Forget about hiring Roberto De Zerbi on a lucrative five-year contract and spending nearly £250million on six new signings. If Tottenham Hotspur want to be successful this season, they need to avoid another injury crisis.

Spurs have been wounded by back-to-back 17th-place finishes in the Premier League and fitness issues played a significant role on both occasions.

Ben Dinnery of Premier Injuries tracks and records data on injuries in the top flight. He defines a time-loss injury as one which forces a player to miss at least one match. Spurs had the second-worst record (37) behind Chelsea (41) for time-loss injuries last season and missed the most games (183). Lessons need to be learned but that is easier said than done.

There are many different factors involved and this is not the first time they have tried to tackle them. Former chief football officer Scott Munn restructured parts of the club, including the scouting and medical departments, following his appointment in 2023. Munn’s changes did not have the desired impact and, arguably, made things worse.

In the summer of 2024, long-serving head of medicine and sports science Geoff Scott left the club. Adam Brett was appointed as director of performance services, effectively replacing Scott, while Nick Davies became the new head of sports science. The Athletic reported in January 2025 that Scott left his role after clashing with then head coach Ange Postecoglou over how to manage the squad’s workload and the recovery of injured players. Spurs insisted Scott’s departure was linked to Munn’s review of the department.

Scott Munn restructured Tottenham’s medical department after he arrived in 2023 (Fred Lee/Getty Images)

Munn lasted two years while Brett and Davies both left their roles after only 12 months. Davies joined Everton where he was reunited with David Moyes, who he had previously worked with at West Ham United. Brett was without a club for a year until he joined MLS side Toronto FC as director of player health and high performance in July this year. Munn was appointed as general secretary of the Kazakhstan Football Federation (KFF) in April. Scott spent four months working with Nottingham Forest on a consultancy basis and left earlier this summer. There has been too much upheaval behind the scenes at Spurs and stability is crucial going forward.

The club advertised for a new director of performance services last summer to replace Brett. At the time, at least one senior figure at the club was confident that Spurs’ medical department would be “fully operational” at the start of the 2025-26 campaign and believed the new hire would take the operation to the next level. In October, they announced the appointment of Dan Lewindon.

Lewindon, who was the City Football Group’s (CFG) director of player and health performance for three years after previous roles with the Lawn Tennis Association (LTA) and England Rugby, did not start the role until February.

Another crucial hire was Carlos Raphael Moersen as director of football operations. Moersen started at the beginning of this summer and has played an integral role in transfers. Apart from negotiating contracts, another part of Moersen’s remit is leading “player care and training ground operations” according to the club’s statement when they announced his appointment in January.

One of the reasons Spurs parted company with Postecoglou a month after winning the Europa League was due to his “extreme playing style” and intense training sessions that senior figures believed contributed to their injury crisis during the 2024-25 campaign.

During the hiring process for the Australian’s successor, Thomas Frank enquired about why they had suffered so many problems.

Frank questioned Tottenham’s injury numbers upon his arrival in N17 (Carl Recine/Getty Images)

Negotiations between Brentford and Spurs over Frank dragged on because he wanted to take several members of his backroom staff across London. Assistant coach Justin Cochrane, head of performance Chris Haslam, coach-analyst Joe Newton, medical lead Nick Stubbings and strength and conditioning coach Tom Perryman followed him immediately.

Rehab physio Liam Horgan, who arrived from Crystal Palace but previously worked with Frank at Brentford, and nutritionist Ted Munson came midway through the season. Cochrane, Haslam and Newton left their roles when Frank was sacked in February.

However, the injuries continued to pile up under Frank, Igor Tudor and De Zerbi. Xavi Simons, Wilson Odobert and James Maddison ruptured their anterior cruciate ligaments (ACLs). Guglielmo Vicario had a hernia operation in March. Ben Davies and Lucas Bergvall both underwent ankle surgery. Destiny Udogie’s form was impacted by issues with his hamstrings for the third year in a row. Mohammed Kudus missed out on representing Ghana at the World Cup after a setback in his recovery from a quad injury he sustained in January. Dejan Kulusevski, one of Tottenham’s best players under Postecoglou, did not play a single minute due to a complex patella (kneecap) injury.

