Spurs have carried out a major review of their performance and medical departments, which included an investigation into whether the Tottenham Hotspur Stadium's retractable pitch is contributing to the club's ongoing injury crisis.
Tottenham lost the most days to injury of any Premier League side this season, while Spurs players missed a combined 370 games across all competitions due to injury this campaign - the most of any top-flight side.
The club's failure to keep players fit nearly led to their relegation as Roberto De Zerbi's side dramatically needed a final-day home win over Everton to secure their Premier League safety.
It is a second consecutive injury-hit season for Spurs, who have lost the most days and games to injury of any Premier League side since the start of the 2024/25 campaign.
A lengthy injury list has played its part in back-to-back 17th-placed finishes for the world's ninth-richest football club.
It is understood the club's new performance director, Dan Lewindon, has completed a thorough review of the injury issue after three months in the job, and the Tottenham Hotspur Stadium retractable pitch is an area of concern.
The serious knee injuries to Dejan Kulusevski and Radu Dragusin came at home last season, while James Maddison partially tore his anterior cruciate ligament (ACL) in last May's home win over Bodo/Glimt, before a full rupture three months later in pre-season in South Korea.
This season, Ben Davies broke his ankle in January's home defeat to West Ham, while Wilson Odobert ruptured his ACL in the home loss against Newcastle.
It is understood Tottenham regularly carry out external independent testing on their home surface to assess the bounce of the pitch compared to that of their training pitch, but to date the results are inconclusive.
However, further detailed testing is planned in the coming weeks to analyse whether there is a difference in their home surface compared to other Premier League pitches.
Tottenham's investigation comes with Real Madrid's new retractable pitch also in the spotlight.
Since the Santiago Bernabeu's reopening, the 15-time European champions have suffered a spate of ACL injuries.
Reports in Spain claim Real are investigating their pitches at both the Bernabeu and their Valdebebas training ground.
While the Bernabeu has only been fully reopened for three years, Spurs have been playing at their £1bn state-of-the-art stadium for the past seven years, with injuries only becoming a real issue in the last two seasons.
Since the start of the 2024/25 campaign, Tottenham have suffered 123 injuries - only north London rivals Arsenal (146) have suffered more in the Premier League in that period.
Multiple Spurs players have also had injury setbacks in the past two seasons, including Mohammed Kudus this campaign.
Spurs' non-executive chairman Peter Charrington promised there would be a "significant focus on raising standards across medical and performance" in an open letter to fans on Monday.
Lewindon's review is understood to have uncovered structural issues within the performance set-up of the club.
There is a belief that there is a lack of integration, communication and shared decision-making, which has led to injuries and injury reoccurrences.
A higher level of support for players individually is wanted by Tottenham head coach De Zerbi.
This has prompted Lewindon to build a small-team approach whereby up to six players are assigned a physio, which allows higher-quality programming and better decisions made around a player's training design and physical preparation.
Tottenham are also looking to appoint a psychologist for the men's team, with the idea that this can improve communication.
Another factor in Spurs' injury crisis has been the number of managerial changes at the club.
Spurs have had four different head coaches in the space of a year - Ange Postecoglou, Thomas Frank, Igor Tudor and De Zerbi - which has led to changing demands on the players.
It is believed these differing training methods and tactics have created an increased risk of injury to the Spurs players.
Spurs boss De Zerbi lost a player to injury in each of his first three games, with Cristian Romero suffering a season-ending injury in the loss at Sunderland, Destiny Udogie picking up a muscular issue in the draw against Brighton, and Xavi Simons suffering an ACL injury in the win at Wolves.
But the handling of Simons' injury drew criticism from some Spurs supporters after the attacking midfielder was given ice spray and allowed to run down the touchline before eventually being stretchered off with the season-ending injury.
It is understood Lewindon was very satisfied with the medical team's handling of the situation.
Simons wanted to continue at Molineux, and with an ACL test hard to perform at pitchside, the decision to allow him the opportunity to try to return to the game was deemed correct by the club.
It is understood no additional damage was done to Simons, who is set to return next season when Spurs will be hoping their injury crisis has been resolved.
Maddison has called on Spurs to investigate the "astronomical" injury problems that have plagued the squad this season.
The playmaker, restricted to three appearances off the bench at the end of the campaign, is one of six Spurs players to have had a serious knee injury since January 2025.
Speaking after Sunday's final-day win over Everton, Maddison said: "Our situation with the injuries has been worse than any other club.
"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 [Dejan] 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."
Maddison believes Spurs, who only confirmed their Premier League safety on the final day, would never have been in that position if they had their key players fit.
"We've been a bit unlucky," Maddison added. "But like I said, the big names that we've missed, it does affect you and you can't just deny that.
"Myself, Kulusevski and [Mohammed] Kudus, and [Rodrigo] Bentancur missed three months and whatnot. 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. But it is the situation we find ourselves in, and I am just proud of the lads to dig deep today."
