Safety of artificial turf and natural grass sports surfaces

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1 Safety of artificial turf and natural grass sports surfaces Executive Summary This paper briefly summarizes some of the research related to traumatic head injuries in the context of sports. We also introduce recently completed testing of natural grass sports surfaces and artificial turf surfaces in terms their ability to attenuate severe impacts. We examine the extent to which natural and artificial grass sports surfaces represent a risk factor for traumatic head injuries and identify the need to develop safety standards for artificial turf surfaces to correlate to the level of safety provided by natural grass surfaces.

2 Safety of artificial turf and natural grass sports surfaces Introduction With the exception of American Football, there have been relatively few professional and semi-professional contact sports competitions played on artificial turf surfaces. Soccer, rugby, Gaelic football, hurling and Australian rules football are predominantly played on natural grass. And as these sports have been played on natural grass surfaces for over a century, we can assume that there is a familiarity and expectation in terms of the degree of safety one can expect of the surface. The number and severity of injuries associated with these sports is considered to be acceptable and somewhat predictable by the participants and coaches. The same however cannot be said of artificial turf. These surfaces until now have not been designed to provide the same degree of safety under severe impact as natural turf. Their design instead has focused on the surface interaction of the athlete s foot and ball behavior. The risk here is that athletes who perceive the surface properties of an artificial surface to be similar to natural grass, may also assume that the degree of safety is also similar. Given the limited amount of high intensity competitive play on these artificial surfaces, the consequences of a lesser degree of safety under severe impact is not yet known. Natural Grass vs. Artificial Turf Surface interaction properties of natural grass in terms of running, turning. sliding, skin friction and ball behavior are well documented and performance standards for artificial turf have been developed accordingly. The degree of safety of a natural grass surface has also been researched and tested, but this is unfortunately not reflected in today s standards for contact sports. The safety criteria of artificial turf surfaces for international rugby expressed in terms of Head Injury Criterion (HIC) for example is roughly one half that of a natural grass surface. When submitted to a severe impact a natural surface has the ability to permanently deform, crush and collapse. This behavior is a very effective means of dissipating the energy of a severe blow and is similar to the way that a crash helmet is designed to absorb significant impacts. Unlike a crash helmet that is only designed for one severe blow, a natural grass surface can be repaired, maintained and made ready for another future impact. The ability of a natural grass surface to effectively absorb the energy of a severe blow is of significant benefit in preventing severe injury, most importantly head injuries. Until now artificial surfaces have not been designed or required to mimic the degree of safety of a natural grass surface. The degree of safety of an artificial turf surface is consequential to a surface compliant with the surface performance properties for a given sport. However with newer technologies optimal surface performance and safety no longer have to be mutually exclusive of one another. The question should not be how much risk athletes, coaches and parents are prepared to accept with artificial turf surfaces, but how safe can a playing surface be designed to reduce the risk of head or other injuries to the greatest degree possible.

3 Head Injuries While severe or fatal head injuries to athletes are a relatively rare occurrence, sports are a common venue for concussions, or Mild Traumatic Brain Injury (MTBI). Concern about minor head injuries has significantly increased in recent years, with the realization that MTBI s can have long-lasting effects on cognitive function and can also expose an athlete to a period of greater risk of severe injury or death from a second or subsequent episode. Severe head injuries have the potential to change lives in a dramatically negative way and carry a greater risk of fatality than more common injuries. Consequently, they have been a focus of attention in the sports medicine community for many years. The extent to which sports surfaces are a factor in brain injury is unclear. The incidence of injuries of all kinds has been well documented for most major sports and recreational activities, but these studies rarely distinguish impacts with the surface from other impacts, nor do they document the surface type or condition involved in a head injury. However, it is reasonable to believe that a collision between the head and a surface has the same injury potential as a direct impact with any other object and the limited information supports this assumption. Mechanisms of brain trauma The fundamental cause of most brain injuries is strain (compression or stretching) of the brain tissue and the blood vessels it contains. Historically, head injuries have been classified in various ways, based on their severity and on the mechanical factors involved. In general, brain injuries can be considered as either focal or diffuse. Focal injuries are typically confined to a local region of the brain and are usually the result of a direct blow to the head. Even if it does not fracture the skull, an event of this type produces a shock wave that alternately compresses and stretches brain tissue, causing local tearing of brain tissue and blood vessels. The subsequent hemorrhaging and haematoma can be fatal. An impact between the head and a sports surface can be expected to result in accelerations that are primarily linear, but rotational accelerations are also possible, depending on the geometry of the head, neck and torso at the instant of impact, and the friction of the surface. The consequences of brain trauma sometimes emerge over time. In the hours and days following the initial traumatic event, physiological changes occur that can have far reaching consequences. When brain cells are torn, calcium and potassium ions escape into the surrounding impulses are transmitted by the flow of these ions across cell membranes, the released ions can disrupt neural function. What follows is a metabolic cascade of events as healthy cells try to compensate for the uncontrolled flow of ions, demanding more energy and consuming more glucose in the process. This metabolic distress leaves the brain vulnerable for some time after the initial injury, increasing the probability of a further injury. Guskiewcz et al (2000), for example, found that football players who had experienced a concussion were three times more likely to experience a second concussion in the same season.

