Inside the injury crisis that threatens to wreck Tottenham's season

“We’ve lost the translator as well, even my translator is injured.”

The injury crisis at Tottenham Hotspur may have denied Ange Postecoglou are substantial chunk of his first-team squad for a substantial chunk of this season, but at least he can still laugh.

The Spurs boss made light of the situation in his press conference ahead of Thursday evening’s Europa League game at Hoffenheim — a match in which he will be without Guglielmo Vicario, Cristian Romero, Micky van de Ven, Destiny Udogie, Pape Sarr, Yves Bissouma, Brennan Johnson, Timo Werner, Wilson Odobert and Dominic Solanke (not to mention unregistered Antonin Kinsky, Djed Spence and Sergio Reguilon) — by joking about his translator needing to stop briefly due to a cough.

Sadly not many of those injuries to his players have been brief and the more players he has had missing, the further down the Premier League his side has plunged. Spurs may hold a slender first-leg advantage over Liverpool in the semi-final of the Carabao Cup and be on course to reach the knockout stages of the Europa League, but their league form has gone from inconsistent to dismal.

They have lost 12 times and their points tally of 24 from 22 games means they are stuck in lower mid-table, closer to the relegation zone than the top four. They have just one win in their last 10 league matches, and that was against bottom side Southampton. Since the start of December, they have conceded the fourth-highest number of goals (24) and have the second-worst record for expected goals against (22.4) and big chances faced (32). Their hopes of improving on last season’s fifth-place finish are remote. In fact, according to Opta’s current predictions, they are more likely to go down than finish in the top four.

This is the story of how and why this injury crisis took hold.

There is no denying that a lot of Tottenham’s problems of late can be attributed to the absence of key players, including Micky van de Ven, Cristian Romero, Destiny Udogie and Guglielmo Vicario. The Italian goalkeeper fractured his ankle in the 4-0 victory over Manchester City in November but Romero, Van de Ven and Udogie have all struggled with soft-tissue injuries.

Postecoglou’s unique philosophy places a significant strain on defenders. They are expected to push high up the pitch and then cover large distances at top speed when Spurs lose the ball. Using data from SkillCorner, the below graphic highlights the physical demands of the Australian’s tactics by comparing the number of high-speed runs Tottenham’s players make in and out of possession compared to their top-flight rivals. 

The 59-year-old likes his squad to train with the same intensity they play games. Training sessions are shorter compared to under previous head coaches but the squad’s physical output is greater. When they participate in drills, assistant coaches watch on from the sidelines and when a ball is cleared they immediately roll a fresh one back in — there is no time for respite. Physically overpowering the opponent is a cornerstone of Postecoglou’s style and this requires a period of adaptation for the players’ bodies to get up to speed.

There was some acceptance Spurs would suffer with injuries last season but they were expected to clear up. After a year of transition, the first-team squad would be more familiar with Postecoglou’s style while the summer transfer window presented another opportunity to sign better quality players. With more trusted options to choose from, Postecoglou could manage the players’ workloads better even with the extra challenge of competing in the expanded version of the Europa League. 

There was evidence to support that. In Postecoglou’s last three club roles, at Brisbane Roar, Yokohama Marinos and Celtic, he overcame teething problems to win the league title in his second season. At one stage during his first year with Celtic all of the senior strikers were injured.

“(The hamstring injuries) are obviously something we want to get on top of but it’s not new to me either,” Postecoglou said in December 2021 after Kyogo Furuhashi was injured in Celtic’s Europa League victory over Real Betis. “The way we play, I understand — and have done at the clubs I’ve been at — that the beginnings are always difficult. We play differently and train differently and it takes players time to adjust to that, and along the way we obviously pay a price.

“But the one thing I’ve never done, and I won’t do in my whole career, is compromise the football team we want to be because we are not quite ready to be there. I’d rather keep going at the pace we are going and it means we are going to have some casualties along the way.”

Postecoglou won two league titles during his time with Celtic (Richard Sellers/Getty Images)

Anton McElhone, who was Celtic’s head of sports science under Postecoglou and had previously worked at Spurs when Mauricio Pochettino was the manager, told The Athletic in June that the way Postecoglou plays is “non-stop.”

