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Incidence of Injury Among Adolescent Soccer Players: A Comparative Study of Artificial and Natural Grass Turfs

Aoki, Haruhito MD, PhD*†; Kohno, Terushige MD, PhD†‡; Fujiya, Hiroto MD, PhD†‡; Kato, Haruyasu MD, PhD†‡; Yatabe, Kanaka MS†‡; Morikawa, Tsuguo MD, PhD§; Seki, Jun MD, PhD

Clinical Journal of Sport Medicine: January 2010 - Volume 20 - Issue 1 - p 1-7
doi: 10.1097/JSM.0b013e3181c967cd
Original Research

Objective: To investigate the incidence of acute injuries and soccer-related chronic pain from long-term training and during matches in adolescent players using natural grass turfs (NT) and artificial turfs (AT).

Design: Case-controlled prospective study.

Setting: Institutional-level Fédération Internationale de Football Association Medical Centre of Excellence.

Participants: Youth soccer players (12-17 years of age) from 6 teams, with a predominant tendency to train on either NT or AT, were included. Of 332 players enrolled in this study, 301 remained to completion.

Interventions: Medically diagnosed acute injuries and chronic pain were recorded daily by team health care staff throughout 2005, and reports were provided monthly to the authors.

Assessment of Risk Factors: Noninvasive prospective study.

Independent Variables: Age and turf type.

Main Outcome Measures: Acute injuries per 1000 player hours on each surface and chronic complaints per 1000 player hours were evaluated according to frequency of surface used ≥80% of the time. Incidence rate ratio (IRR) of acute injuries and chronic complaints during play on NT and AT was calculated.

Results: There was no significant difference in the incidence of acute injuries between the 2 surfaces during training and competition. However, the AT group showed a significantly higher incidence of low back pain during training (IRR, 1.62; 95% confidence interval, 1.06-2.48). Early adolescence and prolonged training hours were factors associated with an increased incidence of chronic pain in the AT group.

Conclusion: Adolescent players routinely training on AT for prolonged periods should be carefully monitored, even on AT conforming to new standards.

From the *Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan; †FIFA Medical Centre of Excellence at Kawasaki, Kawasaki, Japan; ‡Department of Sports Medicine, St. Marianna University School of Medicine, Kawasaki, Japan; §Orthopaedic Surgery, Kawasaki Steel Company Hospital, Chiba, Japan; and ¶Orthopaedic Surgery, Nishi-Omiya Hospital, Saitama, Japan.

Submitted for publication May 18, 2009; accepted October 19, 2009.

We received no research funding from any other source.

The authors state that they have no financial interest in the products mentioned within this article.

Reprints: Haruhito Aoki, MD, Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.