The Controversy Over Grass

madison plains

Where Pigskin Meets Grass

To be clear, my topic today is NOT a survey of what cannabis legalization has wrought in states like Washington or Colorado [as an aside, in our own little corner of the USA the question of legalization will be on the ballot in Ohio this fall].

The grasses we’re discussing are ‘Bermuda,’ ‘Fescue,’ ‘Bluegrass’ and the like.

And the question today is not whether ‘the Dude abides’ [he most certainly does], but is this: which is the safer surface on which to play sport, grass or turf?

The subject came to mind after reading about a recent kerfuffle in the NFL.  The Houston Texans have played on a specially designed grass surface over the years. This season, they are switching to turf in response to concerns voiced about the field quality by opponents such as the Kansas City Chiefs.  In the NFL, in this season for this stadium, there’s a push toward turf.

On the other hand, readers may remember the controversy that raged much of this year regarding the use of turf [as opposed to grass] for the FIFA Women’s World Cup. And that ‘other’ world cup, Rugby World Cup 2015, is taking place right now in England, with  Twickenham Stadium and its grass pitch as that event’s centerpiece.

Grass vs. turf?  The perennial question.  Looking at it solely from the perspective of injury prevention [as opposed to factors such as sports performance or maintenance costs], we have looked at this question from time to time in the blog and in the journal.

For instance, this summer, in the July 2015 CJSM, O’Kane et al. published their timely findings looking into shoe wear and surface type on injury rates in female youth soccer players.  They found that a grass surface and wearing cleats on grass raised rates of lower extremity injuries; they concluded: “When considering playing surfaces for training, communities and soccer organizations should consider the third-generation artificial turf a safe alternative to grass.” Something to consider in this population and this sport and a countervailing argument to the push for grass in future iterations of the Women’s World Cup? Perhaps.  Or might that be too great of a generalization, extrapolating from the youth to the elite sport level?  Very likely.

What about you: your thoughts on this matter?  Taken purely from the perspective of sporting safety and injury prevention, what are your thoughts, your read of the medical literature?  Grass vs. Turf:  which is safer?  Does the sport matter?  Does the level of play matter?

Tell us in the poll!


Super Bowl Aftermath


Julian Edelman, New England Patriots pic: Jeffrey Beall

It’s a Tuesday as I write, so literally (and figuratively) I do not propose to do any “Monday Morning Quarterbacking.”  I’ll leave it to others to deconstruct Pete Carroll’s decision at the end of the game (though I don’t think it was that crazy of a call, and was in keeping with other contrarian decisions he has made that actually got the Seahawks into the Super Bowl–like the fake field goal call against Green Bay in the NFC Championships).

The Russell Wilson interception obviously turned out badly for Seattle, and sent all of New England into a frenzied state of joy (though a snowstorm in the region is causing the fans there to hold off one more day from a celebratory parade through Boston).

No, I’m here to focus on sports medicine–specifically the management of Julian Edelman’s apparent concussion in the big game–and encourage you, the reader, to take a poll to stimulate conversation about the issue.

I’m sure a lot of us in the sports medicine world had a sense of deja vu when we saw Edelman stay in the game after what many viewers thought was a concussion:  in the 2014 FIFA World Cup there were several similar incidents, when several players had suspicious head injuries whose management was questionable.  In the aftermath of that tournament, we had a podcast with guests Matthew Gammons and Cindy Chang , physicians of the American Medical Society of Sports Medicine (AMSSM), exploring the issues involved with management of possible concussions in real time, in the setting of a highly visible sporting event…like the Super Bowl.

The NFL has, in the wake of much criticism, introduced new concussion protocols.  It is my understanding that “….. the NFL assigns an independent physician to each team to monitor head injuries, and there is another independent ‘spotter’ who watches players on both teams from a booth above the field and can radio to the sidelines if there is evidence of an on-field concussion.” [1] Additionally, each team has its own medical personnel to monitor the situation as well as do any necessary evaluations.

It is not clear to me, however, that there is an independent physician who is empowered to remove a player from the field of play; to mandate removal if necessary, and not just ‘monitor.’  Should there be a clinician who i) has no conflict of interest [as exists intrinsically in any dynamic that involves medical personnel employed by a team:  player safety comes first, but there are, inarguably, biases that can creep into our decisions when player performance, especially in the setting of the World Cup or the Super Bowl, is at a premium]; and ii) who has the power, and the backing from the league, to disregard the player’s opinion, the coaches’ opinions, etc. and can mandate even the removal of a key player like, say, Tom Brady, for suspicion of a concussion, on the biggest stage of their sport.

And so, today’s poll:



[1] The Super Bowl’s Concussion Calculation, The New Yorker, Ian Crouch., accessed 2/3/15


Super Sunday

rachel nichols

Some of the media absurdity, and social media fun, in the run up to the Super Bowl

Why is Marshawn Lynch not talking?

