The 2020-21 Premier League season is just over two months old and for those players expecting to play for their countries at the delayed Euro 2020 or Copa America next summer, there are another eight months of football across multiple competitions to get through before “the end” in mid-July.

In June, ESPN spoke to sports scientist Dr. Tom Little about the challenges that faced the top players this season. He warned of an “incredibly difficult” year ahead, both mentally and physically, due to the increased workload caused by a fixture list truncated by the impact of the coronavirus pandemic. Dr Little’s forecast has been proven worryingly correct, and he can only see more problems ahead.

“It’s a difficult time, but what do you do?” said Dr. Little, who has worked with Manchester City and Burnley. “Do you not have the European Championship at the end of this season? Nobody wants that, so it is going to be the same all season long. And every player that goes into the Euros is going to have a pretty risky profile in terms of fitness and fatigue.”

According to premierinjuries.com, there have been 103 muscle injuries in the Premier League this season — a 16% jump after the same number of matchdays last season — and the campaign has still to reach its traditional pinch-point of mid-winter, when games and injuries increase in tandem during December and January. Liverpool have more injuries than any other top-flight team, with Jurgen Klopp’s squad missing eight senior players after eight Premier League games; Leicester and Manchester United have seven apiece; Arsenal and Man City have five first-team players missing due to injury, although Chelsea (3) and Tottenham (4) have so far been relatively unscathed during a busy start to the season.

As a direct consequence of an English season concertinaed by the pandemic, the workload has become incessant, with every weekend and midweek until mid-January taken up by fixtures. As a result, sports science and staff tasked with keeping players fit have become increasingly important. Little, now Head of Performance at EFL Championship side Preston North End, has told ESPN that this season, the role has become as challenging as it’s ever been.

“It’s hard,” Little said. “Injuries are up 16% in the Premier League compared to this stage last season. It’s not at the extent of injuries we saw in the NFL after their Lockout season in 2011, when there was a significant spike in Achilles tendon injuries, but there is no doubt that 16% is significant, and it’s why people are reacting and looking for solutions.”

One measure that could have helped ease the injury and fatigue issues in the Premier League was the continuation of five substitutes being allowed per game. This was permitted during Project Restart, but when Premier League clubs voted on its implementation for this season, it was rejected, despite being sanctioned for UEFA’s club competition and most major leagues in Europe including the German Bundesliga, Italian Serie A and Spanish Primera Division.

The view within the English game was that allowing five subs would benefit the bigger clubs with stronger squads and leave the smaller teams at a disadvantage.

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“The five substitutes is the big one,” Little said. “I was beyond flabbergasted when clubs voted against that, but I was thinking from an entirely selfish sports science perspective in that I want to protect players. But those who voted, the club’s CEOs, have other considerations such as protecting their own teams and also, from a financial perspective, the more players involved on a match-day means more payments and bonuses to be paid, so it’s not just about what is best for the players. But something will have to be done because we are heading into an unprecedented number of games until mid-January.”

More games means less time to train and build endurance, but a crucial factor, according to Little, is the extra demand placed on the body by playing in a competitive fixture, as opposed to training.

“The main issue, without a doubt, is the congestion of fixtures,” he said. “It’s not just the physical load: if you play Saturday, Tuesday, Saturday, you are having slightly more load than you would in a normal training week.

“But it’s not the amount of load, it is the type of load. It is intensity of speed and movement, and that more than doubles during a three-game week, in terms of sprint distance, high accelerations and decelerations — high impact twisting and turning. They are the things that really go up in terms of loading when playing a game. These factors are having a big effect on the body in terms of games because there is no respite.”

As an example, those teams involved in the Champions League and Europa League must play three European fixtures between Nov. 24 and Dec. 10. Arsenal, Man City, United and Tottenham also have to play in the Carabao Cup quarterfinals on Dec 22-23, with the FA Cup third round — and a potential Carabao Cup semifinal — to add into the mix in early January.

Between Nov. 21 and Jan. 16, Arsenal, City, United and Spurs will play at least 15 games, adding another if they reach the Carabao Cup semifinals. Sixteen games in 57 days works out at a game every 3.5 days — a punishing schedule.

“Teams are playing 2-3 games a week now, right up until mid-January,” Little said. “The top players have international duty on top of that — England, for instance, are now in the middle of their third three-game international break since September. So the top players have the high load of games, then the travelling and extra fatigue, lack of sleep that comes with it.”

The first spare midweek in mid-January sees the 10 Premier League games split across two midweeks. However, the heavy load of games then resumes, with seven Premier League matchdays and two rounds of the FA Cup to be played in the month before the Champions League returns on Feb. 16; last season, there were four Premier League fixtures and only one FA Cup round. The two-week winter break that all clubs received in 2019-20 has also had to be scrapped.

Man City and Man United also still have to fit in an extra game, playing Aston Villa and Burnley respectively. They were allowed to start the season a week late due to playing in the Champions League and Europa League in August, but that has purely kicked the can down the road. Both clubs will now have to play either in the blank January midweek, or on one of the two spare dates during the UCL round of 16 in February and March.

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Ale Moreno slams England’s lack of attacking ingenuity in a 2-0 loss to Belgium in the Nations League.

While preseason preparations are regarded as generating a crucial bedrock of fitness for the season ahead, Little believes that even with a full preseason this year, the injury count would only be around 10% less because the fixture pile-up is the prime cause of the problem.

“In preseason, you’re not just working for match fitness. You’re also putting in the building blocks to make you more robust. You work on basic endurance and strength, but you are gradually progressing to try and be as match specific as possible. It takes time, but all everyone did this year was go straight into getting players as match-fit as possible because you were straight into games.

“Fitness is basically a product of how fit you are and how fatigued you are,” he said. “So these guys are just steadily increasing their fatigue. Their performance levels are decreasing, as is their robustness, over time.”

The good news, however slight, is that there are areas in which players can boost their fitness levels and diminish the fatigue factor. Players are now allowed to receive massages from staff wearing Personal Protective Equipment (PPE), but cryotherapy continues to be prohibited due to COVID-19 protocols.

For Little, the benefits of rest and nutrition cannot be overstated.

“The big things that can help mitigate fatigue are optimum nutrition and sleep,” he said. “If those factors aren’t right, all of the other potential percentage gains don’t really come into play.

“In terms of sleep, it is very specific to each individual, but generally, you would be wanting players to get between seven and nine hours a night, and preferably the higher end of that. At the younger end, late-teens and early-20s, it can go up to 10 hours. But with away match travel, late night games, things like that interfere and it’s not easy for players to get the full amount of rest that they need. To help with that, some clubs are starting training at different times, especially after night games.”

It is at times like these when players simply have to tick every box in terms of rest and nutrition. If they do listen to the experts, rest up and eat well, they will give themselves the best chance of staying fit, healthy and available.

“With nutrition, it is the same basics — increase carbohydrates before the games and then carbs and proteins after the games,” Little added. “One big thing we are concentrating on is increasing information about the diet — healthy whole food diets that are rich in vegetables, fruits, salads, nuts and seeds, spices, green teas. We have pushed that a little bit more to help deal with the extra rigours the guys are going through.”

Despite all the help and support provided by sports science, however, fixture congestion is the problem that won’t go away this season. And any player involved in an international tournament next summer will arrive there after taking part in a football marathon.