Players in Germany’s Bundesliga are most likely to be injured amongst Europe’s top five domestic leagues but England’s Premier League bears the most injury-related costs, according to a report published on Tuesday.

The fourth edition of insurance firm Howden’s Men’s European Football Injury Index charts the upward trend in injuries recorded in the Premier League, Bundesliga, LaLiga, Ligue 1 and Serie A with a combined 4,123 during the 2023-24 season — a 4% rise on 2022-23 and 37% more than in 2020-21.

Injuries cost clubs a combined 732 million euros ($797.73 million) last season in wages paid to players while out of action while since the report’s first edition in 2020-21, there have been 14,292 injuries in Europe’s top leagues, costing clubs 2.3 billion euros in players’ salaries.

The report comes with player welfare, including injuries, an increasingly hot topic with FIFA’s expanded Club World Cup and UEFA’s revamped club competitions adding to the workload of already packed domestic schedules.

On Monday players’ union FIFPRO Europe and the domestic leagues warned that players could be pushed to strike action.

James Burrows, Head of Sport at Howden, said the data underlines the ever-increasing physical demands on players.

“As fixture congestion intensifies with expanded competitions domestically and internationally, we are seeing more players sidelined for longer periods, with a notable 5% rise in injury costs this season alone,” he said.

The Howden report highlights a worrying increase in the severity of injuries to Premier League players aged under 21 with each injury equating to an average 44-day lay-off — up from 26.5 in 2022-23.

Knee injuries across all age groups reached a new high with 367 across the top leagues last season, costing clubs a combined 141 million euros.

Overall last season, an injury occurred every 92 minutes across the five leagues, costing teams an average of 172,975 euros per game. Bundesliga clubs had an injury every 52 minutes with Darmstadt enduring one every 33 minutes.

Borussia Moenchengladbach became only the second team to record more than 100 injuries in a season since the first publication of the report.

The Premier League’s total number of injuries actually fell from 944 in 2022-23 to 915 in 2023-24, although the English top-flight made up 44% of injury costs for the five leagues last season. Injuries last season cost Premier League clubs a combined 318 million euros, compared to LaLiga’s 142 million.

Manchester United had the highest injury cost figure in the Premier League last season with 39 million euros being paid to players unavailable because of 75 injuries. Newcastle United were the most injured team with 76.

Bayern Munich’s 96 injuries across last season’s Bundesliga campaign cost them 39 million euros while champions Bayer Leverkusen sustained only 36 injuries, costing 3.45 million.