Turf Burn: The King of Pain


Raspberry is definitely the new black. image credit: Storelli.com

Raspberry is definitely the new black. image credit: Storelli.com


We all know that injuries suck, but the undefeated mother of all that is unholy in soccer is the turf burn. Let’s take a deep dive into understanding turf burns and the recommended methods of prevention, protection and treatment.

1. Raspberries

Field injuries are more common than you might think. Turf burns bleed, hurt, and can get dangerously infected. Because most players play through these injuries, they often go unreported. But with the explosive global growth of soccer world combined with generally poor field conditions and an increasing number of synthetic surfaces, skin injuries seem to be increasing in number and severity. 

A Dutch study reported that 84% of professional soccer players sustained at least one major turf burn during the season, with goalkeepers at the highest risk. Several outbreaks of antibiotic resistant staph infections in athletic teams have also been directly linked to turf burns.

2. The first cut is the deepest

Turf burns are not really thermal(burn) injuries. The combination of violent mechanical shearing of the skin and frictional abrasion can lead to large areas of superficial skin injury, which we all know are extremely painful and can take weeks to heal. 

A new study examined severe turf burns and found that they were more similar to skin grafts and bikers’ road rash than to a heat or chemical burn. The same study found that less abrasive damage was seen during soccer slide tackles on wet natural grass than on dry grass or synthetic turf.

3. The grass is always greener

There is little doubt that most soccer players perceive that artificial turf is more threatening than natural grass. No shocker there. A group of international female soccer player felt so strongly that they filed suit against FIFA and the Canadian Soccer Association prior to the 2015 World World Cup to halt the use of synthetic turf during the tournament (the suit was later dropped). But current research on newer 3rd and 4th generation (Field Turf, etc) surfaces has not confirmed this belief. However, the conflicting data showing otherwise comparable injury rates between natural and synthetic turf fields still confirms that skin abrasion rates are higher on artificial grass surfaces. 

Despite lingering health concerns, the high cost of maintaining high-grade natural grass fields has driven many communities around the country to convert to artificial surfaces. There are now over 14,000 synthetic sports fields in play in the US alone with a 10% increase per year.

The only touching that skin is Storelli. image credit Storelli.com

The only touching that skin is Storelli. image credit Storelli.com

4. You’ll never walk alone

We all know that soccer fields are not the most sterile places on earth. All types of bacteria and other nasty contaminants populate our pitches. The bigger problem with skin abrasions is that they provide sudden exposure of subcutaneous blood vessels to millions of these opportunistic bacteria. In one study, 42% of players harbored staph bacteria. Yikes!

Worse yet, antibiotic resistant bacteria can live for weeks on both natural and synthetic fields as well as happily colonizing your sweaty old gear. Because up to 10% of these abrasions will become infected if untreated, players need to become more proactive in treating. The old adage of “leave it alone and let the air get at it” only delays healing and leads to increased scarring and re-injury.

Want a better approach? Aggressively scrub the area clean with a disinfectant (chlorehexidine=GOOD, hydrogen peroxide=BAD) and then keep it clean, moist, and covered using Tegaderm or hydrogel. This can trim healing time from 3 weeks down to as little as 7-10 days. Oh, yeah, and no sharing towels in the locker room or using a communal whirlpool.

5. Less is more

Soccer players need to start borrowing tactics from our road rash-plagued bike racing cousins and start covering ourselves with the latest in modern, breathable next generation contact padding that have ignited a growing interest in protecting our largest organ. Field maintenance, although expensive, also needs to become a priority. Both natural and artificial turf fields should be irrigated to control radiant temperatures and decrease abrasive risk.

R. Rocco Monto, MD, is the author of the Amazon bestseller, THE FOUNTAIN, and a contributing writer for Storelli.com focused on soccer training techniques and mental and physical exercises to help better your game.



1. Begier EM, Frenette K, Barrett NL: A high-morbidity outbreak of methicillin resistant staphylococcus aureus among players on a college football team, facilitated by cosmetic body shaving and turf burns.

2. http://www.calrecycle.ca.gov/publications/Documents/Tires%5C2010009.pdf

3. Centers for Disease Control and Prevention. Methicillin-resistant Staphylococcus aureus infections among competitive sports participants

4. DiFiori JP, Benjamin HJ, Brenner J, Gregory A, Jayanthi N, Landry GL, Luke A. Overuse injuries and burnout in youth sports: a position statement from the american medical society for sports medicine. Clin J Sports Med, 2014;24(1):3-20.

