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Tottenham’s hamstring injuries: Why are they getting so many?
LONDON, ENGLAND - NOVEMBER 06: Micky van de Ven of Tottenham Hotspur is substituted after going down with an injury during the Premier League match between Tottenham Hotspur and Chelsea FC at Tottenham Hotspur Stadium on November 06, 2023 in London, England. (Photo by Ryan Pierse/Getty Images)
By Charlie Eccleshare
4h ago
In last Friday’s press conference, Tottenham head coach Ange Postecoglou gave his customary medical bulletin.
Reporters were told Ben Davies will be out for about a month with a damaged hamstring, Dane Scarlett had picked up a similar injury in training and Giovani Lo Celso would also be out for a month — with a muscular problem that could also be a hamstring, pending further diagnosis.
A couple of days later, Postecoglou confirmed that Ryan Sessegnon, finally back after a hamstring operation, had missed the weekend trip to Manchester United because he’d felt a niggle in training.
The Sessegnon issue pre-dates Postecoglou’s appointment last summer and this niggle may be unrelated to his previous lay-offs, but either way, that’s a lot of hamstring injuries in the space of a few days.
And it comes at a time when Micky van de Ven and Cristian Romero are just returning to the team after hurting their hamstrings. The former was out more than two months with his, the latter three weeks.
Earlier in the season, Brennan Johnson was sidelined with a hamstring injury, while Pape Sarr was subbed off with one against Bournemouth on December 31. Destiny Udogie meanwhile pulled out of the Italy squad in November with a hamstring problem, having missed Spurs’ trip to Crystal Palace in late October because of the issue.
You get the idea.
Premier Injuries, a website which tracks and records injury data for the Premier League, categorises time-loss injuries as ones that force a player to miss a Premier League game. Naturally, this isn’t always an exact science, as you can have an injury that, because of scheduling, doesn’t actually mean missing a league game. But even if we don’t include Sarr (while Lo Celso, even possibly Sessegnon, might need to be added retrospectively), that’s still six hamstring issues that have forced Spurs players to miss a Premier League game this season — Van de Ven, Romero, Davies, Johnson, Udogie and Scarlett — a tally surpassed only by Palace (nine), according to Premier Injuries’ data.
Spurs have been one of the teams worst hit by hamstring injuries this season
Crystal Palace
9
Tottenham
6
Luton Town
6
Liverpool
6
Brighton
6
Chelsea
5
Aston Villa
5
Arsenal
5
Nottingham Forest
5
Manchester United
5
Newcastle United
5
Sheffield United
5
Manchester City
3
AFC Bournemouth
3
Wolves
3
Fulham
3
Brentford
2
Everton
2
West Ham United
1
Burnley
1
(Source: Premier Injuries)
We’re only just past halfway through this season and that tally of six is the same as Tottenham had to deal with in the whole of 2022-23, one more than in both 2021-22 and 2020-21, and one fewer than in 2019-20.
Spurs have already had as many hamstring injuries as they normally do in a whole season
23-24
6
22-23
6
21-22
5
20-21
5
19-20
7
(Source: Premier Injuries)
Clearly, this is not coincidental. Especially as, during his 2021-22 debut season as Celtic, Postecoglou’s squad were plagued by the same issue. By the mid-December, the Scottish Premiership side already had six players sidelined with hamstring problems.
Postecoglou said at the time that, “(the hamstring injuries) are obviously something we want to get on top of but it’s not new to me either. 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.”
More than two years on, Postecoglou echoed those sentiments on Friday, saying, “It’s part of the game we have; for the guys, it’s a big physical output but we haven’t been able to, because of the circumstances, rotate the squad too much.
“Probably Ben Davies is a classic example of that — playing a lot and we haven’t been able to rotate him out. It’s just a consequence of the way we play and the way we train. At the same time, when we get a more robust and deeper squad, we’ll be able to overcome it.”
So, is this just a question of the players getting used to Postecoglou’s methods?
That’s a big part of it, yes, but there are other issues at play too, and the problems Spurs are having reflect wider themes in the game…
How do injuries at Spurs this season compare to other clubs?
In general, injuries are up across the Premier League compared to this stage in previous seasons.
