Background In a recent single season audit of men’s English professional football, the incidence of injury was reported as 9.11 injuries/1000 h (Jones et al., 2019). Whilst this provides an up to date estimate of a single season, there is a paucity of research examining the incidence of injury over multiple seasons in English football.

Objective The aim of this study was to examine the injury trends in English professional football over 11 seasons (2007/8–2013/14 and 2015/16–2018/19).

Design Retrospective case series.

Setting Professional football players competing in the English Football League.

Participants 363 players from four squads.

Main outcome Data collection procedures followed the guidelines set out in the Union of European Football Associations (UEFA) consensus for all 11 seasons. Injury incidence per 1000 h was estimated from match and training exposure.

Results There were 907 injuries recorded over 11 years. The overall incidence rate was 6.5/1000 h (95% CI). The incidence rate in match play was significantly higher than training (58 vs 2.8/1000 h, P<0.001, 95% CI). Incidence rates remained stable over 11 years and there was no significant difference for muscle and ligament incidence rates between seasons (<0.05).

The most common site of injury was the thigh, (27%, 242/907). Muscle strains accounted for 49% (445/907) of all injuries. The hamstrings were the most frequently injured muscle group, accounting for 17% (150/907) of all injuries and 34% (150/445) of muscle injuries. There was a significant increase in the number of hamstring injuries occurring during match play across seasons (P=0.024, 95% CI). Re-injuries constituted 6% (55/907) of all injuries and caused longer absences than initial injury (14.7 vs 8.5, P<0.001, 95% CI).

Conclusions Whilst overall incidence rates remain stable, the incidence of hamstring injuries remains high and re-injuries had a higher severity than initial injuries.