Executive Summary
Most research comparing synthetic turf and natural grass on concussion has focused on a single question: which surface produces more concussions? A 2024 study from UT Southwestern Medical Center asked a different, arguably more clinically useful question — when a young athlete does sustain a head-to-ground concussion, does the surface they were injured on affect how severe that concussion turns out to be?
The study, led by senior author C. Munro Cullum, Ph.D., of the Peter O’Donnell Jr. Brain Institute, drew on the North Texas Concussion Registry (ConTex), a multi-institutional research database. It is described by its authors as the first study to specifically examine post-concussion symptom differences by playing surface in young football athletes.
Key Findings
- Study design: 62 male football players, ages 10–24, who sustained a helmet-to-ground concussion during practice or competition and were evaluated at a specialty concussion clinic within 14 days of injury. 33 were injured on natural grass; 29 on artificial turf.
- Symptom severity was significantly higher in the natural grass group. Average total symptom severity score was 26.6 for athletes injured on grass versus 11.6 for those injured on turf (a validated 0–6 scale summed across the 22-item SCAT5 symptom checklist).
- Total number of symptoms was also significantly higher on grass — an average of 10.3 reported symptoms versus 5.9 for the turf group.
- The two groups were evaluated at a similar point post-injury (roughly 5–6 days on average) and had comparable concussion and headache history, meaning those factors don’t explain the difference.
- The researchers’ interpretation, in their own words as reported by UT Southwestern: modern artificial turf systems — long synthetic fibers with infill installed over a shock-absorbing pad — appear to provide meaningful impact attenuation for head-to-surface contact, while many natural grass fields, particularly at the youth level, may be inconsistently maintained and harder underfoot than commonly assumed.
Important Limitations
- Small sample size. 62 total participants (33 grass, 29 turf) is a modest cohort for drawing firm conclusions, and the authors themselves describe the findings as preliminary.
- No data on individual field condition or maintenance. The study could not control for how well-maintained the specific grass or turf fields were at the time of injury — a variable the lead author explicitly flags as relevant and unmeasured.
- Observational, not experimental design. The study compares outcomes after the fact; it cannot establish that surface type directly caused the symptom difference, only that an association was observed.
- Regional and demographic scope is limited to athletes captured by a North Texas concussion clinic registry, which may not generalize to all climates, field types, or levels of play.
- This study addresses symptom severity after a concussion has occurred — it does not address whether one surface produces more concussions overall, which is a separate body of research.
Why This Matters
For athletic directors and parents, the intuitive assumption is often that grass is the “softer,” safer surface by default. This study complicates that assumption in a useful way: among athletes who were already concussed, those injured on grass reported meaningfully worse outcomes than those injured on modern turf systems. That doesn’t mean turf prevents concussions outright — this study wasn’t designed to answer that question — but it does suggest that surface hardness and consistency, not surface type in the abstract, may be the more relevant variable, and that well-engineered turf systems can outperform poorly maintained or inconsistent natural grass on this specific measure.
Act Global Perspective
This study lines up with something Act Global emphasizes across our technical content: player safety on any surface — natural or synthetic — is driven by consistency, shock attenuation, and maintenance, not by the surface category alone. A well-built, well-maintained turf system with proper fiber length, infill, and shock pad specification is engineered specifically to manage head and body impact forces, which is measured directly through metrics like Head Injury Criterion (HIC) testing on every system we install.
We’d also point field owners to the study’s own caution: this is one study, with a modest sample, and it does not mean natural grass is inherently more dangerous. It means field condition and construction quality matter enormously, on either surface — which is exactly why independent, ongoing testing (not a one-time installation certification) is central to how Act Global approaches player safety.
Related Resources
- HIC Explained — Head Injury Criterion in Synthetic Turf
- ACL Injury Risk on Synthetic Turf vs. Natural Grass — Review of Howard et al. 2020
- Does Synthetic Turf Increase Injury Risk? What the Data Shows (coming soon)
Access the Original Study
This review is Act Global’s independent summary of publicly available peer-reviewed research, prepared for educational purposes. Act Global does not host or reproduce the original article. Read the full study directly from the publisher:
- Heinzelmann MM, Stokes M, Miller SM, Bunt SC, Hynan LS, Didehbani N, Cullum CM. “Impact of Playing Surface on Concussion Symptoms in Young American Football Players.” Clinical Journal of Sport Medicine, 34(4):357–361, July 2024. DOI: 10.1097/JSM.0000000000001204
- UT Southwestern research summary: utsouthwestern.edu/newsroom
This is an Act Global Research Review — an independent interpretation of publicly available peer-reviewed research prepared for educational purposes only. It does not constitute medical, legal, or engineering advice.