Ben Dinnery, founder of Premier Injuries, says that, ahead of the festive period, injuries were up about 20 per cent on the same period in the past four seasons. Hamstring injuries were even further up, and have been far and away the most common kind suffered over the first half of 2023-24.
The timing of the 2022 World Cup in the November and December (moved from the northern hemisphere’s summer because of the intense heat then in host nation Qatar), which upset players’ long-developed rhythms, and football’s ever-shortening off-season, coupled with demanding summer tours are cited as reasons for why injuries in general are on the rise.
As for the increased hamstring injuries specifically, part of that is down to teams performing more sprints per game in the Premier League. This has gone up season by season since the data started being collected in the 2020-21 season. Sprints per game that year were 127 per team per game, which was up to 134 a year ago, and top-flight sides were at 136 a game for this season as of late December.
Luke Anthony has worked as a physiotherapist for several clubs — including as head of medical for Watford and Reading while they were in the Premier League. He has also worked in rugby and cricket and is now the clinical director at GoPerform, a sports injury and human performance centre.
He explains why the increase in sprints and a more intense way of playing can lead to more hamstring injuries, and why this can particularly affect a team such as Tottenham.
Pape Sarr went off with a hamstring injury against Bournemouth in December (Marc Atkins/Getty Images)
“Things that stress the hamstring are a high volume of high-speed running (doing 80 per cent of top speed repetitively). The other is maximal sprints,” Anthony says.
“Players’ stats, especially for a manager like Ange Postecoglou, are now higher in those areas.”
The numbers bear this out — as of November, when UK broadcaster Sky Sports released the data, Tottenham were way out in front for most team sprints in Premier League matches this season.
“If, for instance, you’re used to doing 400m of high-speed running and that goes up to 1,200m, that will have an effect on your body, stressing your hamstrings more,” Anthony continues. “You might still be doing 10 kilometres a game but it’s a different kind of running.”
While increased injuries, and especially muscular ones, are a league-wide issue, Spurs have still been one of the teams worst affected. We’ve already seen how highly they rank for damaged hamstrings compared to the rest of the division, and it’s a similar story for injuries as a whole.
As of last week, Spurs ranked sixth when it came to the total number of injuries (20) which have led to players missing a Premier League game. However, if we adjust the numbers to injuries per 1,000 minutes played in all competitions to compensate for how relatively few matches Tottenham have played, they went up to second (10.1 per 1,000 minutes played).
And if we make that adjustment to Spurs’ hamstring injuries compared to those in the previous few seasons, we can also see just how many more they are getting in the current one: they have picked up 2.9 hamstring injuries this season per 1,000 minutes played using the Premier Injuries definition — compared to 1.3 in 2022-23, 1.0 in 2021-22, 0.9 in 2020-21 and 1.5 in 2019-20.
Spurs are tracking to have way more hamstring injuries than previous seasons
23-24
2.9
22-23
1.3
21-22
1
20-21
0.9
19-20
1.5
(Source: Premier Injuries)
That’s a huge increase.
Why are Spurs suffering so many hamstring injuries?
Tottenham would not be the first club to suffer a number of injuries, especially muscular ones, after recently appointing a new manager. Even this season, one of the other Premier League teams to have a high number of hamstring injuries (five) are Chelsea, who hired Mauricio Pochettino last summer.
Callum Walsh, Newcastle United’s former head of sports science, is a strong believer in this trend, and pointed out earlier in the season that six of the 10 teams with the most players out had managers who had just overseen their first pre-season in that job.
“There is some research that shows clubs who change managers see a slight increase in injury,” says Anthony. “The reason being that, as a player, your physiology is adapted to the way you train and play, so if for instance you play for an Antonio Conte team and it’s slightly more structured and you don’t look to press so heavily all around the pitch, you might find you do less high-speed running. Then, suddenly, you’re playing in a different system with different physiological demands.”
Walsh expands on this, saying, “With a new manager, everything can change, and this knock-on effect is something a lot of teams don’t consider. I was at a club where something changed 500 per cent in one metric. That’s a big thing to get used to.
“Training methods, types of sessions, length — all these things can be very different from manager to manager.”
Tottenham are a good example of this — with sessions now shorter but a lot more intense with Postecoglou than in the previous two seasons under Conte.
