The rate of non-contact lower extremity injuries in the NFL was nearly equal on artificial and natural turf in 2023, league officials told ESPN, the second time in three years that those trend lines essentially crossed.
The data, collected by a joint committee of the NFL and the NFL Players Association, adds to the ongoing debate about the safety of playing surfaces at the NFL's 30 stadiums.
Jeff Miller, the NFL's executive vice president of communications, public affairs and policy, said the similar rates indicate that “all surfaces need to be examined” to find opportunities for improvement. NFLPA Executive Director Lloyd Howell last fall asked all teams to switch to grass fields afterward New York Jets quarterback Aaron Rodgers tore his left Achilles tendon on the artificial turf at MetLife Stadium. In a statement released to ESPN this week, the union said the numbers were close in 2023 only because injuries on grass fields were increasing.
“As we have said repeatedly,” the statement said, “the injury data in a year-long time capsule does not cover what we have known since we began tracking these injuries: that a well-maintained, consistent turf surface is still easy “is safer.” for players than on any artificial turf pitch. Last year's injury data shows that injury rates on grass have unfortunately increased compared to the previous year.
“However, the data cannot explain what players have been sharing with the NFL for years: that we feel much worse after playing on synthetic surfaces and that we overwhelmingly prefer consistent, high-quality turf fields.”
“This year’s injury data also does not explain how quickly they are converting NFL stadium surfaces from poor plastic to better turf for international soccer friendlies and tournaments.”
The NFL/NFLPA Committee defines playing surface-attributable injuries as those occurring in the lower extremities, without contact with another player, and serious enough to require missing games. They account for about a third of all NFL injuries and about half of all lower extremity injuries, according to Dr. Mackenzie Herzog, an epidemiologist at IQVIA and consultant to the NFL and NFLPA.
In 2023, the incidence rate (per 100 games) of such injuries was 0.001 higher on artificial turf (0.043) than on natural turf (0.042). That equates to a total of six to eight injuries over the course of the 17-week season, Herzog said, so the rates are “almost identical.” In 2021 there was a similar difference between tariffs.
In 2022, the artificial turf rate was 0.048 and the natural turf rate was 0.035.
“Sometimes the artificial turf injury line goes up and sometimes it goes down,” the NFL’s Miller said, “and the same goes for the natural turf line. We need to better understand why this might be the case over time, for both lines to work.” They go in the same direction and both go down.
Following the uproar over Rodgers' injury, ten other NFL players suffered torn Achilles tendons during regular season games. There were a further 12 in pre-season games and training sessions, and the total of 23 was in line with the level of previous seasons. According to Dr. According to NFL Chief Medical Officer Allen Sills, the number of Achilles tendon injuries in the NFL has been between 20 and 22 since the league switched to a 17-game regular season.
“We haven’t seen an epidemic of Achilles tendon injuries this year,” Sills said.
Several teams replaced a type of artificial turf called “slit film” after the 2022 season, noting that it resulted in higher injury rates than other forms of turf and grass. Two more will do so after the 2023 season, making Paycor Stadium in Cincinnati the only facility not planning on slot sheet replacement before the 2024 season.
Despite this data, and as the NFLPA said in its statement, many players say they feel less pain after playing on turf than after playing on turf. Sills and Miller said this week that the NFL/NFLPA committee has several research initiatives underway to address surface conditions, including the possibility of growing turf for indoor stadiums.
“We believe this is important work,” Sills said. “It hasn't been done at the level that we think would withstand the forces that NFL players are currently putting on these fields, but that's also a very active line of research.”
In the meantime, the committee is studying the impact of introducing consistent turf management and style protocols to reduce the adjustments players need to make from stadium to stadium.
“We believe this will be a key driver in reducing injuries,” Sills said.
Regardless of the field, the NFL saw an undisputed decline in serious injuries in the 2023 season, Miller said. The number of games missed due to all injuries decreased by approximately 700 compared to 2022, primarily due to a decrease in lower extremity injuries.
The NFL believes its intervention efforts – working with the medical team and coaching staff in the first few weeks of spring training to find ways to manage the “ramp-up period” and reduce lower extremity injuries in training camp – are paying off.
The NFL's numbers show a 29% decrease in lower extremity injuries during training camp and a 50% decrease in the recurrence of these injuries over the course of the year. Herzog said the number of regular-season games missed due to lower extremity strains – which represent the No. 1 injury burden in the league – was down 24% compared to the previous two years.
“We've really focused on this and made it an offseason priority to talk to coaches, strength coaches and performance directors about trends and observations, particularly how we get players back,” Sills said. “We’ve seen that the first two weeks of training camp really provide an opportunity to ease the stress.”
The NFL also stated that ACL injuries decreased in 2023. There were 52 ACL injuries recorded in preseason and regular season games and practices, a 24% decrease from the average of the previous two seasons, according to the league.
Meanwhile, the number of concussions remained relatively stable. The NFL had 219 concussions in preseason and regular season games and practices, up from 213 in 2022.
The NFL has met its goal of reducing the number of concussions on kickoffs, with the number dropping from 20 in 2022 to eight in 2023, but Miller said that was a direct result of a rule change limiting fair catches at the 25-yard line. The concussion rate on re-kickoffs remained the same as in previous years, according to Sills.
Miller said the competition committee plans to revisit the kickoff this offseason with the goal of keeping the game in play but making it safer. He said they have studied the XFL rule and will continue to look for ways to change the game to make it safer without making it disappear.