Background The influence of fixture congestion on injury rates and team performance has only been scarcely investigated.

Objective To study associations between match load, recovery days, injury rates and team match performances in professional football.

Design Prospective cohort study.

Setting European professional football.

Participants 27 teams, all selected by the UEFA and all competing at the highest level of European football, playing 8 150 competitive matches during the 11-year study period were included.

Assessment of risk factors Injury rates and team match performances were compared depending on the number of recovery days between matches using two different cut offs (≤3 vs. >3 days and ≤4 vs. ≥6 days). Match load, injury rates and team match performances were also studied over extended match sequences during the season, each sequence containing five consecutive matches over a mean of 27 days (range 7–104 days).

Main outcome measurements Number of time loss injuries/1000 h of exposure and amount of matches won, lost or drawn.

Results Team performance showed no association with match load except for Europa League matches that indicated more matches lost with ≤3 days compared with >3 days recovery (P=.048). Total injury rates and muscle injury rates, specifically hamstring and quadriceps injuries, were increased in league matches with ≤4 days compared with ≥6 days recovery preceding the match (rate ratio [RR] 1.09, 95% CI 1.00–1.18, and RR 1.32, 95% CI 1.15–1.51, respectively) while no differences were found when using the other cut off (≤3 vs. >3 days). High match load during a match sequence was associated with an increase in muscle injury rates (P=.012).

Conclusions Fixture congestion was associated with increased muscle injury rates but had no, or very limited, influence on team match performances.