Do athletes get hurt more on turf fields than on grass?

The short answer

Two studies carry the most weight here, and they don’t tell exactly the same story.

A 2019 cohort study in the American Journal of Sports Medicine looked at every lower-body injury reported across NFL games from the 2012 through 2016 regular seasons, under the league’s mandated injury-reporting rules. It found synthetic turf carried a 16% higher rate of lower-body injuries per play than natural turf. The gap widened when the researchers isolated noncontact and surface-contact injuries — the kind caused by how a foot plants and releases, not by a hit from another player.

A 2023 systematic review, also in the American Journal of Sports Medicine, pulled together 53 studies published between 1972 and 2020, across sports, competition levels and turf generations. Its read was more mixed: most studies of new-generation turf (13 of 18) found overall injury rates similar to grass. But when the reviewers broke injuries down by body part and sport, differences reappeared.

For a school board, athletic director or parks committee, the honest summary is: overall injury risk looks roughly comparable on modern turf, but the type of injury shifts, and for football specifically, the shift is toward more knee and ankle injuries on turf, not fewer.

What the NFL cohort study found

The Mack et al. 2019 study is the more tightly controlled of the two, because it tracks one sport, one governing body, and a single standardized injury-reporting system across five seasons.

The core numbers:

• 16% more lower-body injuries per play on synthetic turf overall (incidence rate ratio 1.16), a result that held even when injuries were narrowed to those causing 8 or more missed days.
• The gap was largest for noncontact and surface-contact injuries — incidence rate ratios ranging from 1.20 to 2.03, all statistically significant. These are injuries where the surface itself, not another player, is the more likely factor.
• The effect held for knee and ankle/foot injuries specifically, the two joint groups closest to where the foot meets the ground.

The authors’ explanation is biomechanical: synthetic turf doesn’t release a cleat as readily as natural turf does, so more load can transfer up through the foot and leg during a plant-and-cut motion. The study describes itself as an epidemiologic test of that biomechanical hypothesis, and its authors conclude the results “add confidence to the conclusion that synthetic turf surfaces have a causal impact on lower extremity injury.”

What the 53-study review found

The Gould et al. 2023 systematic review covers far more ground than one league or one sport — which is also why its findings are less uniform.

Its headline results:

• Overall injury rates: most new-generation turf studies (13 of 18) found no meaningful difference from grass.
• Foot and ankle injuries: the largest share of studies, on both old- and new-generation turf, reported a higher rate on artificial turf.
• Knee and hip injuries in soccer: similar rates between turf and grass on new-generation surfaces.
• Knee injuries in football: the opposite pattern — players, especially at high levels of competition, were more likely to injure a knee on turf than on grass.

One finding is worth pulling out on its own, because it speaks directly to why the research can look contradictory at a glance. The reviewers checked the funding behind the handful of studies that found the reverse pattern — a higher overall injury rate on grass than turf — and reported that every one of those studies had received financial support from the artificial turf industry. That doesn’t mean every industry-adjacent study is wrong, but it does mean a school board weighing “grass is more dangerous” claims should ask who funded the study making that claim.

Reading the two studies together

The NFL study and the systematic review aren’t measuring the same thing, and that’s most of why their emphasis differs:

	NFL cohort study (2019)	53-study review (2023)
Scope	One league, one sport, five seasons	53 studies, multiple sports, 1972-2020
Turf generation	Modern synthetic only	Old- and new-generation, analyzed separately
Overall injury finding	16% higher on synthetic turf	Mostly similar on new-generation turf
Sharpest signal	Noncontact injuries, all lower-body	Foot/ankle injuries; football knee injuries

Put together, the pattern that survives across both is narrower than “turf is more dangerous” or “turf is fine.” It’s closer to: for football, and for the foot and ankle in particular, turf carries a documented higher injury rate in the best available research; for soccer knee and hip injuries and for overall injury counts on modern turf, the evidence is closer to even.

What this means for a field decision

Injury data is one input into a synthetic vs. natural field decision, alongside maintenance, water use, and how many hours of play the field needs to absorb. A few things worth carrying into that conversation:

• Sport matters. The clearest turf-associated risk in the review was for football knee injuries and for foot/ankle injuries generally — not for soccer knee and hip injuries, where the surfaces looked similar.
• Turf generation matters. Both studies focus heavily on new-generation turf. Older turf, tested less often in newer research, showed a foot-and-ankle gap too.
• Level of competition matters. The elevated knee-injury finding for football was strongest at high levels of competition, which may not transfer directly to youth or recreational leagues that neither study measured.
• Check who funded the study. If a source claims grass is the more dangerous surface, the systematic review’s own check found that claim traced back to turf-industry-funded research in every case it reviewed.

A synthetic sports field still solves real problems a grass field can’t — consistent footing after heavy rain, a schedule that doesn’t rest on a growing season, and far less water and mowing than a natural surface needs to stay playable. Our sports field turf page covers how we scope a field project: a free visit to measure and check the ground, and a layout you approve before work starts.

A short checklist for the decision

1. Name the sport and level of play. The injury pattern for elite football is not the injury pattern for youth soccer, and the research doesn’t cover every combination equally.
2. Ask which turf generation is being compared. Old-generation and new-generation turf show different results in the review; make sure any claim you’re handed specifies which.
3. Trace the funding on any study that favors one surface strongly. The review found a clean pattern here worth checking yourself.
4. Weigh injury data alongside maintenance and playability, not instead of them — the field also has to hold up to your actual practice and game schedule.
5. Get the ground assessed before comparing costs. Drainage, base and site conditions affect how either surface performs, and that’s specific to your field, not the literature.