“It was a high-pressure job, week in, week out, and in the first few months, we had a horrendous injury list because we might not have been able to train the way we wanted to,” McElhone said about his time working with Postecoglou at Celtic. “He was understanding, as he said that every club he goes to, in the first six months he has injuries, as they’re not used to training at that level. We had to make sure the data was right and they were training hard enough.”

The huge difference with Spurs is that the situation has not improved after 18 months. In fact it has got worse. Ben Davies, Son Heung-min, Richarlison, Wilson Odobert, Udogie and Van de Ven have all struggled with hamstring injuries this season and suffered setbacks in their recovery. Over the last fortnight, Timo Werner, Yves Bissouma and Pape Matar Sarr have become the latest victims to suffer hamstring injuries. Dominic Solanke, meanwhile, suffered a knee injury in training which forced him to miss Sunday’s defeat to Everton, while Brennan Johnson is out for up to four weeks with a calf issue. 

The intense schedule of matches is a factor. Spurs have already played nearly as many games as last season. Due to the Europa League and their progress in the Carabao Cup, there have been hardly any opportunities to give the players an extended break which has left them trapped in a vicious cycle of match after match. In an atrocious stroke of luck, when Postecoglou did give the players two days off after the 2-2 draw with Wolverhampton Wanderers in December, an illness spread through the squad which badly impacted James Maddison, Fraser Forster, Radu Dragusin and Archie Gray’s ability to train, let alone play. 

Postecoglou has said he has never experienced an injury crisis this severe and for this extended period of time before. Have they simply been unlucky, or are they suffering due to a flawed approach?

Tottenham only played 41 games in all competitions last season as they were not in any European competition and exited the FA Cup and the Carabao Cup in the early stages. They still suffered a lot of injuries compared to previous seasons, as the graphic below shows. 

Ben Dinnery of Premier Injuries tracks and records data on injuries in the Premier League. He defines a time-loss injury as one which forces a player to miss at least one match. Last season, Spurs had the seventh-worst record in the division, suffering 37 time-loss injuries. Manchester United struggled the most with 45. 

While Tottenham’s injured players missed a grand total of 1,402 days, many of their rivals towards the top of the Premier League, including Newcastle United (1,950), Chelsea (1,745), Brighton (1,727) and Man United (1,620), suffered more. 

If you dig deeper into the data, you can see that Spurs had the joint-fourth worst record with Brighton (9.3) for the injury incidence rate per 1,000 minutes. Only Crystal Palace (10), Man Utd (9.9) and Chelsea (9.4) had higher rates. The data suggests that a thin-squad was being pushed close to its limits.

Since the end of last season Tottenham’s medical and sports science departments have undergone significant change. It all started when Geoff Scott left his position as head of medicine and sports science in the summer. It ended a 20-year association with Spurs for Scott who became their head physio in 2004 after leaving Fulham. He worked under 11 different managers including Mauricio Pochettino, Jose Mourinho, Antonio Conte and Postecoglou.

Scott left Spurs after clashing with Postecoglou. Sources with knowledge of the situation, who asked to remain anonymous to protect relationships, say that the pair fell out over how to manage the first-team squad’s workload and the recovery of injured players. However, the club insists that Scott’s departure did not involve Ange Postecoglou and was instead a result of the review and restructure of the department.

Following Scott’s departure, Adam Brett was appointed as director of performance services. Brett started his career in rugby union before spending nearly a decade with Brighton. Brett oversees sports science, medical, nutrition and psychology as part of his role and can be spotted next to the bench on a matchday. He reports into chief football officer (CFO) Scott Munn.

Spurs CFO Scott Munn has overseen the restructure of many departments at the club (Quinn Rooney/Getty Images)

The medical team is just one of the many departments that was overhauled by Munn following a thorough review of the club’s football operations. Munn arrived in April 2023 and since then he has been trying to change how Tottenham operate off the pitch, to bring them more in line with modern best practices. This has led to a raft of new appointments and the restructuring of key departments. 

Recruitment, for example, is completely transformed following the departure of experienced scouts such as David Pleat and Ian Broomfield last summer. The medical department is just the latest department to undergo the same process. 

Nick Davies, who had previously worked with West Ham United, West Bromwich Albion and Wales, became the new head of sports science. As part of his responsibilities, he leads the initial warm-ups in training. 