“The schedule, when days off are, this can make a big difference,” Walsh continues. He also points out that Postecoglou did not bring his own medical team with him to north London and so, inevitably, he and the Spurs staff will have been getting used to each another over these past few months. Other managers, Conte being one, like to have their own fitness or medical or sports science staff follow them from club to club.
Conte trained Spurs’ players differently to how successor Postecoglou does it (Michael Steele/Getty Images)
There’s no right way of doing things, but a period of acclimatisation is inevitable for all involved.
“Every coach is different and so if you’re someone in my kind of role, it takes time to understand all of the manager’s habits and quirks,” Walsh says.
“And speaking generally, for medical staff it can take a bit of time to realise exactly what a new manager’s training sessions look like. This could impact, for instance, when they might feel comfortable allowing an injured player to be reintegrated (with the rest of the squad). These things take time to fully understand if you haven’t worked much together.”
There are other factors to consider too when a club changes manager.
One is that the players will likely try extra-hard in training to make an impression, which can lead to an increase in injuries. It also means some players won’t have a full pre-season with the new man (if they themselves are new signings, or are returning to the club late having competed in a national-team tournament that summer), and this is something that managers put a huge amount of importance on.
Postecoglou mentioned it when explaining the high number of injuries his Celtic team were getting. And it was a theme Conte constantly returned to during his first season at Spurs, which had seen him hired midway through in November 2021. Conte also had to deal with several muscular injuries early on in his time at the club, with Son Heung-min, Eric Dier, Steven Bergwijn and Romero affected, the latter while on international duty.
And speaking of Conte, there was a feeling at Spurs when he left late last season that the players weren’t actually that well conditioned. They did a lot of running in training — including that famous session in South Korea — and would often cover large distance during matches, but they weren’t doing lots of sprints compared to their opponents.
When Postecoglou came in, therefore, he had a lot to change physically in a short space of time. And with results needing to be instant, players were pushed hard both in pre-season and since.
As Anthony puts it, “When you’re adapting to doing a lot more sprints, you’re at risk. And hamstrings are the things most likely to go.”
What do the precedents for this sort of thing tell us?
There are a couple of high-profile recent precedents in English football of a new manager coming in and there suddenly being a lot of muscular injuries at that club. One offers encouragement, the other concern.
The first is Jurgen Klopp at Liverpool, whose players initially suffered physically under him. They were being asked to train and work much harder in matches, covering a collective 116km in his first match in charge — away at Spurs in October 2015 — compared to a season average of 107.9km. Days off were reduced and training became as intense as the matches themselves — James Milner tells a story of a younger player vomiting during one session.
The injuries started to pile up and, during that season and the next, whether Klopp was working the players too hard became a recurring debate. However, the players acclimatised to Klopp’s methods over time and it stopped being a major issue — even though Liverpool, like most clubs, have still had subsequent periods where they have suffered badly with injuries.
Then there’s Marcelo Bielsa at Leeds United.
Bielsa is an extreme case, notorious for his “Murderball” training sessions, but Postecoglou’s sessions are similarly intense, with numerous former players recalling practice matches where, whenever the ball went out of play, another one would be instantly thrown onto the pitch.
Bielsa is utterly uncompromising in his physical demands, and one narrative around his first season at Leeds in 2018-19 was that the team tailed off on the run-in (taking one point from the final four matches), and so missed out on automatic promotion, because of physical burnout.
Injuries were common at Leeds under Bielsa (Michael Regan/Getty Images)
Leeds had great success under him subsequently but, unlike at Klopp’s Liverpool, there was never a let-up with the injuries.
Pretty much every player suffered — some worse than others — and by the time Bielsa was sacked in February 2022, they had recorded no fewer than 90 different injuries in that season alone. In a typical campaign, the average Premier League side expects to cope with around half as many.
Staggering numbers — and a reminder that things don’t always ease once players get used to a manager’s methods.
Crucially, though, they did under Postecoglou at Celtic, in what is surely the most relevant example for Spurs.
Injuries weren’t much of a talking point in his second season in Glasgow, helped by the fact that it was more recognisably his squad, and with more players he could trust in the ranks, Postecoglou was able to select a lot more effectively. The full-backs and wingers, such demanding roles in his teams, were rotated especially often.
