Tottenham Hotspur are ready to make sweeping changes to their medical department to try to prevent another injury crisis from derailing future campaigns.
Spurs feel a major reason for their struggles this season, in which they only avoided relegation on the final day, are a consequence of the numerous fitness issues their players have suffered.
James Maddison, the Spurs midfielder, described the club’s injury situation as the worst in the league and said the problem was “astronomical”.
The England international missed most of the campaign with an anterior cruciate ligament (ACL) injury and he was far from alone in the treatment room.
Key attacker Dejan Kulusevski did not play a single minute of the season because of his knee injury, while fellow forwards Mohammed Kudus and Dominic Solanke have missed long spells. Xavi Simons and Wilson Odobert also suffered ACL ruptures this season.
Telegraph Sport understands that new performance director Dan Lewindon, who started working at Spurs in February after joining from City Football Group, has conducted a thorough investigation into the club’s injury woes.
That review will lead to major changes across the first-team set-up, and eventually across the whole club.
Among the areas of improvement that Spurs have identified is a need for more individualised player care, including changes to a player’s training based on the requirements of their position and their injury history.
Spurs have also arranged for independent testing of their home pitch and training pitches, to examine whether there is a problem with the grass’s bounciness. Further tests on the playing surfaces are planned in the coming weeks and months.
They are also hiring a lead psychologist for the first team, to help the players and coaching staff manage the intense emotional demands of playing for one of the Premier League’s biggest teams.
There is internal acknowledgment that the frequent changes of manager at Spurs have created a higher risk of injury for the players this season, because of the lack of consistency in training methodology and playing style.
After sacking Ange Postecoglou last summer, Spurs have since moved from Thomas Frank to Igor Tudor and then to head coach Roberto De Zerbi.
The rate of ACL injuries is a particular concern for the Spurs medical department, although it is understood that key fitness personnel are satisfied Simons did not suffer any further damage after initially attempting to run off his knee injury against Wolves in April.
Speaking after the 1-0 victory over Everton on the final day of the season, Maddison said: “Our situation with the injuries has been worse than any other club. People try to 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] Guéhi. 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. If we had had myself, Kulusevski and Kudus, and [Rodrigo] Bentancur missed three months.
“If you had had them for the whole season, we wouldn’t have been in this situation, I strongly believe. That’s just not me being naive, that’s just a fact.”