Turf vs. Grass: What Does the Evidence Say About Injury Risk?
When it comes to choosing between natural grass and artificial turf, one of the biggest questions we hear from athletes, parents, and coaches is: Does surface type affect injury risk?
Here’s what the research tells us and how footwear plays a role.
Overall Injury Rates
Modern, well-maintained artificial turf appears to have a similar overall injury rate compared to natural grass. Research by McLeod TCV and colleagues found comparable injury incidence in professional soccer players across both surfaces.
Foot & Ankle Injuries
Some studies suggest a slightly higher incidence of foot and ankle injuries on turf, particularly during cutting and pivoting movements. A systematic review by Williams S highlights the importance of monitoring drills that involve quick changes o
Knees, Thighs & Pelvis
The data here is mixed. A meta-analysis by Grooms DR found that injury risk for areas like the knees, thighs, and pelvis may be comparable, and in some cases slightly lower, on turf versus grass.
The Missing Piece: Footwear Matters
Surface and shoe type work together. The interaction between the two directly affects traction, stability, and rotational forces on the lower body.
Turf shoes (short, rubber studs) are designed to reduce excessive grip on artificial surfaces, helping limit rotational stress on the foot and ankle.
Firm ground cleats may perform well on natural grass but can sometimes create too much traction on certain turf systems.
Worn-out shoes, regardless of type, can reduce stability and shock absorption.
When footwear creates too little traction, athletes slip. When it creates too much, the foot may “stick” while the body rotates, increasing stress on the ankle or knee. Matching the shoe to the surface is a simple but powerful injury-reduction strategy.
Practical Takeaways for Coaches and Athletes
1. Turf Is Generally Safe
When properly maintained, artificial turf is not inherently more dangerous than grass.
2. Monitor Foot & Ankle Stress
Pay attention during cutting, pivoting, and change-of-direction drills — especially on turf.
3. Field Maintenance Matters
Surface age, infill quality, and upkeep significantly affect traction and shock absorption.
4. Choose the Right Footwear
Match cleats or turf shoes to the surface, and replace worn-out footwear promptly.
5. Training Still Matters Most
Surface type and footwear are important, but strength, neuromuscular control, movement quality, and smart load management remain the foundation of injury reduction.
If you have questions about footwear selection, transitioning between surfaces, or returning to play after a foot or ankle injury, our team at Omaha Physical Therapy Institute is here to help. Our goal is simple: keep your athletes strong, resilient, and performing at their best, no matter the surface.
References:
Williams S, et al. Systematic review of turf vs. grass injuries in soccer. Sports Med. 2022.
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