5. Synthetic playing surfaces and athlete health. J Am Acad Orthop Surg

6. Ekstrand J, Nigg BM: Surface-related injuries in soccer. Sports Med, 1989

7. Ekstrand J, Timpka T, Hagglund M: Risk of injury in elite football played on artificial versus natural grass: a prospective two-cohort study. Br J Sports Med



10. Hill AP: Perfectionism and Burnout in Junior Soccer Players: A Test of the 2 x 2 Model of Dispositional Perfectionism. J Sport Exer Psych


12. Kazakova SV, Hageman JC, Matava M, et al: A clone of methicillin-resistant staphylococcus aureus among professional football players. N Engl J Med

13. Incidence, causes, and severity of high school football injuries on-field turf versus natural grass: A five-year prospective study. Am J Sports Med

14. Peppelman M, Van Den Elinde WA, Langewouters AM, Weghuis MNO, Van Erp PE: The potential of the skin as a readout system to test artificial turf systems: clinical and immunohistological effects of sliding on natural and artificial turf

15. Silva JM: An analysis of the training stress syndrome in competitive athletics. J App Sport Psych

16. Community-associated methicillin-resistant Staphylococcucsaureus survival on artificial substrates. Med Sci Sports Exer.

17. Yamaner F, Gumus M, Gulu E, Kartal A: Evaluation of injuries in professional Turkish football players. Eur J Gen Med.

18. Zanetti EM: Amateur football game on artificial turf: player’s perceptions. Appl Ergon.

Dr. Monto featured in Men's Health magazine

Dr. Monto featured in Men's Health magazine


The ankle is highly stable in a neutral standing position. But in a downward-flexed, on-your-toes position, the joint depends more on support from injury-prone ligaments and tendons.

Top Threat: Sprain

What it is: A tear in one of the ligaments — usually on the outside of the ankle — that supports the joint. Severe sprains that leave the ankle unstable may eventually damage the joint’s bones and cartilage.

Cause: Stretching the ligament beyond its limits, usually by rolling the foot as you walk or run on an uneven surface, making a cutting move, or stepping on someone’s foot. Just a month ahead of Portugal’s 2018 World Cup bid, star forward Cristiano Ronaldo sprained his ankle and had to leave the game. “Outside of sports, the most common scenario for men is rolling the foot while going down a step,” says Rocco Monto, M.D., spokesman for the American Academy of Orthopaedic Surgeons.

Treatment: Rest and compress the ankle, possibly with help from a brace. Rehab will build supporting muscles and increase balance with exercises like standing on one foot with eyes closed— important for preventing repeat sprains due to ankle instability. Surgery to reconstruct the ligament and brace the ankle is rarely needed.

Defense: Build calf muscles with exercises like calf raises to increase support around the ankle and improve balance. “They’re like stirrups that hold the ankle in,” says Dr. Monto.

Nantucket Magazine features Dr. Monto's book, The Fountain

The summer heats up as the hottest new magazine, N, debuts Dr. monto's new book, The Fountain: A Doctor's Prescription to Make 60 the New 30. 

Here's an excerpt..." I am afraid of dying. It’s not the end that concerns me, it’s what happens before. You see, getting older is a relatively new thing, and we really aren’t that good at it. To be sure, modern medicine has done a great job helping us all live longer. Clean water, antibiotics and modern surgery have postponed the ultimate checkout time for most of us. The problem is that while lifespan has increased, our health span hasn’t kept pace.

Our parents, who worked their whole lives for a retirement they thought would be filled with joy and fulfillment, wither away while their frail bodies and minds disintegrate. They linger on while heart disease, hypertension, strokes, renal disease, diabetes, dementia and depression are more common than ever. Aging has become a disease. But it doesn’t have to be like this. We can turn the tide. How do I know? Because I’ve done it."

N Magazine is available online and at newstands and booksellers throughout Nantucket and Cape Cod.

The Fountain Named one of the Best Wellness Books of The Year

The Like Me, They Really Like Me!

photo credit : Tim Ehrenberg, Nantucket Bookworks

photo credit: Tim Ehrenberg, Nantucket Bookworks

Dr. Monto's new book, The Fountain: A Doctor's Prescription to Make 60 the New 30 was named by Books for Better Living as one of the hottest new wellness books of 2018. Check it out at BBL.com. Order your copy today at Amazon, or your favorite local bookseller.

Maybe everyone doesn’t necessarily want to live longer, but everyone would probably agree that it’d be nice to live healthier, more fit, and dare I say, more youthful as we get older. Dr. Rocco Monto discusses how to do just that in his book The Fountain, focusing on the four pillars of science, diet, exercise, and medicine to show us how to ease the negative effects of growing older, prevent disease, and live more energetic and full lives as we age.