There has been a lot of change in a short time and more is to come. Tottenham are currently hiring for a number of roles including a rehabilitation physiotherapist and performance rehabilitation coach. The job description for the rehabilitation physiotherapist on LinkedIn says that the ideal candidate will “return injured players to training through a seamless, progressive and motivational programme, utilising both evidence-based and experienced-based practice.” Spurs are also searching for a head of men’s medical, who would report to Brett. Spurs want a separate head of medical for the men’s and women’s first teams as well as their academy. These new jobs were planned following the strategic review and are not a response to their current injury issues. 

Before they lost to Everton, Tottenham had suffered 21 time-loss injuries this season, the third worst record after Brighton (23) and Aston Villa (22). Brighton are the only side to have lost more days (914) to injury than Spurs (655). Those figures will only increase now Solanke, Bissouma, Johnson and Sarr are unavailable.

Solanke suffered a knee injury in training last Saturday when he went to take a shot. Postecoglou said “we don’t think it’s serious” but he will be out “for probably a few weeks.”

A few days before, Postecoglou had praised the 27-year-old’s performances this season but said “we’ll be able to get more out of him if we can get him some help.” Unfortunately, a move for Paris Saint-Germain’s Randal Kolo Muani did not materialise, and that help didn’t arrived in time.

Prior to the knee injury, Solanke — Tottenham’s club record signing — had played in almost every fixture for Spurs this season. He missed two games early on after picking up an ankle injury on his debut last August, and he missed the Fulham home game on December 1 with illness. But of the five games where Solanke started on the bench, he had to be brought on every single time: against Ferencvaros, AZ Alkmaar, Galatasaray, Rangers and finally Tamworth, where he ended up having to play almost one hour on their 4G pitch. 

The forward only missed five league games through injury across his last three seasons with Bournemouth. He will have already matched that record in his short Spurs career by Sunday when his new club face Leicester City without him.

It was a surprise when Van de Ven and Romero were named in the starting XI for the defeat by Chelsea on December 8. Van de Ven had been unavailable for five weeks since suffering a hamstring injury in the Carabao Cup victory over Manchester City on October 30. Romero had been struggling with a toe problem linked to a tackle on Morgan Rogers in the 4-1 win over Aston Villa on November 3. Romero started for Argentina in a World Cup qualifier away to Paraguay on November 15 but came off at half-time and did not play for club or country again for three weeks. 

Postecoglou said on November 22, the day before Spurs beat Man City in the league, that “we’re hoping by the middle of December (Van de Ven) will be back and available to play.”

Also on November 22, Postecoglou had said of Romero that he “hasn’t been fully fit for probably two to three weeks.”

“(Romero’s) soldiered on through it because that is the kind of character (he is) and we needed him but I think when he went away he realised this is not healing the way we want it to,” the head coach added. “It’s a couple of separate issues. And I spoke to him and said: ‘Look. Just have a break. We need you 100 per cent fit.’ As much as we’d love to have him out there, I think it’s best for him he gets totally over everything. He had the birth of his daughter this week as well which is also a significant event in his life.”

On December 4, the day before Spurs faced Bournemouth, Postecoglou said: “between now and Christmas (December 25) hopefully we’ll get Romero and Micky back.”

Some 48 hours later, following a fractious defeat to Andoni Iraola’s side, Postecoglou gave an update on Romero’s availability for Chelsea that weekend: “Cuti is due to train, we’re not doing much today but we’ll see how he goes tomorrow.

“He just hasn’t been able to feel 100 per cent. But we’re closer now so there’s definitely light at the end of the tunnel. The first thing is that he feels more comfortable so hopefully he’s available soon.” 

Postecoglou then spoke about whether he would need Romero “to do a job” against Chelsea if he was not completely ready. “I don’t think I have to ask him, Cuti’s the kind of guy if he feels he can get out there and help us, he will,” Postecoglou said. “I won’t have to twist his arm.”

Van de Ven and Romero only participated in a couple of training sessions before facing Chelsea. They had returned ahead of schedule on the eve of an important game against one of Spurs’ biggest rivals.

Sources familiar with the situation, who asked to remain anonymous to protect relationships, say that the medical staff had reservations about Van de Ven’s readiness to play. But nevertheless, he started the match on December 8. The club insist he was ready but the plan had only been to play him for around 60 minutes. Due to circumstances during the match he ended up playing for 79 minutes.