“The players’ physiology will adapt as they get used to training methods,” says Anthony. “It’s all about adaptation — once you’ve done it over a long-enough period, you get used to that kind of matchplay. They (Tottenham) should be better off in the second season, once they’re more used to it.”
What are the risks and how can clubs mitigate them?
The biggest risk in all of this is reinjury. All of the experts The Athletic consulted for this article said like a mantra: “The biggest predictor of injuries is previous injury.”
This is a particular risk with hamstrings, with some research claiming that 30 per cent of footballers reinjure them within a couple of weeks of coming back from the initial absence. That figure is disputed, but the risk of a newly-healed hamstring going again is well known. Van de Ven and Romero are evidence of that, having both suffered such injuries previously.
Some players will be genetically more predisposed to injuries of any type, but there’s no suggestion that’s the case here.
As for how else clubs can mitigate against hamstring issues specifically, one way is through muscle training for the players to strengthen certain parts of the body that are vulnerable. The problem teams have is that the more games they play, the less time they have to do this kind of work between fixtures, as everything becomes about recovery and preparation for the next match.
In this respect things are likely to get harder for Postecoglou, with Spurs looking good to be back in Europe next season, having missed out this time, and so managing a greater work load with far fewer free midweeks.
Van de Ven missed 10 Premier League matches due to his hamstring injury (Ryan Pierse/Getty Images)
On the flipside, by next season Postecoglou will have a squad in place that’s deeper and better suited to how he wants to play.
And this is the key lesson in all of this, according to Walsh: things take time to develop and the way to protect players in the long term is through stability and a coherent strategy.
“Boards (at clubs) need to understand that this sort of thing can take a while — look at Liverpool with Klopp,” Walsh says. “And then you have to sign players aligned with what you need. And you’ll have some, and sign some, who just won’t be durable enough.
“It’s about getting the profile of players to suit the team.”
We tend to think of players’ suitability for a manager or head coach in terms of how they play and how good they are. But clearly, with football more intense than ever, an increasingly important element is whether they can cope with that regime’s unique physical demands.
Postecoglou is more demanding than most, and so, as he expected, the adaptation period at Spurs has been challenging — though he is convinced it’s one he and the team will overcome.
LONDON, ENGLAND - NOVEMBER 06: Micky van de Ven of Tottenham Hotspur is substituted after going down with an injury during the Premier League match between Tottenham Hotspur and Chelsea FC at Tottenham Hotspur Stadium on November 06, 2023 in London, England. (Photo by Ryan Pierse/Getty Images)
By Charlie Eccleshare
4h ago
In last Friday’s press conference, Tottenham head coach Ange Postecoglou gave his customary medical bulletin.
Reporters were told Ben Davies will be out for about a month with a damaged hamstring, Dane Scarlett had picked up a similar injury in training and Giovani Lo Celso would also be out for a month — with a muscular problem that could also be a hamstring, pending further diagnosis.
A couple of days later, Postecoglou confirmed that Ryan Sessegnon, finally back after a hamstring operation, had missed the weekend trip to Manchester United because he’d felt a niggle in training.
The Sessegnon issue pre-dates Postecoglou’s appointment last summer and this niggle may be unrelated to his previous lay-offs, but either way, that’s a lot of hamstring injuries in the space of a few days.
And it comes at a time when Micky van de Ven and Cristian Romero are just returning to the team after hurting their hamstrings. The former was out more than two months with his, the latter three weeks.
Earlier in the season, Brennan Johnson was sidelined with a hamstring injury, while Pape Sarr was subbed off with one against Bournemouth on December 31. Destiny Udogie meanwhile pulled out of the Italy squad in November with a hamstring problem, having missed Spurs’ trip to Crystal Palace in late October because of the issue.
You get the idea.
Premier Injuries, a website which tracks and records injury data for the Premier League, categorises time-loss injuries as ones that force a player to miss a Premier League game. Naturally, this isn’t always an exact science, as you can have an injury that, because of scheduling, doesn’t actually mean missing a league game. But even if we don’t include Sarr (while Lo Celso, even possibly Sessegnon, might need to be added retrospectively), that’s still six hamstring issues that have forced Spurs players to miss a Premier League game this season — Van de Ven, Romero, Davies, Johnson, Udogie and Scarlett — a tally surpassed only by Palace (nine), according to Premier Injuries’ data.
