With the use of artificial turf in football the subject of much debate, FIFA.com spoke to Jan Ekstrand, Professor in Sports Medicine, team doctor of the Swedish national team in the eighties and nineties and currently vice-chairman of the UEFA Medical Committee. As director of the Football Research Group in Sweden, Ekstrand has carried out a series of studies on the risk of injury on artificial turf, which provide useful scientific data for this discussion. 

FIFA.com: What kind of research have you done concerning artificial turf?
Dr. Jan Ekstrand: Some ten years ago, FIFA and UEFA decided to conduct joint research into the issue of injuries on artificial turf. UEFA, actually my research group, was tasked with performing research into elite football in Europe. We carried out a study on top teams that played all of their home matches on artificial turf and their away matches on natural grass in order to compare the incidence of injury on both surfaces. The study was conducted mainly in Scandinavia, but also in the Netherlands and Switzerland. I would like to point out that when we talk about artificial turf, we mean FIFA-certified football turf, what we call football turf or third-generation artificial turf.

Would you conclude that there are more injuries on artificial turf than on natural grass?
The results of all of the studies – the ones we carried out on elite football but also other studies on amateur and youth football as well as in other regions, such as America – are all entirely consistent: the total risk of injury is the same on football turf as it is on natural grass. We see the same result in all studies, there is no increase in injuries when playing on FIFA-certified football turf. Some studies show a small difference in the injury pattern, with an increase in ankle ligament injuries on football turf but a decrease in muscle injuries. I have to say that our studies only focused on injuries that caused absence from either training or matches. There might have been sore muscle or back pain issues that were not part of the studies but that some players and teams have reported.

Are there long-term studies for players who have played regularly on artificial turf?
Our studies focused on short-term injuries causing absence. There are no studies on the long-term effect of playing football in general, whether on artificial turf or on natural grass. This is because it’s extremely difficult to ensure a proper follow-up after 20 or 30 years.

What about leg burn after tackles made on artificial turf? Do you agree that we would not see such injuries on natural grass?
To our surprise, there was no difference there either. This was the most common injury in the seventies with the first artificial turf, which was basically a plastic carpet, but it is not the case today. In fact, we saw more instances of leg burn on natural grass. I think this is a myth which comes from the seventies, when artificial turf was first introduced.

What about the recovery time after injury? It seems to be longer on turf than on natural grass.
There again, there is no difference. All studies have reached the same conclusion.

Does the quality of turf make a big difference?
Well, we don’t know, because there are so many different types of artificial turf and so far there have not been any studies that take into account all of the different parameters. Maintenance is also a very important aspect that hasn’t been studied so far. The studies we have carried out give us a general result: injuries are similar on both surfaces, in general the rate is not higher on football turf. But some questions remain open: for instance, the effect of maintenance or the type of construction of the pitch.

And what about the quality of natural grass?
That’s a good question. We usually make a comparison between artificial turf and good-quality grass. But the reality is different; in many cases, natural grass pitches are of poor quality. I actually suggested at one point to test all pitches as we do for the FIFA-certified football turf, but economically this idea would be very difficult to put in place. But I know from experience in Scandinavia that almost half of all elite matches are played on turf because it allows for a longer season, maintenance is easier and the alternative would be a bad grass pitch because of the weather conditions.

What about the perception of some players who say that the game is different? Does it impact on the body?
The reality is that artificial turf is not very popular among elite coaches and players. This is based on the bad experience in the early days of artificial turf, but there is no scientific substance behind it. The potential impact on the game has been included in different tests and there’s no difference. Perception is one thing and reality is another thing. I visited most of the top clubs in Europe and almost all of them have excellent football turf pitches. Usually the senior squad doesn’t use the turf for training but the academy very often does. So I think it’s a generational issue; the new generation coming from the academies will be used to playing on football turf.

It is sometimes said that it is harder or more demanding to play on artificial turf for “older” players. Can you comment on that?
There’s no study that backs this idea. I think it is more a problem that these players are older and we know, for instance, that muscle injuries increase with age. And actually artificial turf could be potentially better for older players since, as I mentioned before, the risk of muscle injuries decreases on turf.

After all your research, would you say that artificial turf is a safe surface?
Yes, definitely, provided it’s a football turf with a certain quality.

Does the surface have a different impact on male and female players?
No, it’s similar. We have studied this question and there are no differences. But it’s difficult because people have this cliché. I can see it in Sweden, for instance: each time a woman suffers a severe knee injury for instance, people start to blame the turf pitch, but it’s absolutely wrong, there’s no scientific evidence for this.