It is well documented that health and social benefits can be attained through participation in sport and exercise. Participation, particularly in sports, benefits from appropriate surface provisions that are safe, affordable and high quality preferably across the recreational to elite continuum. Investment, construction and research into artificial sports surfaces have increased to meet this provision. However, not all sports (e.g. golf, rugby and cricket) are suited to training and match-play on artificial turf without compromising some playing characteristics of the games. Therefore, full sport surface provision cannot be met without the use of natural turf surfaces, which also have an important role as green spaces in the built environment. Furthermore, a significant number of people participate in outdoor sport on natural turf pitches, although this is a declining trend as the number of synthetic turf surfaces increases. Despite natural turf being a common playing surface for popular sports such as soccer, rugby and cricket, few biomechanical studies have been performed using natural turf conditions. It is proposed that if natural turf surfaces are to help meet the provision of sports surfaces, advancement in the construction and sustainability of natural turf surface design is required. The design of a natural turf surface should also be informed by knowledge of surface-related overuse injury risk factors. This article reviews biomechanical, engineering, soil mechanics, turfgrass science, sports medicine and injury-related literature with a view to proposing a multidisciplinary approach to engineering a more sustainable natural turf sport surface. The present article concludes that an integrated approach incorporating an engineering and biomechanical analysis of the effects of variations in natural turf media on human movement and the effects of variations in human movement on natural turf is primarily required to address the longer-term development of sustainable natural turf playing surfaces. It also recommends that the use of 'natural turf' as a catch-all categorization in injury studies masks the spatial and temporal variation within and among such surfaces, which could be important.