Spurs have been one of the teams worst hit by hamstring injuries this season
Crystal Palace
9
Tottenham
6
Luton Town
6
Liverpool
6
Brighton
6
Chelsea
5
Aston Villa
5
Arsenal
5
Nottingham Forest
5
Manchester United
5
Newcastle United
5
Sheffield United
5
Manchester City
3
AFC Bournemouth
3
Wolves
3
Fulham
3
Brentford
2
Everton
2
West Ham United
1
Burnley
1
(Source: Premier Injuries)
We’re only just past halfway through this season and that tally of six is the same as Tottenham had to deal with in the whole of 2022-23, one more than in both 2021-22 and 2020-21, and one fewer than in 2019-20.
Spurs have already had as many hamstring injuries as they normally do in a whole season
23-24
6
22-23
6
21-22
5
20-21
5
19-20
7
(Source: Premier Injuries)
Clearly, this is not coincidental. Especially as, during his 2021-22 debut season as Celtic, Postecoglou’s squad were plagued by the same issue. By the mid-December, the Scottish Premiership side already had six players sidelined with hamstring problems.
Postecoglou said at the time that, “(the hamstring injuries) are obviously something we want to get on top of but it’s not new to me either. 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.”
More than two years on, Postecoglou echoed those sentiments on Friday, saying, “It’s part of the game we have; for the guys, it’s a big physical output but we haven’t been able to, because of the circumstances, rotate the squad too much.
“Probably Ben Davies is a classic example of that — playing a lot and we haven’t been able to rotate him out. It’s just a consequence of the way we play and the way we train. At the same time, when we get a more robust and deeper squad, we’ll be able to overcome it.”
So, is this just a question of the players getting used to Postecoglou’s methods?
That’s a big part of it, yes, but there are other issues at play too, and the problems Spurs are having reflect wider themes in the game…
How do injuries at Spurs this season compare to other clubs?
In general, injuries are up across the Premier League compared to this stage in previous seasons.
Ben Dinnery, founder of Premier Injuries, says that, ahead of the festive period, injuries were up about 20 per cent on the same period in the past four seasons. Hamstring injuries were even further up, and have been far and away the most common kind suffered over the first half of 2023-24.
The timing of the 2022 World Cup in the November and December (moved from the northern hemisphere’s summer because of the intense heat then in host nation Qatar), which upset players’ long-developed rhythms, and football’s ever-shortening off-season, coupled with demanding summer tours are cited as reasons for why injuries in general are on the rise.
As for the increased hamstring injuries specifically, part of that is down to teams performing more sprints per game in the Premier League. This has gone up season by season since the data started being collected in the 2020-21 season. Sprints per game that year were 127 per team per game, which was up to 134 a year ago, and top-flight sides were at 136 a game for this season as of late December.
Luke Anthony has worked as a physiotherapist for several clubs — including as head of medical for Watford and Reading while they were in the Premier League. He has also worked in rugby and cricket and is now the clinical director at GoPerform, a sports injury and human performance centre.
He explains why the increase in sprints and a more intense way of playing can lead to more hamstring injuries, and why this can particularly affect a team such as Tottenham.
Pape Sarr went off with a hamstring injury against Bournemouth in December (Marc Atkins/Getty Images)
“Things that stress the hamstring are a high volume of high-speed running (doing 80 per cent of top speed repetitively). The other is maximal sprints,” Anthony says.
“Players’ stats, especially for a manager like Ange Postecoglou, are now higher in those areas.”
The numbers bear this out — as of November, when UK broadcaster Sky Sports released the data, Tottenham were way out in front for most team sprints in Premier League matches this season.
“If, for instance, you’re used to doing 400m of high-speed running and that goes up to 1,200m, that will have an effect on your body, stressing your hamstrings more,” Anthony continues. “You might still be doing 10 kilometres a game but it’s a different kind of running.”
While increased injuries, and especially muscular ones, are a league-wide issue, Spurs have still been one of the teams worst affected. We’ve already seen how highly they rank for damaged hamstrings compared to the rest of the division, and it’s a similar story for injuries as a whole.
