A four-match international break has presented a stress test. “The intensity of the squad, the athleticism of it, really, I think it’s designed for the elite,” said the Wales head coach, Craig Bellamy, on the completion of four matches in 11 days. Elite club coaches would disagree. The Nations League and the wider set of international games staged across the globe have been accompanied by a daily list of casualties, club officials viewing matches through their fingers as players pull up and gesture to the bench.

Hamstring and muscle problems have been rife. Sunderland, for example, will be without Brian Brobbey, a key striker, and Dan Ballard, a defensive mainstay, because of strains picked up playing for the Netherlands and Northern Ireland respectively. Bournemouth, yet to win a Premier League match, have lost Alex Scott for up to two months. His performance for England in their 7-0 victory against Croatia won rave reviews, a young player taking his chance and outshining Luka Modric. It came at a heavy cost. A quadriceps injury that had been diagnosed pre-match worsened. “There was zero risk taken from our side,” said Thomas Tuchel. The Bournemouth coach, Marco Rose, is unlikely to see it that way.

The break had begun with a new phrase entering the football lexicon. Cole Palmer, despite missing the World Cup, would be absent, for reasons of “load management”, said the briefing. The phrasing, also offered for Declan Rice’s absence, is borrowed from the NBA, where basketball’s star players are asked to negotiate an 82-game regular season before the playoffs. Elite football is making similar demands: Rice played 69 matches during the 2025-26 season, 5,394 minutes in total.

Arsenal still had 17 players called up for internationals. Mikel Arteta, given a long time to stew over a 3-0 defeat by Brighton, is counting them back into training with concern. Ezri Konsa’s withdrawal from the England squad on Monday followed injuries for Christos Tzolis and Kai Havertz. Playing for Greece against the Netherlands, Tzolis pulled his shirt over his head after injuring a hamstring. Against the same opponents, playing for Germany, Havertz suffered a similar problem, another setback for a player too often denied to Arteta. A further scare came when Max Dowman, playing for England Under-19s, left the field after taking a heavy tackle.

There is better news for Martin Ødegaard, the recipient of a hefty challenge from Portugal’s Bernardo Silva when playing for Norway on the first Sunday of the break. “Nothing dramatic” in the X-ray was the verdict from the Norwegian camp before Ødegaard returned to face the same opponents. That second encounter with Portugal was marked by concern for Erling Haaland when he requested to leave the field. It was all part of the plan, with the Norway head coach, Ståle Solbakken, saying: “For those who play in the Champions League and have had little vacation, it’s more brutal than for the others.” Haaland will be centre stage when Manchester City travel to Liverpool for their first match since the club was found guilty of 100-plus breaches of Premier League financial regulations. The club have given him a brief, though required, rest.

Almost certainly to the disquiet of Enzo Maresca, City’s Elliot Anderson and Marc Guéhi were, alongside Harry Kane, the only England players to start all four Nations League matches, with Nico O’Reilly withdrawing halfway through. Liverpool’s problems appear to run deeper, with Alexander Isak and Cody Gakpo, early successes for the Andoni Iraola regime, sustaining injuries with Sweden and the Netherlands respectively. Jérémy Jacquet, another bright spark this season, reportedly strained a hamstring with France.

The Premier League weekend’s other headline clash, Manchester United hosting Tottenham in a derby of fading dreams, will also be without key personnel. United’s Patrick Dorgu pulled up with a hamstring injury when playing for Denmark. Another option at left-back, Noussair Mazraoui, took a knock playing for Morocco against Lesotho. Bruno Fernandes, who has been playing through an injury described by his national coach, Jorge Jesus, as a “complicated problem”, is likely to push through the pain barrier. Spurs’ relief that Micky van der Ven’s hand injury was not serious was tempered by Jan Paul van Hecke’s foot injury, while the World Cup winner Pedro Porro missed Spain’s assignments and will not return in time for the trip to Old Trafford.

The injuries are not confined to English football. Elite European players are affected, too. Bayern Munich have lost Jamal Musiala to the torn muscle in his right thigh sustained on international duty with Germany. Jürgen Klopp’s selection of 44 players for his first camp was partially designed to lower the load yet still delivered casualties.

Even the very best get hurt. Kylian Mbappé sprained his knee in the second match of Zinedine Zidane’s France reign, though appears on the road to recovery judging by social media pictures of a cycling expedition. How José Mourinho received that can only be speculated on, given Real Madrid’s manager said this week of players in downtime: “You cannot ride a bike. You fall off your bike, and you don’t play three matches maybe, or maybe worse, maybe you break a leg.”

Mourinho is not alone in having his mood darkened by this extended international break.