Adam RafaelOn 20 March 2026, England manager Thomas Tuchel announced a 35-man squad for upcoming World Cup qualifier matches against Costa Rica and Croatia — and Trent Alexander-Arnold was not in it. The Real Madrid midfielder, who left Liverpool for Spain in January 2025, has struggled with persistent fitness issues throughout the 2025/26 season, making only 8 La Liga starts. Then, three days later on 23 March, he was dropped to the bench by Real Madrid as a disciplinary measure for arriving late to training. The contrast between potential and reality has rarely been starker — and it raises a question every amateur athlete should consider: what do recurring injuries and fitness setbacks really mean, and when should you seek professional help?
Why Tuchel dropped Alexander-Arnold: the official reason
Tuchel was direct about the England omission. "It's purely a sporting decision," he told journalists on 20 March. "I want to try some different players and different options." Tino Livramento and Djed Spence were selected ahead of Alexander-Arnold, signalling that persistent availability issues have cost the 27-year-old his international place — at least for now.
At club level, the situation was equally stark. Real Madrid imposed a bench sanction on 23 March after Alexander-Arnold arrived late to training. He came on as a substitute in the 3-2 win against Atlético Madrid and provided the assist for Vinícius Jr's winner. He later posted a five-word message on Instagram: "Real Madrid and nothing else."
Whether he returns to the England squad for the World Cup in the summer of 2026 remains uncertain. Tuchel emphasised the door is not permanently closed.
Recurring fitness issues in professional football: what the data says
Alexander-Arnold's season is a case study in the cumulative effect of fitness problems. According to Transfermarkt data, he missed 11 matches through injury during the 2025/26 season, with persistent soft tissue and fitness complaints disrupting his ability to play consistently.
Research published in the British Journal of Sports Medicine shows that professional footballers who experience soft tissue injuries have a 30–40% higher risk of recurrence within the same season if they return to play before full rehabilitation is complete. The pressure to return quickly — from clubs, managers, and players themselves — is consistently cited as a key risk factor.
For amateur athletes, the patterns are remarkably similar. A 2024 study by Loughborough University found that non-professional footballers aged 25–40 are twice as likely to sustain a serious soft tissue injury compared to those aged 18–24 — and three times more likely to experience a recurring injury after an incomplete recovery.
What recurring injuries tell you about your body
When an injury keeps coming back, it is rarely just bad luck. Sports medicine specialists identify several underlying causes:
Incomplete rehabilitation: Returning to sport before the tissue has fully healed sets up a cycle of reinjury. Pain reduction does not equal tissue repair — the absence of pain can be misleading.
Biomechanical imbalances: Muscle weakness, poor flexibility, or asymmetries between left and right sides create uneven load distribution. Over time, this creates stress concentrations in specific tissues that break down repeatedly.
Training load errors: Sudden spikes in training volume or intensity — the classic "weekend warrior" pattern — overwhelm the body's adaptive capacity and increase injury risk significantly.
Poor sleep and recovery: Sports science increasingly recognises that sleep quality directly affects tissue repair. Consistently sleeping fewer than 7 hours increases injury risk by up to 60%, according to a study published in Sleep Health (2023).
This article provides general information and is not a substitute for professional medical advice. If you are experiencing recurring injuries or persistent pain, consult a qualified sports medicine specialist or GP.
The psychology of being dropped: an underrated health issue
Alexander-Arnold's situation highlights another dimension that affects athletes at every level: the psychological impact of exclusion, underperformance, and the fear of missing out.
Being dropped from a team — whether a national squad or a Sunday league side — activates the same psychological stress responses as social rejection. Research from the University of Amsterdam (2023) found that athletes who perceived their sports identity as central to their self-worth were 45% more likely to experience clinical anxiety symptoms following a significant performance setback.
The physical-psychological connection matters for recovery too. Chronic stress elevates cortisol levels, which impairs tissue healing and immune function. An athlete under significant psychological pressure will physically recover more slowly — even with identical treatment.
Sports psychologists and exercise medicine practitioners increasingly work together to address this dual challenge. Recognising when performance anxiety or exclusion stress is becoming a health issue is the first step to addressing it.
When should amateur athletes seek a sports medicine specialist?
You do not need to be a Premier League footballer to benefit from professional advice. Sports medicine consultants work with athletes at every level. Key indicators that you should book a consultation include:
- The same injury has recurred twice or more in the same season or training cycle
- Pain persists more than two weeks after rest and standard self-treatment
- You have returned to training and the injury has returned within two months
- Your performance has declined despite normal training volume — often a sign of overtraining or poor recovery
- You feel anxious, low, or unmotivated in relation to your sport for more than a few weeks
A sports medicine specialist can assess your biomechanics, review your training load, and create a targeted rehabilitation plan. Unlike a GP, they understand the demands of sport and the difference between a minor setback and a warning sign that requires intervention.
Get expert advice from a sports medicine or health specialist at Expert Zoom — online consultations available with qualified practitioners across the UK.
