Natural grass or artificial turf? Study sheds light on concussions and football fields (2024)

As football season kicks off this fall, a new study suggests that players on certain fields could be at a higher risk of suffering a concussion.

The study, which was conducted by researchers at UT Southwestern Medical Center and published last month in the Clinical Journal of Sport Medicine, looked at 62 football players between 10 and 24 years old who had had a concussion. Of those, players on natural grass experienced more severe concussions and a higher number of symptoms than those who played on synthetic turf.

Though previous research has suggested that concussions may be more prevalent on grass fields than artificial turf, this is the first time scientists have examined how concussion symptoms differ based on the playing field, said C. Munro Cullum, a professor of psychiatry, neurological surgery and neurology at UT Southwestern who led the study.

“This study is intriguing as it examines the possibility that artificial turf can reduce the severity of post-concussion symptoms compared to concussions that occur from head impact on natural grass,” said Dr. Nicholas Stetkevich, a pediatric sports medicine physician with Texas Children’s Hospital in Houston who was not involved in the study. He added that since it’s a small pilot study, it’s not meant to be definitive, but it does open up areas of further research.

In the United States, between 1.7 million and 3 million sport or recreation-related concussions occur every year, with around 300,000 from football. In 2022, 2.3 million children below the age of 17 were diagnosed with a concussion or a brain injury, a diagnosis most prevalent among older boys, according to a survey by the Centers for Disease Control and Prevention.

Studies have linked repeated blows to the head, which are common among football and hockey players, with chronic traumatic encephalopathy, a fatal and incurable degenerative brain disease. A 2019 study out of Boston University, for example, found that for every year of playing tackle football, a player’s risk for the disease increased by 30% and for nearly every three years of playing, the risk doubled.

To see whether there was a relationship between concussions and the type of football field, Cullum and colleagues at UT Southwestern turned to a database they established in 2015. Called the North Texas Concussion Registry, it pulls patient medical information from multiple concussion clinics in North Texas to shed light on potential risk factors and how those translate into concussion numbers and recovery.

The researchers focused on male football players between the ages of 10 and 24 who had sustained a helmet-to-ground concussion and were seen at a concussion clinic within two weeks of their injury.

Thirty-three athletes who fit the criteria had sustained their injury on grass fields; 29 others did so on artificial turf. What Cullum and his colleagues found next surprised them: Football players who played on grass reported around 10 concussion-related symptoms, while those who played on artificial turf reported around six.

The natural grass group also reported more severe symptoms than their artificial turf counterparts. They were more likely to experience blurred vision, noise sensitivity, feeling in a fog, difficulty remembering, fatigue or low energy and confusion.

The findings are concerning but don’t make a definitive case for natural grass over artificial turf, said Dr. James McDeavitt, a professor of physical medicine and rehabilitation at Baylor College of Medicine who was not involved in the study.

When artificial turf was first introduced in the 1960s, it was difficult for athletes to plant their cleats into the hard surface. Agrochemical company Monsanto created the first synthetic turf, ChemGrass, and published a 1968 study that said turf could “reduce football injuries by 80%.”

Independent studies in subsequent years found this wasn’t the case. Turf was instead linked to an increased risk of musculoskeletal injuries.

“They’ve improved artificial turf — it’s spongier now and gives a bit more — but the NFL is moving away from it for the most part and there are only five Major League Baseball teams that currently use artificial turf,” McDeavitt said. “It’s largely to prevent musculoskeletal injuries, not brain injuries. It’s pretty clear that the rate of knee injuries is higher with artificial turf than it is on natural grass.”

Governing sports organizations like the University Interscholastic League have protocols to protect young athletes from concussions, said Summer Ott, a neuropsychologist at UTHealth Houston and the director of the Rockets Sports Medicine Institute Concussion Program at Memorial Hermann. Ott was not involved in the new study.

Over the last decade or so, the UIL has taken steps to minimize concussions by setting limits on how often athletes can engage in contact practices and by phasing out some of the more risky drills, Ott explained. One example is the Oklahoma drill, which dates back to the 1940s and involves two players colliding into each other after a running start. In 2019, the NFL asked teams to stop using this drill and similar high-impact ones during training camp practices to reduce the risk of concussions.

There have also been efforts to prevent concussions using protective headgear. Last year, the first quarterback-specific helmet designed to help reduce concussions was approved by the NFL and its players association. In April, the NFL announced players would be allowed to wear Guardian Caps during regular-season games. The caps are soft-shell helmet coverings meant to minimize the impact of violent collisions and cut down on concussions. Another cap designed by a Dallas resident that’s been tested on area high school football teams may also help minimize concussions.

Determining how a playing surface fits into sports-related concussion prevention and management will require extensive research before scientists and health care professionals can say anything prescriptive, Cullum said. Other factors that may affect the risk of injury include body weight, musculature and mental health.

“It’s hard to generalize from one single study unless it’s really large and well done,” Cullum said, noting that his team’s hope is for their study to lead to more research into the topic.

Miriam Fauzia is a science reporting fellow at The Dallas Morning News. Her fellowship is supported by the University of Texas at Dallas. The News makes all editorial decisions.