--- title: "Do Athletes Get Hurt More on Turf Fields? | TIMELESS Grass & Greens" description: "A peer-reviewed NFL cohort study and a 53-study systematic review, read together, on lower-body injury rates for turf and grass fields." url: https://www.timelessgrass.com/blog/turf-vs-grass-field-injury-rates/ updated: 2026-09-12 --- Heat and safety # Do athletes get hurt more on turf fields than on grass? * * * Updated 2026-09-12 The short answer ## Do athletes get hurt more on turf fields than on grass? It depends on the injury. A 2019 NFL cohort study found 16% more lower-body injuries per play on synthetic turf, mostly noncontact injuries. A 2023 review of 53 studies found similar overall and knee injury rates on new-generation turf, but a higher foot-and-ankle rate, and more knee injuries for elite football players specifically. Planning a turf installation? Get a layout, turf options and a written quote for your space. [Request a free estimate](https://www.timelessgrass.com/estimate/?use=Commercial%20or%20sports%20field) [Call 303-349-2368](tel:3033492368) We’ll call to arrange a free site visit. [Jump to the checklist](https://www.timelessgrass.com/blog/turf-vs-grass-field-injury-rates/#a-short-checklist-for-the-decision) On this page On this page 1. [The short answer](https://www.timelessgrass.com/blog/turf-vs-grass-field-injury-rates/#the-short-answer) 2. [What the NFL cohort study found](https://www.timelessgrass.com/blog/turf-vs-grass-field-injury-rates/#what-the-nfl-cohort-study-found) 3. [What the 53-study review found](https://www.timelessgrass.com/blog/turf-vs-grass-field-injury-rates/#what-the-53-study-review-found) 4. [Reading the two studies together](https://www.timelessgrass.com/blog/turf-vs-grass-field-injury-rates/#reading-the-two-studies-together) 5. [What this means for a field decision](https://www.timelessgrass.com/blog/turf-vs-grass-field-injury-rates/#what-this-means-for-a-field-decision) 6. [A short checklist for the decision](https://www.timelessgrass.com/blog/turf-vs-grass-field-injury-rates/#a-short-checklist-for-the-decision) ## 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](https://www.timelessgrass.com/services/sports-field-turf/) 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. ## Common questions ### Does synthetic turf cause more injuries than grass? The two largest bodies of evidence point in slightly different directions. The 2019 NFL cohort study found a 16% higher rate of lower-body injuries per play on synthetic turf across 2012-2016 games. The 2023 systematic review of 53 studies found most new-generation turf research shows similar overall injury rates. Neither finding cancels the other; they measure different things. ### Which injuries are more common on turf? Foot and ankle injuries showed up more often on turf in the 2023 systematic review, in both old-generation (3 of 4 articles) and new-generation turf studies (9 of 19 articles). The NFL cohort study found the turf effect was strongest for noncontact and surface-contact injuries specifically, not contact injuries. ### Are knee injuries more common on turf? For soccer, the systematic review found similar knee and hip injury rates between turf and grass on new-generation surfaces. For football, it found the opposite: players, particularly at high levels of competition, were more likely to sustain a knee injury on artificial turf than on natural grass. ### Why do some studies find grass has more injuries? The 2023 systematic review checked this directly. Only a few of the 53 articles it reviewed reported a higher overall injury rate on natural grass than turf, and it found every one of those studies received financial support from the artificial turf industry. ### Does this apply to youth and recreational fields? Both studies center on elite competition: NFL games and, in the systematic review, all levels but weighted toward professional and collegiate research. Neither study measured youth or recreational play directly, so treat the findings as evidence about high-level competitive fields first. ## Related turf questions - [Artificial turf around a pool: what to plan for](https://www.timelessgrass.com/blog/artificial-turf-around-a-pool/) - [How Much Room a Backyard Golf Net or Hitting Bay Needs](https://www.timelessgrass.com/blog/backyard-golf-net-and-hitting-bay-space/) - [Can artificial turf catch fire?](https://www.timelessgrass.com/blog/can-artificial-turf-catch-fire/) ## Where to go next - [Sports field turf](https://www.timelessgrass.com/services/sports-field-turf/) - [Turf in Denver Metro](https://www.timelessgrass.com/denver-metro/) - [Turf in The Grand Strand](https://www.timelessgrass.com/grand-strand/) - [Turf in Northeast Florida](https://www.timelessgrass.com/northeast-florida/) Free estimate ## Planning a turf installation? Tell us about the area you want to install or replace. We’ll call to arrange a free site visit. [Or call 303-349-2368](tel:3033492368) Your free estimate includes - A visit to measure your space - A custom layout, drawn for your space - Turf options, side by side - A written price, with no pressure to sign [Request a free estimate](https://www.timelessgrass.com/estimate/) Five short steps. We’ll call to arrange your visit.