As of last week, Spurs ranked sixth when it came to the total number of injuries (20) which have led to players missing a Premier League game. However, if we adjust the numbers to injuries per 1,000 minutes played in all competitions to compensate for how relatively few matches Tottenham have played, they went up to second (10.1 per 1,000 minutes played).
And if we make that adjustment to Spurs’ hamstring injuries compared to those in the previous few seasons, we can also see just how many more they are getting in the current one: they have picked up 2.9 hamstring injuries this season per 1,000 minutes played using the Premier Injuries definition — compared to 1.3 in 2022-23, 1.0 in 2021-22, 0.9 in 2020-21 and 1.5 in 2019-20.
Spurs are tracking to have way more hamstring injuries than previous seasons
23-24
2.9
22-23
1.3
21-22
1
20-21
0.9
19-20
1.5
(Source: Premier Injuries)
That’s a huge increase.
Why are Spurs suffering so many hamstring injuries?
Tottenham would not be the first club to suffer a number of injuries, especially muscular ones, after recently appointing a new manager. Even this season, one of the other Premier League teams to have a high number of hamstring injuries (five) are Chelsea, who hired Mauricio Pochettino last summer.
Callum Walsh, Newcastle United’s former head of sports science, is a strong believer in this trend, and pointed out earlier in the season that six of the 10 teams with the most players out had managers who had just overseen their first pre-season in that job.
“There is some research that shows clubs who change managers see a slight increase in injury,” says Anthony. “The reason being that, as a player, your physiology is adapted to the way you train and play, so if for instance you play for an Antonio Conte team and it’s slightly more structured and you don’t look to press so heavily all around the pitch, you might find you do less high-speed running. Then, suddenly, you’re playing in a different system with different physiological demands.”
Walsh expands on this, saying, “With a new manager, everything can change, and this knock-on effect is something a lot of teams don’t consider. I was at a club where something changed 500 per cent in one metric. That’s a big thing to get used to.
“Training methods, types of sessions, length — all these things can be very different from manager to manager.”
Tottenham are a good example of this — with sessions now shorter but a lot more intense with Postecoglou than in the previous two seasons under Conte.
“The schedule, when days off are, this can make a big difference,” Walsh continues. He also points out that Postecoglou did not bring his own medical team with him to north London and so, inevitably, he and the Spurs staff will have been getting used to each another over these past few months. Other managers, Conte being one, like to have their own fitness or medical or sports science staff follow them from club to club.
Conte trained Spurs’ players differently to how successor Postecoglou does it (Michael Steele/Getty Images)
There’s no right way of doing things, but a period of acclimatisation is inevitable for all involved.
“Every coach is different and so if you’re someone in my kind of role, it takes time to understand all of the manager’s habits and quirks,” Walsh says.
“And speaking generally, for medical staff it can take a bit of time to realise exactly what a new manager’s training sessions look like. This could impact, for instance, when they might feel comfortable allowing an injured player to be reintegrated (with the rest of the squad). These things take time to fully understand if you haven’t worked much together.”
There are other factors to consider too when a club changes manager.
One is that the players will likely try extra-hard in training to make an impression, which can lead to an increase in injuries. It also means some players won’t have a full pre-season with the new man (if they themselves are new signings, or are returning to the club late having competed in a national-team tournament that summer), and this is something that managers put a huge amount of importance on.
Postecoglou mentioned it when explaining the high number of injuries his Celtic team were getting. And it was a theme Conte constantly returned to during his first season at Spurs, which had seen him hired midway through in November 2021. Conte also had to deal with several muscular injuries early on in his time at the club, with Son Heung-min, Eric Dier, Steven Bergwijn and Romero affected, the latter while on international duty.
And speaking of Conte, there was a feeling at Spurs when he left late last season that the players weren’t actually that well conditioned. They did a lot of running in training — including that famous session in South Korea — and would often cover large distance during matches, but they weren’t doing lots of sprints compared to their opponents.
When Postecoglou came in, therefore, he had a lot to change physically in a short space of time. And with results needing to be instant, players were pushed hard both in pre-season and since.
As Anthony puts it, “When you’re adapting to doing a lot more sprints, you’re at risk. And hamstrings are the things most likely to go.”
What do the precedents for this sort of thing tell us?
There are a couple of high-profile recent precedents in English football of a new manager coming in and there suddenly being a lot of muscular injuries at that club. One offers encouragement, the other concern.
