Synthetic turf playing fields may pose additional concussion risk for children
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ANAHEIM, Calif. — Findings presented here suggest that young athletes may be at greater risk for head injuries on synthetic turf vs. natural grass fields.
Previous research has shown that some injuries are more common for athletes who compete on synthetic turf, but evidence has been inconclusive that the same goes for concussions.
To help fill the gap, Ian K. Chun, BS, a 3rd-year medical student at the University of Hawaii John A. Burns School of Medicine, and colleagues studied whether the hardness of a synthetic turf field might pose an additional risk for children who play football.
Chun and colleagues said synthetic turf football fields are becoming more popular because they are cheaper to care for even though studies have shown that over 15% of concussions among high school athletes were attributed to contact with the playing surface.
“One of the issues that we first ran into when we were setting up [our] study is that we couldn’t give ourselves concussions,” Chun said during a press conference at the AAP National Conference & Exhibition.
Their solution was to equip a mannequin with accelerometers and drop it on high school football fields all over Oahu, Hawaii, to measure the differences in impact deceleration between fields covered with synthetic turf and grass fields.
They mounted the sensors on the forehead, right ear and top of the mannequin’s head and dropped it from around 2 feet more than 1,700 times — 10 times each on its front, back and left side at the 40-yard line, 20-yard line and in the end zone — to calculate the magnitude of impact. They picked 10 natural grass and nine synthetic turf fields for the study and conducted the experiments at least 24 hours after a rainfall because rain can affect the hardness of playing fields, Chun said.
They calculated that the impact deceleration of the mannequin was greater on synthetic fields compared with natural grass fields — that “synthetic turf fields were harder than natural grass fields,” Chun said. Specifically, all accelerometers showed significantly greater impact on the forward and backward falls on synthetic turf compared with natural grass surfaces. On side falls, the sensor at the top of the mannequin’s head showed a significantly greater impact deceleration on synthetic turf.
The results do not prove that the risk for concussion is greater on synthetic turf compared with natural grass because the study did not compare concussion rates between children who play on these surfaces, Chun said. Pursuing that question would take a larger study and more resources.
However, Chun said, “The logical conclusion that one could make is that a harder field would result in a larger concussion risk.”
Chun’s University of Hawaii collaborators included Nathaniel Villanueva, BS, a medical student, and professor of pediatrics Loren G. Yamamoto, MD, MPH.
Perspective
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Concussions in youth athletes have taken on greater importance in all sports activities over the past several decades, and appropriately so. We now have a better understanding of the injury in general and ways to evaluate and diagnose the injury as well as to treat it more effectively. In fact, multiple sets of guidelines for management are also now available to health care providers as well as parents, athletic and school personnel.
Fundamentally, mechanisms of injury are critical factors to understand as they offer possible opportunities for prevention or reduction of injury risk. Player behavior and technique, coaching technique, contact frequency and intensity, and protective equipment have all been identified as important factors in promoting safer sports. In football, much attention has been paid to the helmet, with the idea that this protective device can mitigate some of the forces transmitted to the head and brain upon contact. Advances have been made with helmet design and materials as recognized by Dr. Stefan Duma and the Virginia Tech group, who provide helmet safety ratings for several different sports and recreational activities.
At the same time, the study by Ian Chun and colleagues recognizes another important part of the injury equation in football — the playing surface that the head and helmet strikes. His study raises an important issue to be considered, as the game (and practice) can be played on various types of fields. This study poses the question: Is there a difference in the type of field surface with respect to head/brain injury risk? The study used accelerometer devices on mannequin heads with helmets to measure the speed or velocity of movement of the head when it was dropped on synthetic turf versus natural grass fields. Chun’s findings provide an important answer to this question — the type of surface does make a difference in the deceleration of force upon impact, potentially affecting the risk of concussion. They report that synthetic turf fields produced a “significantly greater impact deceleration” when compared to natural grass fields. Whereas a host of factors are considered when the choice is made regarding the type of playing surface, these findings suggest that head injury risk, in addition to other orthopedic injuries, should also be considered.
References:
Davis GA, et al. Br J Sports Med. 2017;doi:10.1136/bjsports-2017-097492.
Lumba-Brown A, et al. JAMA Pediatr. 2018;doi:10.1001/jamapediatrics.2018.2853.
Reed N, et al. Living guideline for pediatric concussion care. PedsConcussion.com. Accessed Oct. 8, 2022. https://pedsconcussion.com.
Virginia Tech helmet ratings. https://www.helmet.beam.vt.edu/. Accessed Oct. 8, 2022.
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Chun IK, et al. Impact force differences on natural grass versus synthetic turf football fields. Presented at: AAP National Conference & Exhibition; Oct. 7-Oct. 11, 2022; Anaheim, Calif.
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