Declan Rice has been managing a neural issue in his hamstring and lower back since around Christmas.
He missed England’s group stage win over Panama with a calf knock.
He has since been struck down by illness ahead of Saturday’s quarter-final against Norway, though he trained on Friday and is expected to be available.
He is also one booking away from a potential semi-final suspension, having picked up yellow cards in both knockout games so far.
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And yet Thomas Tuchel simply cannot leave him out.
Thomas Tuchel cannot afford to leave Declan Rice out
Look at England’s back six without Rice. Elliot Anderson. Marc Guehi. Ezri Konsa. Djed Spence. Nico O’Reilly. There’s not much top-level experience there.
Jordan Henderson has broken his arm. The midfield options beyond Rice are Elliot Anderson, Kobbie Mainoo, and the ever-present Jude Bellingham — who has been outstanding in a number ten role, scoring four and assisting one, and cannot simply be dragged back into a deeper position without significantly weakening England’s attack.
There is the possibility of Rice dropping to right-back following Jarrell Qunasah’s red card against Mexico.
He has played through pain for the entirety of England’s campaign — 89 minutes against Congo, the full 90 against Mexico in a dramatic 3-2 win with ten men for almost 50 minutes.
But take Rice out of the midfield entirely and it gets ugly.
Declan Rice is being run into the ground and it will hurt Arsenal
There has been a worrying trend around the fitness of Arsenal players during this tournament.
Mikel Arteta has already overhauled his medical department this summer in response to the toll last season took on his players.
But there is only so much a new medical team can do when the player in question is being asked to play through a neural issue, a calf problem, and illness.
Norway, captained by Martin Odegaard setting up a fascinating Arsenal subplot, await on Saturday.
England need Rice. Tuchel knows it. And Arsenal will be hoping he comes through unscathed, with the title defence beginning on 21 August.
He will almost certainly miss that game, and possibly a couple further ones after that.
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