Van de Ven went off towards the end of Tottenham’s defeat to Chelsea (Catherine Ivill/Getty Images)

Romero also started, but within 14 minutes of his return from injury, he walked off the pitch with his shirt over his face after picking up a muscle issue. Van de Ven went down in the 79th minute holding the back of his right leg and had to be replaced by Archie Gray.

After the game, Postecoglou called Romero’s injury “hugely disappointing” but said that “the plan was always for (Van de Ven) to play 60/70 minutes” and he “just felt tightness.” He denied gambling on the fitness of his first-choice centre-backs. 

“No, Romero didn’t injure the same thing,” Postecoglou said. “It’s a totally different injury but also I’m sure people are aware of our situation. It’s not like I’ve got a multitude of options so you’ve got to make these decisions. Both players trained well and wanted to help. So you make these decisions with all the best information.”

But the fact that Romero suffered a quad injury within minutes of returning to first-team football, having only trained the day before the Chelsea game, raises questions about his rehab work. In general, when a player comes back from a bad hamstring injury, they need to replicate their physical output in a game in training. For example, they need to match the amount they sprint in a game and the amount of high intensity running which is measured and checked via GPS metrics. The more time players have to train and build up sharpness the less likely they are to suffer any more problems.

Given that Romero was struggling to train fully in November, and only able to play 45 minutes for Argentina during the international break, how much work was he able to do? Was he still struggling to train due to his toe injury? If he was, was he able to do the work to mimic kicking a ball? This is the work that helps to protect against the kind of quad injury he suffered within minutes of his return. The club say that this sort of injury is impossible to predict and this speculation is hindsight.

It has been over a month and neither player has returned to training let alone full fitness. Van de Ven and Romero’s surprisingly quick return in December came despite Radu Dragusin, who at that point had started five Premier League games in a row including the 4-0 victory over Man City at the Etihad, being available, though perhaps in need of a rest. Would it have been wiser to start Dragusin and only play one of Van de Ven or Romero?

Udogie came off in the first half of last month’s 5-0 win against Southampton with muscle soreness and missed the Carabao Cup quarter-final victory over Manchester United before being an unused substitute in the defeat to Liverpool. The 22-year-old returned to the starting XI at Nottingham Forest on December 26, then pulled up with a hamstring problem in the draw with Wolves a few days later. He is due to be out for six weeks in total.

Before Tottenham faced Newcastle on January 4, Postecoglou was asked if these injuries could have been avoided if he had a bigger squad. 

“I know we always want a head on a stick and we want somebody to blame, and there’s always somebody at fault, but some of it’s just life,” he said. “Football is like life and you know how sometimes in life you get one thing go wrong and you get another thing later on, and you’re doing nothing different, you’re just going ‘why is it always me at the moment?’.

Udogie limps out of Tottenham’s match at Southampton (Andrew Matthews/Getty Images)

“We lost Djed (Spence) with a red card and he was supposed to start over Destiny (against Wolves). Destiny starts, doesn’t get the rest. It’s like that’s just life and sometimes no one’s at blame, no one’s at fault, you know, it’s just, we’re going through a bad trot, but it is temporary, we’ll get through it. We’ll analyse areas we can improve in and move forward from there.”

Udogie underwent thigh surgery last April and only returned to full fitness towards the end of pre-season. The full-back has started 18 times in the league this season which is the third-highest in Tottenham’s squad after Dejan Kulusevski (20) and Pedro Porro (19) despite missing their last three games through injury. Only Porro (1,806), Kulusevski (1,771), Solanke (1,601) and Johnson (1,497) have registered more minutes than Udogie (1,436).

Spence was left out of the Europa League squad and only made five substitute appearances across the Carabao Cup and Premier League before he started at right-back against Southampton on December 15. Within a minute, he had set up James Maddison for the opening goal. The 24-year-old then assisted Solanke’s second goal in the 4-3 victory over Manchester United. The former England Under-21 international has now started eight of Tottenham’s last 10 matches in all competitions — he came off the bench against Tamworth and was suspended for the 2-2 draw with Wolves.

