing characteristics, the authors recommend that standardization
should be compulsory in new artificial turf grounds, regardless of the sporting competition
that is held.

14. 12
Title: Comparison of injuries sustained on artificial turf and grass by male
and female elite football players
Author(s) Ekstrand, J., Hägglund , M. & Fuller , C.W.
Year 2011
Journal Scandanavian Journal of Medicine and Science in Sports, 21(6); 824-832
The authors compared incidences and patterns of injury for female and male elite teams
when playing football on artificial turf and grass. 20 teams playing home matches on 3G
pitches were followed over time. Risk of injury risk from playing on 3G was compared with
playing on grass. Results showed there were no significant differences in the nature of
overuse injuries recorded on artificial turf and grass for either men or women. Similarly, the
rate of acute injuries did not differ significantly between artificial turf and grass, for men or
women. During matches, men were less likely to sustain a quadriceps strain and more likely to
sustain an ankle sprain on artificial turf.