The Safety of Artificial Turf vs. Grass as a Sport Playing Surface

Mo soccer

Safety aside, soccer and a muddy, grass field: a boy’s idea of heaven!

The World Cup has arrived, at last, and brought with it already the first controversy of the tournament: did Fred flop?
But in the world of football/soccer, there is another, older controversy: turf vs. grass. We revisit this issue by looking at a previous blog post (it is very difficult to write while watching Mexico vs. Cameroon!).
Turf vs. grass: which is safer? Take a read, and let us know what you think.

sportingjim's avatarClinical Journal of Sport Medicine Blog

I was interviewed last week for a newspaper article which looked at the debate over a local school’s intention to transform a grass playing surface to artifical turf.

Among the controversies in sports medicine, the turf vs. grass wars are not the loudest nor the meanest, but they have been among the most persistent ever since 1966, when the Houston Astros first introduced a synthetic turf playing surface in the Astrodome, and dubbed it Astroturf.

Picture_of_Reliant_Astrodome Reliant Astrodome

The history of the Astrodome makes for interesting reading:  of note, the original intention was for the surface to be natural grass, and the makers of the dome had installed traslucent skylights to allow for grass to grow on the indoor surface.  Alas, not enough light made it to the playing surface, the grass died, and Astroturf was born.

The progress of science and technology have seen Astroturf give way to…

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Return to Play Decisions

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Though a beautiful time of year, fall is not
the most idyllic for a sports medicine clinician

Like many of the readers out there, my colleagues and I are deep in a football season, where we are managing various teams and their mounting injuries.  For a sports medicine physician, fall in America must be a bit like early spring for an accountant (tax day = April 15):  it’s the time to buckle down and crank through patients, the time, from a certain perspective, to see the volume of patients that will sustain the business through leaner times of the year.

When I’m out of the clinic and on the sidelines, I’m also doing one of the parts of my job that is the most fun, and I’m sure my colleagues out in the blog sphere will agree.  But I wouldn’t describe the work as an idyll.  I can be enjoying my team’s performance, and then called in three directions at once, treating players and making decisions on whether they can get back into the game:  decisions that can have significant consequences for the player and the team.

I thought I would write somewhat extemporaneously today, and in sharing some of the more interesting cases I have seen of late think in a more structured way about how we primary care sports medicine physicians make return to play (RTP) decisions.

RTP decisions make the headlines all the time.  In the professional leagues of North American sports, in just the last two weeks, we have seen discussions about Kobe Bryant’s return to the NBA from late spring Achilles tendon surgery; Rob Grownkowski’s ‘delayed’ return from a surgically treated forearm fracture; the much anticipated return of Derrick Rose more than a year after his ACL reconstruction; debate over RGIII and whether he has come back too soon from his own multi-ligamentous knee injury…….the list goes on!

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The end of a season?

In my own practice, I have been trying to return players back to American football while they have recovered from a kidney contusion, a posterior elbow dislocation, a complete rupture of the ulnar collateral ligament, and a demyelination injury of the axillary nerve.  Of the four, two are back playing; the elbow dislocation is still rehabbing, and i hope to return in a hinged knee brace before the end of the year; and the axillary nerve injury continues to have pain and profound weakness of his deltoid, and his recovery will extend beyond the end of this season (much to the coach’s dismay).

Despite being one of the more important aspects of our job, there is very little in the way of evidence-based medicine to guide a clinician in these decisions. Read more of this post

League of Denial: A review of the PBS documentary

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49ers legend Steve Young
one of the great interviews on the
documentary, “League of Denial”

I watched the PBS Documentary “League of Denial” this week, and I’m sure many of you did as well.

In one word:  Bravo.

I thought the folks at PBS’ Frontline did a fantastic job, touching on many facets of what is arguably the biggest sport public health story of the last two decades.  There were so many dimensions to the nearly two hour documentary, it’s hard to know where to begin my review.  In nearly two hours, PBS (with a ‘redacted assist,’ if that’s the phrase, from ESPN), covered a lot of ground.

I thought I would highlight some of the major personas that showed up, and divide them into the following four categories: “Winners,” “Losers,” “Meh,” and “In Memoriam”

Winners

Bennet Omalu, the neuropathologist who broke the story of chronic traumatic encephalopathy (CTE), is my pick for the most compelling figure in this documentary.  A physician of great training and accomplishment, he had the mixed fortune of conducting the post-mortem examination of Mike Webster, the Pittsburgh Steelers icon who died young and whose brain showed the pathologic changes of CTE, the first case documented in an NFL player and reported in this study.

Dr. Omalu’s story, both personally and professionally, is worthy of its own documentary.  Originally from Nigeria, he knows little about American fooball and nothing about the Steelers icon when he first meets the latter’s corpse and goes about his job.  He reports being thoroughly unimpressed with the gross morphology of the deceased’s brain:  how it looked ‘normal.’  It was only on conducting his histopathologic exam that he made his stunning discovery.

For this and further efforts in investigating CTE in deceased NFL players’ brains, he was smeared by the NFL and its affiliated physicians.  Omalu poignantly states as a result, he wished he had never ‘met Mike Webster.’

As an Associate Editor of a medical journal, I found the calls by some in the NFL medical community (see below) for Omalu to retract his CTE study and their ad hominem attacks to be the more egregious sins (among many) reported in the documentary.  The process of science, spearheaded by peer-reviewed literature, is one of openness; disagreements are cause for further study, not suppression.  Retraction should be reserved for outright fraud.  The calls for retraction in this case are shameful.

Ann McKee, another neuropathologist now with the Boston Center for the Study of Traumatic Encephalopathy, has picked up the baton and is continuing to carry on the research into CTE in former professional football players, despite further pushback from vested interests and more ad hominem attacks that insinuate that, as a woman, what might she know about football?

Steve Young who experienced five or six concussions in his career, is one of the former players interviewed for this documentary.  I remember Steve Young well, as I lived in the Bay Area for many of the seasons of his glorious career with the 49ers, and I remember too when he had his career-ending concussion. Read more of this post

The Confederations Cup and Estadio do Maracana

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Seleção Brasileira played on the grass of Estadio do Maracana.
Photo courtesy of Erica Ramalho/Wikimedia

Brazil was in epic form last night when they ripped Spain 3 – 0 to win the Confederation’s Cup in Rio’s glittering Estadio do Maracana (Maracana Stadium).

As many of the readers know, there have also been epic clashes throughout the country.  Large crowds have protested several issues, not the least of which is the huge capital investment the country is making in its sporting infrastructure, in lieu of other public works, heading into the 2014 World Cup and 2016 Summer Olympics (in Rio de Janeiro).

I certainly don’t pretend to understand the politics, but last night’s glorious football got me to thinking about a sports medicine controversy:  turf v. grass, which playing surface is safer for football (futbol, soccer) players?

This blog has discussed this issue before, with posts by me and the  previous on line editor, Chris Hughes, which I would recommend to you.

But today, I thought I would put the issue to the readers:  which surface do you think is safer for football/soccer players?  Take the poll below, or at the journal’s main page, and let us know.  I’ll  post the results in a week.  Feel free as well to elaborate on your vote in the comments section below.

If you didn’t get the chance to check out our blog posst on the weekend’s other huge sporting events,  the first stages of The Tour de France and Wimbledon, please do so and let us know what you think.

Is it really already July?!!  Have a good week!