Trent Alexander-Arnold injury shows Man City's biggest problem is also hurting Liverpool - and there is no end in sight

Manchester City's injury issues were thrust front and centre by Pep Guardiola on Friday when he questioned England's assessment of Jack Grealish.

The forward has not featured for City in recent weeks and so was a surprise inclusion in the Three Lions squad for next week's Nations League games. Lee Carsley said Grealish had trained with City and that England had communicated with all clubs over picked players.

Guardiola vehemently disagreed and ruled Grealish out of the game with Brighton on Saturday. The 29-year-old is one of five certain absentees for City with question marks also surrounding Nathan Ake.

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Rodri is out for the season while Oscar Bobb has not yet featured since fracturing his leg in the summer. John Stones and Ruben Dias are also missing alongside Grealish while Ake has been left out of the Netherlands squad amid injury concerns.

Jeremy Doku, Kyle Walker and Manuel Akanji have at varying stages in the last month played through issues or missed matches, while Kevin De Bruyne has yet to fully return from an issue he picked up in September despite a late cameo in midweek. Guardiola operates with a relatively small senior squad through choice but recently compared the relentless fixture list with the NBA in America.

City may be out of the Carabao Cup but they are playing two extra group stage matches in the Champions League and may yet face a play-off round to reach the last 16. The Blues will be fancied to go deep in the FA Cup and at the end end of the season face an expanded Club World Cup a summer after several City stars featured in the Euro 2024 final. It all adds up to a 12 month campaign with players feasibly turning out in more than 70 club games with international fixtures stacked on top.

“In the past, the previous ­seasons, we played a lot of games," Guardiola said this week. "Maybe when we go to the World (Club) Cup, arriving at the last stages of the competition, we’re going to play more than 70 games.

"And 70 games is like the NBA, but the NBA has four-month holidays, and we have three weeks, because it’s not this season, it comes from the previous season, the previous season, the previous season. When that happens, you have injuries for a long time."

Indeed a report from global insurance group Howden's highlighted a rise of injuries among Premier League players under the age of 21 with the 'ever-increasing physical demands' on players cited as a reason. FIFPRO and the PFA have voiced concerns while earlier this season Rodri suggested players could take strike action.

It is not just a City problem either. Arsenal have been without several first team players for much of the campaign, including captain Martin Odegaard, while Liverpool were without four first team players for their weekend game with Aston Villa and lost Trent Alexadner-Arnold inside the opening quarter.

The upcoming international break offers the chance of respite for some, but sparks worry among clubs concerned that those who do head off to represent their countries might pick up fresh issues or play unnecessary minutes.

Guardiola and City might be watching a few international matches from behind the sofa.