Spence’s contributions in and out of possession — he kept Mohamed Salah quiet in the first leg of the Carabao Cup semi-final — raise questions over why he was not trusted to play more earlier in the season. Spence is capable of playing on the left or right and could have regularly rotated with Udogie and Porro to lessen the burden and expectation on them to perform at a high level in every game. 

The graphic below shows how these injuries have disrupted Postecoglou’s preferred starting XI. They have used 15 different players across the defence and in goal this season which is the joint-most in the division alongside Bournemouth, Leicester City and Southampton.

Spurs had high hopes for Odobert after they signed him from Burnley in August for £25million plus add-ons. The winger spent all of pre-season with Burnley and made one appearance for them in the Championship before leaving. 

He started for Spurs against Coventry in the third round of the Carabao Cup on September 18 but lasted barely 20 minutes before suffering a hamstring injury. The then 19-year-old missed a month of action before returning off the bench in a 0-0 draw with AZ Alkmaar on October 24. Odobert has not played since after undergoing surgery on his right hamstring.

Odobert, Udogie, van de Ven and Romero are not the only players this season to break down so quickly after coming back from injury. Son missed three games either side of the October international break with a persistent hamstring injury but played 70 minutes against West Ham United in between. Richarlison missed most of pre-season with a calf problem but then suffered a hamstring injury in the first few weeks of the campaign. The Brazilian returned in October and broke down on his third appearance as a substitute with what Postecoglou called a “significant hamstring injury,” costing him another two months out. Ben Davies returned to training at the end of December a couple of weeks after going off with a hamstring injury against Bournemouth but suffered a setback too. 

Ben Davies suffered an injury during the defeat at Bournemouth (Dan Mullan/Getty Images)

“That’s been our major problem this year — guys who are coming back from injury rather than us losing players as such,” Postecoglou said on December 27 before Spurs played Wolves. “Knock on wood but the core group of players who are training and playing games have no issues. So we’re looking at those things and why they’re happening. It’s certainly happened too often this year where guys have come back and they’re the ones who are missing. I think just about all of them, apart from Vicario, are recurrences of an injury. Even with Romero, it was a different injury, but it’s still a guy coming back, so it’s something we’re looking at.”

Richarlison made his comeback as a late substitute in last week’s north London derby defeat to Arsenal. He then came on at half-time and scored against his former club Everton on Sunday. Postecoglou acknowledged the club have taken a different approach with his rehab on this occasion.

“We’ve tried different ways and Richy is trying different ways,” he said two days before the defeat at Goodison Park. “We’ve been really careful in the way we’ve brought him back this time. He’s probably been ready to go for a couple of weeks. We’ve given him extra work. I thought he was really good when he came on the other night (against Arsenal), you could see his quality. He is one of these guys that does lead by example, particularly when he plays. It’s great to have him back. With Richy, it’s about him gaining confidence in his body as well. We can do that in the next few weeks.”

Postecoglou acknowledged in November that Richarlison and Odobert’s injuries could be linked to the intensity of Tottenham’s training sessions and playing style.

“The nature of the way we train and play is always going to be on the edge,” he said. “It’s kind of by design which means you can have some attrition but the ones we’ve had this year for the most part like Richy and Wilson are just a consequence of the way we train and play and players just not being ready for it.”

The question all Tottenham fans want answered is when this is going to end.

The injured players are starting to come back and more will be back in the first team pretty soon. Although of course after recent events everyone will be especially keen to manage those returns patiently.

There is another concern which is the huge workload put in by the non-injured frontline players. Dejan Kulusevski, Pedro Porro, Radu Dragusin and Archie Gray have being playing non-stop for months. Their minutes will have to be managed if possible to reduce the risk of them following their team-mates into the treatment room.

Ultimately Tottenham need more players. If they had higher quality back-ups from the start of this season — especially at centre-back, up front and on the wing — then Postecoglou would have been able to rotate more, and load his key players less.

On Wednesday evening at his pre-match press conference in Germany, Postecoglou admitted it was possible that Spurs might not sign anyone else this month. “The club is working hard to get some help for the players,” he said. “As far as I know at the moment there’s nothing imminent but things happen quickly in the last week of the window, so still hopeful.”

And if Tottenham do not add another outfield player this month, leaving themselves with the same thin squad, it will be impossible not to keep playing the same players for the rest of the season. And impossible to avoid the risk of a repeat.

Additional reporting: Mark Carey and Thom Harris