Injuries are going up…. But what goes up must come down…. Right?

Exploring injury costs and potential methods of reducing injury risk

It has been well documented that injury rates keep increasing throughout professional sport, with sports such as football/ soccer showing no signs of slowing down. 

Across Europe’s top five football leagues, the estimated salary cost from days lost to non-contact injury alone exceeds £262 million ($356 million) per season, before accounting for surgery, scans, and specialist fees. Sprinting, kicking, and change of direction account for 74% of those costs in football; in basketball, jumping/landing, change of direction, and sprinting account for 85%. So why are we still seeing a rising increase in trends? Support systems around clubs are healthier/ larger than ever, with increased resources to examine relationships to injuries…. But given the mechanisms of these injuries, what more can we do to potentially off-set these costs? Are we missing opportunities to provide better insights?

Across multiple sports (such as football/basketball), sport Science, Medicine and performance departments are increasingly being set key performance indicators by their organisations around player/athletes injuries and availability. In the age of big data sets and increasing availability of transparency from federations, clubs staff are being benchmarked and compared to league or country standards. For example, the UEFA injury reports, with work led by Jan Ekstrand and colleagues, has been exploring common trends and patterns across both the men's and women's game for multiple years. With the added interest into this area, more detailed reports are now available in football (European injury audit data) and basketball (NBA Injury Report 25.26), linked with the average salary information of players across the sports, the true cost for organisations and teams can be analysed.

What really is the cost of non-contact injuries?

Using AI tools (google gemini), to analyse the resources outlined above, Table 1 provides estimations into the cost of injuries for a club overall, based upon different weekly average salaries of their players, with Table 2 looking into the specific athletic action that caused the injury and its estimated cost across different leagues.

Table 1- Example seasonal costs for a club with 15 muscle injuries in a year

Table 2- The average cost per injury type in different football competitions/ leagues as estimated from using injury audit reports.

What are the main causes of non-contact injuries?

For multiple years in sport, there has been a consistent emphasis on the increasing occurrence of non-contact injuries, as these are deemed as “preventable” (can we prove if any injury is really preventable?), with suggestions that better planning, load monitoring, screening, diet, recovery etc all being associated to some of the causes. For example, in football, across the top 5 european leagues, 74% of non-contact injuries occur through sprinting, kicking or change of direction actions, whereas in basketball, 85% of non-contact injuries are related to jumping/ landing, change of direction and linear running/sprinting during transition. The majority of these athletic actions, practitioners working in the field, have been tasked with reducing athletes' risk of these injuries, applying different methods to help us through monitoring, training interventions or screening tools. With pre-season on the horizon, multiple professional organisations will be planning their profiling batteries to help gain the information required to write individualised programmes for players, to help identify areas of development that may reduce/ offset the risk of certain injuries. 

Is our focus giving a true reflection of injuries?

If injuries are going up still, what are we missing? Multiple scientific research papers suggest that by profiling players and prescribing specific training interventions, that should be enough? The nature of injuries is multi-faceted, but if we don’t have a true view of all areas potentially within our control, then we face an uphill task to combat the increasing number and severity of injuries with match demands going up (See The evolution of physical & Technical performance in the premier league ). Some reflection questions that might be worth challenging ourselves on are, 

• Are we assessing the dose-response nature of movement demands appropriately?
• Do we screen players for injury risk when they are in fit/ready status? Why not when they are in a fatigued state, when injuries are more likely to occur?
• If they are at greater risk of injury during games/ open training environments, why do most of our screening protocols happen in a closed environment, single plane task?

A step in the right direction with Sub-Max field tests?

There have been some great insights over the years on how to challenge this using sub-maximal field tests. Recent work by the likes of Martin Buchheit, Tzlil Shushan & Shaun McLaren (and more!) have looked at using field based protocols to assess the metabolic response to exercise which can be embedded in a teams warm-up (See Tzlil’s recent post here for more details). Given the availability of technologies, how can we optimize these activities and gain as many insights in one protocol? A methodological comparison of this was presented by Shushan and colleagues (2023) which used upper body mounted devices, heart rate and foot-mounted devices to examine the reliability of metrics that could inform practitioners across the internal and external training loads pathway. 

However, this is still within a closed environment at the start of a session, without the response of the following exercise accounted for. If these protocols are so easy to implement, why can’t they be done at the end of a session also? Some research articles have done this to assess youth players responses to small sided games (Salter et al., 2022), but why is this not applicable in practice to get a better understanding of athletes' response to exercise?

Lab to the Field concept: How are our athletes running, rather than what they’ve run?

Recent research articles around the “lab to the field” concept (Verhuel et al., 2020) still remains a challenge to gain these insights in open team sport environments for understanding HOW an athlete moves (and how this changes over time). Within open environments, there are a couple of examples that could be explored. The concept of invisible monitoring (Leduc & Weaving, 2025), has been discussed across multiple platforms (Sportsmith, HIIT Science), with the use of accelerometers/IMU’s utilsied to normalise locomotor running activities during open environments to help assess an athletes levels of neuromuscular fatigue. From recent work into international youth tournaments (King et al., Unpublished), we know that utilising foot-mounted IMU units can provide these insights within match play, across multiple matches and may be an indicator of potential movement mechanic alterations, While this will be explored in future pieces, within senior male and female athletes, this may have implications for monitoring neuromuscular fatigue (acute and chronic), but in addition for a youth population, may help us gain insights into topics such as adolescent awkwardness. 

Take Home Messages: Reflection questions

1. Do you know the real cost of injuries for your organisation?
2. Are you covering all bases with the injury types your organisation sees?
3. What are the differences within your athletes response to exercise when fresh vs. fatigued? 
4. Are we challenging our current methods to gain better insights from open environments as opposed to just using closed environment tasks?

REFERENCES
1. Howden — Men’s European Football Injury Index 2024/25.
2. NBA — Official Injury Report, 2025/26 Season.
3. The Evolution of Physical and Technical Performance Parameters in the English Premier League. ResearchGate.
4. Shushan, T., et al. (2023). Methodological comparison of internal and external load measures. PubMed.
5. Salter, J., et al. (2022). Youth player responses to small-sided games. Wiley Online Library.
6. Verheul, J., et al. (2020). Measuring biomechanical loads in team sports — from lab to field. Taylor & Francis.
7. Leduc, C. & Weaving, D. (2025). Invisible monitoring. IJSPP, Human Kinetics.
8. Tzlil Shushan — LinkedIn post on sub-maximal field testing.
9. Sportsmith — Pacey Performance Podcast #209.
10. HIIT Science — The paradox of invisible monitoring.