As more suburban schools switch to artificial turf, injury debate carries on

The Elgin City Council approved a new stadium for Larkin High School on Oct. 8, built around a synthetic turf field for football, soccer and other sports.

Benet Academy in Lisle also plans new artificial turf fields.

They’re part of an ongoing trend among suburban high schools, which prefer artificial turf surfaces because over their life spans — seven to 20 years, depending on use — they can host athletic practices and contests, school activities such as marching band and even graduation ceremonies without the wear and tear suffered by real grass.

“Our field is used so much not only by us here in the building but also by the community that I couldn’t fathom not having it at this point,” said Ryan Rubenstein, athletic director at Barrington High School, which has had synthetic turf since 2008.

Experts and studies, however, continue to debate whether athletes are more at risk of injury on synthetic surfaces.

One study, from Current Orthopaedic Practice in 2021, states that data collected from 26 high schools indicated athletes were 58% more likely to sustain injuries on artificial turf. But other studies have shown no significant difference, or even a higher frequency of injuries on grass.

“I have not seen a significant difference between grass and turf,” said Sarah Anderson, whose 24-year career as St. Francis High School’s athletic trainer includes work on both surfaces. Synthetic turf was installed at the Wheaton school in 2012.

“I feel like there are specific issues, like turf burns from being on turf, but you can scratch yourself on grass, too,” she added.

Karissa Niehoff, CEO of the National Federation of State High School Associations in Indianapolis, said the issue has “been quiet” for most of her eight-year tenure.

“We have not heard much about whether turf itself was the cause of an injury,” she said. “It’s important to consider whether there was a predisposition for an injury — a compromised joint, lack of muscle strength. Did the athlete plant their foot and get hit simultaneously? Was it a plant-and-go motion that was extreme?”

What has been discussed more often, she said, are the chemicals found in the rubber particles that make up synthetic turf’s infill and provide cushion on impact. Niehoff said legislation proposed in Massachusetts would ban all artificial turf for that reason. A recent NBC News article noted bans, restrictions or options to impose bans exist in Boston and parts of California, Connecticut and Vermont.

“The data regarding the link between artificial turf, particularly crumb rubber, and health risks is scant. Much more research is needed,” Niehoff said.

Christy Collins of Indianapolis-based Datalys Center co-authored a 2022 study focused on anterior cruciate ligament (ACL) injuries in high school football and boys and girls soccer from 2007-08 through 2018-19.

The study found ACL injuries were more likely to occur on artificial turf in both boys and girls soccer, but there was no significant difference in football. The conclusion noted, “this relationship was not statistically significant for all sports.”

In an email to the Daily Herald, Collins said more research is required.

“This research is especially important because the type, quality and maintenance of artificial turf can vary greatly high school to high school,” said Collins, whose organization collects injury data reported by high school athletic trainers. “Additionally, this relationship may be impacted by other factors such as type of shoe worn by the athlete.”

Dr. Joseph Lamplot of Endeavor Health Northwest Community Hospital in Arlington Heights agrees that footwear and field condition are factors. He’s the head orthopedic surgeon for the Chicago Fire soccer team, and director of Sports Medicine Research for Endeavor Health’s Orthopaedic & Spine Institute.

Lamplot said in an email that some studies show higher rates of foot and ankle injuries on artificial turf while others suggest sport- and sex-specific differences, such as more ACL injuries in female soccer players.

One study he cited, in the May 2023 American Journal of Sports Medicine, reviewed 53 studies published between 1972 and 2020. It showed a higher rate of foot and ankle injuries on artificial turf over grass, though knee and hip injuries were reported to be similar.

The report’s conclusion also noted that among the articles stating higher injury rates on natural grass, “all of these studies received financial support from the artificial turf industry.”

Another study Lamplot noted, from eClinicalMedicine in April 2023, reviewed 22 studies of soccer athletes and “demonstrated a lower injury incidence on artificial turf compared with natural grass.”

“The bottom line,” Lamplot said, “is that artificial turf is not uniformly more dangerous than natural grass, but there may be certain athlete groups and injury types that occur at higher rates on artificial turf.

“Most current evidence suggests that modern artificial turf systems likely have similar overall injury risks as natural grass, and that is why nearly all high schools, many colleges,and the majority of professional organizations play on modern artificial turf,” he added.

Dr. Mark Neault, who practices orthopedic sports medicine at Northwestern Medicine Lake Forest Hospital and is team doctor for three high schools, said sports injuries have increased overall.

He doesn’t attribute that to playing surface, but to higher levels of play in youth sports and year-round activity that reduces recovery time.

Neault offered a study of 39 college football programs evaluated between 2006 and 2020. While medical procedures rose over time regardless of playing surface, the study showed “significantly lower incidences on artificial turf versus natural grass.”

Meanwhile, Barrington Athletic Director Rubenstein stands behind his field.

“We are very satisfied with our turf,” he said.