The first is Jurgen Klopp at Liverpool, whose players initially suffered physically under him. They were being asked to train and work much harder in matches, covering a collective 116km in his first match in charge — away at Spurs in October 2015 — compared to a season average of 107.9km. Days off were reduced and training became as intense as the matches themselves — James Milner tells a story of a younger player vomiting during one session.
The injuries started to pile up and, during that season and the next, whether Klopp was working the players too hard became a recurring debate. However, the players acclimatised to Klopp’s methods over time and it stopped being a major issue — even though Liverpool, like most clubs, have still had subsequent periods where they have suffered badly with injuries.
Then there’s Marcelo Bielsa at Leeds United.
Bielsa is an extreme case, notorious for his “Murderball” training sessions, but Postecoglou’s sessions are similarly intense, with numerous former players recalling practice matches where, whenever the ball went out of play, another one would be instantly thrown onto the pitch.
Bielsa is utterly uncompromising in his physical demands, and one narrative around his first season at Leeds in 2018-19 was that the team tailed off on the run-in (taking one point from the final four matches), and so missed out on automatic promotion, because of physical burnout.
Injuries were common at Leeds under Bielsa (Michael Regan/Getty Images)
Leeds had great success under him subsequently but, unlike at Klopp’s Liverpool, there was never a let-up with the injuries.
Pretty much every player suffered — some worse than others — and by the time Bielsa was sacked in February 2022, they had recorded no fewer than 90 different injuries in that season alone. In a typical campaign, the average Premier League side expects to cope with around half as many.
Staggering numbers — and a reminder that things don’t always ease once players get used to a manager’s methods.
Crucially, though, they did under Postecoglou at Celtic, in what is surely the most relevant example for Spurs.
Injuries weren’t much of a talking point in his second season in Glasgow, helped by the fact that it was more recognisably his squad, and with more players he could trust in the ranks, Postecoglou was able to select a lot more effectively. The full-backs and wingers, such demanding roles in his teams, were rotated especially often.
“The players’ physiology will adapt as they get used to training methods,” says Anthony. “It’s all about adaptation — once you’ve done it over a long-enough period, you get used to that kind of matchplay. They (Tottenham) should be better off in the second season, once they’re more used to it.”
What are the risks and how can clubs mitigate them?
The biggest risk in all of this is reinjury. All of the experts The Athletic consulted for this article said like a mantra: “The biggest predictor of injuries is previous injury.”
This is a particular risk with hamstrings, with some research claiming that 30 per cent of footballers reinjure them within a couple of weeks of coming back from the initial absence. That figure is disputed, but the risk of a newly-healed hamstring going again is well known. Van de Ven and Romero are evidence of that, having both suffered such injuries previously.
Some players will be genetically more predisposed to injuries of any type, but there’s no suggestion that’s the case here.
As for how else clubs can mitigate against hamstring issues specifically, one way is through muscle training for the players to strengthen certain parts of the body that are vulnerable. The problem teams have is that the more games they play, the less time they have to do this kind of work between fixtures, as everything becomes about recovery and preparation for the next match.
In this respect things are likely to get harder for Postecoglou, with Spurs looking good to be back in Europe next season, having missed out this time, and so managing a greater work load with far fewer free midweeks.
Van de Ven missed 10 Premier League matches due to his hamstring injury (Ryan Pierse/Getty Images)
On the flipside, by next season Postecoglou will have a squad in place that’s deeper and better suited to how he wants to play.
And this is the key lesson in all of this, according to Walsh: things take time to develop and the way to protect players in the long term is through stability and a coherent strategy.
“Boards (at clubs) need to understand that this sort of thing can take a while — look at Liverpool with Klopp,” Walsh says. “And then you have to sign players aligned with what you need. And you’ll have some, and sign some, who just won’t be durable enough.
“It’s about getting the profile of players to suit the team.”
We tend to think of players’ suitability for a manager or head coach in terms of how they play and how good they are. But clearly, with football more intense than ever, an increasingly important element is whether they can cope with that regime’s unique physical demands.
Postecoglou is more demanding than most, and so, as he expected, the adaptation period at Spurs has been challenging — though he is convinced it’s one he and the team will overcome.
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