4 Head Injury Criterion The purpose of testing the shock attenuation properties of a sports surface is to estimate the probability that an impact on the surface will cause an injury. The two test methods and references used to describe the degree of safety of a surface are Head Impact Criterion and G max. Research demonstrates that the Head Impact Criterion (HIC) is the most accurate measure of head injury potential of a sports surface as it takes into consideration not only the peak force of an impact, but the duration of the impact as well. Understanding the H.I.C. of a surface is to accurately predict the likelihood of a moderate, severe and catastrophic head injury. Empirically determined relationships between HIC scores and the probability of head injury are widely used as a way of estimating injury risk (NHTSA, 1997; Prasad and Mertz, 1985). An HIC score of 1,000 represents the safe limit of human tolerance, above which the risk of fatal head injury is non-zero. However less severe head injuries with long term effects can be incurred at much lower HIC scores. In Figure 1, each curve estimates a specific level of trauma for a given HIC score. The chart shows that at a HIC score of 500 there is a 79% probability of a minor injury, a skull trauma without loss of consciousness, or that the athlete will incur a minor concussion. At the same HIC value the risk of a major injury (skull fracture, extended period of unconsciousness) is 13%. The risk of a 500 HIC score producing a critical or fatal head injury is very low, but the probability of experiencing this head impact and not being injured at all is only 21%. Fig. 1 Figure 1 shows examples of Expanded Prasad-Mertz Curves. (NHTSA, 1997; Prasad and Mertz, 1985) Each curve estimates the probability that an impact with a given HIC score will result in a specified level of head trauma.

5 Abbreviated Injury Scale The abbreviated Injury Scale (AIS) classifies head injuries according to a series of injury characteristics of ascending severity. The table below shows the characteristics that define each level of the injury scale. HIC testing of natural grass vs. artificial turf A recent series of tests was carried out in Ireland on behalf of the Gaelic Athletic Association. Several fields were tested to benchmark the H.I.C. of the natural grass fields vs. artificial turf fields. The results below identify a significant difference in the results of the two categories of surfaces: Natural Grass Fields: name condition mean HIC (critical fall height) Thurles dry / wet 1.93m St. Vincent dry 1.55m Parnell Park dry 1.75m Artificial Turf Fields: name condition mean HIC (critical fall height) University Dublin College dry / wet 1.17m Ballymun dry 0.95m St. Brigids dry 0.90m Although this data is limited in scope, the results show that the natural surfaces have an average HIC 74% greater than the artificial surfaces (1.74m vs. 1.00m). What is clear is that the artificial surfaces tested do not were not designed to perform to the same degree as natural turf in terms shock absorption under severe impact.

6 Conclusion The risk of head injury is of important concern in the design of sports surfaces. Catastrophic head injuries have life changing, even life-threatening consequences. Sports are a common venue for concussion, more formally described as Mild Traumatic Brain Injury or MTBI. Indeed, the US Centers for Disease Control and Prevention considers the incidence of sports related MTBI to have reached epidemic proportions. A great deal of effort and investment has been made by various sports governing bodies to identify the surface behavior of natural grass and performance standards for artificial turf have been developed accordingly. The same cannot be said for safety standards for artificial turf. To ensure that serious injuries on artificial turf do not become more frequent or more severe as compared to natural grass, a similar approach will need to be adopted to develop safety standards for contact sports, or any sport where an impact with the surface is likely.

7 REFERENCED STANDARDS ASTM F355 Standard Test Method for Shock-Absorbing Properties of Playing Surface Systems and Materials. ASTM International, West Conshohocken PA, USA. EN1177 Impact absorbing playground surfacing- safety requirements and test methods. European Committee for Standardization, Brussels, Belgium. REFERENCES: Centers for Disease Control and Prevention, Sports related recurrent brain injuries, United States. MMWR Morbidity and Mortality Weekly Report 46: Gadd CW, Use of a weighted impulse criterion forestimating injury hazard. Proc 10th Stapp Car Crash 68 Conference; SAE Paper , Society of Automotive Engineers, Warrendale PA, USA. Gurdjian ES, Webster JE, Linear acceleration causing shear in the brainstem in trauma of the central nervous system. Mental Adv Dis 24:28. Gurdjian ES, Webster JE, Lissner HR, Observations on the mechanism of brain concussion, contusion and laceration. Surg Gynec Obstet 101: Guskiewicz KM, Weaver NL, Padua DA, Garrett WE, Epidemiology of concussion in collegiate andhigh school football players. Am J Sports Med 28: Katayama Y, Becker DP, Tamura T, Hovda DA, Massive increases in extracellular potassium and the indiscriminate release of glutamate following concussive brain injury. J Neurosurg 73: Naunheim R, McGurren M, Standeven J, Fucetola R Lauryssen C, Deibert E, Does the use of artificial turf contribute to head injuries? J Trauma 53: Prasad P, Mertz HJ, The position of the United States delegation to the ISO working group on the useof HIC in the automotive environment. SAE Paper# Society of Automotive Engineers, WarrendalePA, USA. Shorten M.R. & Himmelsbach, J.A. (2003) Sports surfaces and the risk of traumatic brain injury. Woltys EM, Hovda D, Landry G, Boland A, Lovell M,McCrea M, Minkoff J, Concussion in Sports. Am J Sports Med 27: Zhang L, Yang KL, King AI, Biomechanics of neurotrauma. Neurological Research 23:

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