First-choice striker Dominic Solanke struggled with ankle and muscle injuries. He only made 15 appearances and started 11 times for a total of 1,000 minutes. Across his last three seasons with Bournemouth, Solanke only missed five league games through injury.

As the above graphic illustrates, only Micky van de Ven, Pedro Porro and Guglielmo Vicario played more than 75 per cent of the available minutes and started over 30 matches. This availability issue made it difficult for Frank, Tudor and De Zerbi to field a consistent starting XI.

“Our situation with the injuries has been worse than any other club,” Maddison told reporters, including The Athletic, after the final day victory over Everton. “People try and say, ‘Oh, but we’ve got this and that’. But ours is astronomical, and we need to look at why that is.

“Sometimes it can just be unlucky, sometimes it can be a coincidence, like me doing my ACL or Kulusevski getting a horrendous knock off (Marc) Guehi. That’s not the medical team, that’s not the pitch or all the theories that you see sometimes; that’s rubbish. We’ve been a bit unlucky. But like I said, the big names that we’ve missed, it does affect you and you can’t just deny that.”

Lewindon, who officially started the day before Frank was sacked, conducted an investigation into the club’s injury record and has instigated important changes, including an increased focus on individualised player care. The squad will be split into groups of four to six players who will have their own physio and sports scientist.

The theory is that staff will be able to dedicate more time to each player and understand them better. This should help medical and performance staff to make informed decisions and recommend small but significant tweaks to a player’s training schedule based on their injury history and the requirements of their position.

Kudus limps out of Tottenham’s match against Sunderland in January (Julian Finney/Getty Images)

Some players, including Kulusevski and Maddison, have worked with external specialists during their recovery. Spurs want to work closely with these specialists to ensure everybody is aligned on the same rehabilitation programme.

Maddison referenced a theory that the retractable pitch at Tottenham’s stadium, which allows them to host NFL games and concerts including Jay-Z’s upcoming two-night tour in September, has exacerbated injuries. Independent testing of the stadium and training pitches, which examined the grass’s bounciness and spring, did not raise any problems.

Changing managers can negatively impact players because they have to quickly adjust to different training methods and playing styles, which can create a greater injury risk. Spurs have had four permanent head coaches over the last 18 months but will be hoping De Zerbi sticks around for the entire duration of his five-year deal.

The Italian has acted cautiously with injured players. He restricted Maddison’s minutes when the midfielder returned from an ACL injury for the final three games of last season. Maddison and £85million ($115m) summer signing Mateus Fernandes were rested on the pre-season tour of Australia and New Zealand because “it is not the right moment to take risks.”

De Zerbi granted Bentancur “extended leave” and let him miss the tour after a “tough season.” Spurs are hiring a lead psychologist to help the first-team squad and staff manage the pressures of elite sport. They are not in European competition this season, which will ease the squad’s workload, but the aim will naturally be to return to the Champions League as soon as possible.

Spurs played Hoffenheim at the stadium on Saturday and behind closed doors at the training ground 24 hours later. Encouragingly, Maddison and Fernandes started the second match. However, Van de Ven, Kudus, Udogie and Solanke did not feature in either fixture.

De Zerbi has acted cautiously with previously injured players (Saeed Khan/Getty Images)

The training ground is being updated too. Lewindon has decided to knock through the gym walls, the idea being to bring together all of the performance-related areas to improve collaboration and the overall atmosphere. Players recovering from long-term injuries will no longer feel so isolated from team-mates and coaching staff.

Spurs’ biggest problem right now is their lack of attacking depth due to Xavi, Odobert and Kulusevski being unavailable. It will increase the pressure on Richarlison, Solanke, Kudus and Mathys Tel to play consistently. There are fitness concerns over Solanke and Kudus, while De Zerbi admitted Richarlison “sometimes wants to leave.”

Spurs have two weeks of the window remaining to complete deals for wide targets Savinho and Cody Gakpo. It is the second year in a row Spurs’ pursuit of Savinho has dragged on and it would be a huge disappointment to fall short again, especially as he is capable of playing on the left and right.

Excitement is understandably high for the upcoming campaign after an unprecedented summer where Spurs have broken their transfer record twice. The changes they have made across the medical and sports science department might turn out to be equally important.

Additional reporting: Thom Harris