Tottenham Hotspur have launched a sweeping overhaul of their medical and performance operations after suffering what senior figures at the club privately describe as an unprecedented injury crisis.

Across the campaign, Spurs lost more days and more games to injury than any other Premier League side, with players missing a combined 370 matches in all competitions. The toll was so severe that Roberto De Zerbi’s team only secured their top-flight status with a tense final-day victory over Everton.

It is understood that new performance director Dan Lewindon has completed a three‑month review that scrutinised every aspect of the club’s physical preparation, from training methods to the much-discussed retractable pitch at the Tottenham Hotspur Stadium.

The playing surface is a particular focus after a cluster of serious knee injuries occurred in home fixtures. Dejan Kulusevski and Radu Dragusin both suffered major damage at the stadium, while James Maddison partially tore his ACL there before rupturing it fully during pre-season in South Korea.

This season, Ben Davies broke his ankle in a home defeat to West Ham and Wilson Odobert ruptured his ACL against Newcastle. Spurs already commission independent testing to compare the bounce and hardness of their stadium pitch with their training ground, but results so far have been inconclusive. More detailed analysis, including comparisons with other Premier League surfaces, is planned.

Lewindon’s review is understood to have identified structural weaknesses in the club’s performance set-up, particularly around communication and shared decision-making. In response, Spurs are moving to a small-team model in which groups of up to six players are assigned a dedicated physio, with the aim of delivering more tailored conditioning and clearer oversight of individual workloads.

The club also intends to appoint a psychologist to the men’s first-team staff to improve communication and support players through long-term rehabilitation.

Frequent managerial changes have compounded the problem. Four head coaches in a year – Ange Postecoglou, Thomas Frank, Igor Tudor and De Zerbi – have brought shifting tactical demands and training intensities, which internal analysis suggests may have increased injury risk.

Maddison, one of six Spurs players to suffer a serious knee injury since January 2025, has publicly called the situation astronomical and urged the club to understand why it has been hit harder than rivals. He insists a fully fit squad would have avoided a relegation battle altogether.

Non-executive chairman Peter Charrington has promised a significant focus on raising standards across medical and performance. Spurs now hope that this root-and-branch review will finally halt a two-year spiral that has left one of the league’s wealthiest clubs fighting simply to stay in it.