Will #DeflateGate show up in the next edition of Webster’s dictionary?

Might Richard Sherman be in a hospital labor and delivery room rather than the stadium on Super Bowl Sunday?

The two week period between the NFL conference championships and the Super Bowl is at last, blessedly, over and it’s time for the real deal, the big kahuna, the game itself:  #PatriotsVsSeahawks.

There is so much room to fill in this fortnight that the media gets a little loopy, and many of the questions being asked with bated breath are, as the above sampling would indicate, fairly ridiculous.

One redeeming dimension to this tempest is that some clever folk get the opportunity to emphasize the absurdity of it all: I especially enjoyed the Jimmy Kimmel spoof of the DeflateGate controversy, “I am the locker room guy,” for which I owe Rachel Nichols a big thank you:  her tweet first made me aware of this hilarious video.

There has been the opportunity, as well, for what I think are intelligent analyses of the current state of the NFL, and of American football itself.  Mother Jones–a magazine not typically paired with, say, Sports Illustrated–recently ran an article entitled “The NFL’s Terrible, Horrible, No Good, Very Bad Year” and which began with a statement which sounds like the NFL apocalypse is nigh:  “From domestic violence and concussions to racist team names and angry cheerleaders, 2014 was a rotten year for pro football.”  Katy Perry–the singer who will perform at halftime this Sunday and the person with the largest twitter following on the planet–made what I think was a particularly concise evaluation of the multiple domestic violence issues occurring this season:  “It wasn’t an image problem–it was a problem.”

Many of the articles I’ve been reading in various periodicals have direct relevance to those of us in the universe of sports medicine.  The New York Times has done a great job in the past several days profiling the increasing awareness of injury risks associated with football; examples include an article on NFL outreach to mothers to assure them of football’s relative safety (and ensure for the league a pipeline of young talent coming their way) and an article profiling the recent study in Neurology purporting to demonstrate the long-term cognitive effects of initiating contact before the age of 12.

The Guardian even stepped into the fray with a very interesting piece on the potential for a measles outbreak in Arizona:  the massing of large populations; the recent outbreak of the disease in nearby California; and the relative lack of herd immunity (thanks to historically low rates of vaccination), contribute to a ‘perfect storm’ of contagion. The most deadly of childhood febrile exanthems–according to the CDC–may make for a post-Super Bowl hangover that won’t go away.

Like many of us who go into sports medicine, though, I do love sports, warts and all.  I am looking forward to a good game between New England and Seattle…..and a respite from the silly stories.

I am looking forward, too, to the research that will eventually come out of the NFL Player’s Association $100 million dollar grant to Harvard looking at player safety.  That’s a 10 year project, and so much of what will be found is still years away.  I am confident, as the evidence comes in, that some of the manuscripts to be published will be found in the pages of CJSM.  I am eager to discuss that research with you along the way.  Super Bowl L (actually Super Bowl 50–the NFL is dispensing with the Roman numerals for a year) will surely have more medically relevant stories seen in a new, evidence-based context…..and, of course, more inanity.

For now:  good luck to both teams.  May the players stay safe on Super Bowl Sunday. And….one last question:

Will Marshawn Lynch grab his crotch in celebration?

See you all next week.



The iconic Empire State Building:
Super Bowl in view.
Photo: Daniel Schwen

After all the talk about Manning’s comeback, Sherman’s rant, the NYC vs. NJ rivalry, and the weather….we have come at last to Super Bowl Sunday. The high holiday of American football.

The collision, not just of two football teams but also of a vast sporting event and the NYC/NJ media megalopolis, has created predictable fireworks.  For example, you can tweet a prediction of who will win the game, with the hashtag #WhosGonnaWin, and determine the lighting color of the  Empire State building itself.

The power of the pen?  No, it’s the power of the tweet!

Getting back to the weather.  It has been frightful, both in North America and Down Under.  The Australian Open almost had player defections over the intense environmental conditions they faced from an uprecedented heat wave.  At the same, a polar vortex swept down over most of Canada and the USA bringing fears of hypothermia, frostbite and other assorted ills to outdoor exercise enthusiasts, sportsmen, and, possibly, spectators.  When all is said and done, however, it appears that Sunday’s Super Bowl game will be played under cold, but tolerable and dry conditions:  the most recent prediction I have seen suggests game time temperature should be just around freezing, and the skies should be clear.

I suspect the NFL commissioner Roger Goodell may have sought some help from Timothy Cardinal Dolan in supplicating the higher powers to ensure the Super Bowl would avoid becoming an Ice Bowl… the last time the NFL championship occurred in the NYC area, in 1962. Read more of this post

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