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Fitness has been a significant factor in West Ham’s success this season, but it is now threatening to be what undoes it.
David Moyes and his side have done so well to push on in the absence of three of their standout players this season. Since losing Declan Rice before Wolves and Michail Antonio half an hour into that game, the Hammers have continued to battle on - but now things are coming undone with Aaron Cresswell also a big loss.
A narrow defeat to Chelsea at the London Stadium on Saturday makes it back-to-back losses for the first time since the opening two games of the campaign.
Defeat at Newcastle last weekend could largely be attributed to Craig Dawson’s maddening spell in the first half, but against Chelsea - in a game which could have handed the Hammers control of the top four race - the injuries finally hit home.
"I think you would have been surprised if we could have easily done it without them," said Moyes.
"It was a tough game for us with who we had out today. I have to credit the players, they showed great character and resilience.
"We're hoping to try and get some players back [for the next game] if we can. Today was really as low as we've been [numbers wise]."
With 22 goals scored by both sides across the Hammers’ last four games, some calm would have been welcome against their London rivals. West Ham did tighten up - this was far more cagey than chaotic.
"Honestly it reminded me of Atletico [Madrid], very tough to play,” said Chelsea boss Thomas Tuchel. “To really hurt them is hard."
West Ham tidied things up at the back, but were far too blunt at the other end without their talisman Antonio - who is still recovering from a hamstring injury.
The hosts were slow to get going but controlled spells of the game against a very defensive Chelsea side, happy to let Jesse Lingard float around 25 yards from goal making little dent in the back five.
Without Antonio to bully and bash the back line there was little space for creativity, while the absence of Rice in midfield meant proceedings were never totally in hand.
West Ham have been free-scoring in recent weeks, but with such significant figures missing against robust opposition, things ground to a halt resulting in the hosts drawing a blank at home for the first time since the opening day of the season.
“We did not work them hard enough or cause them enough problems,” said Moyes.
“It was tough today, we did not get any breakthrough and we needed the extra player that we did not have at the end.”
This was arguably West Ham’s biggest game of the run-in. Chelsea are now three points clear of the Hammers, who no longer have hold of their top four destiny. Their run-in is - on paper - favourable, but having kept everyone so fit for so long this season, they may have to limp over the line.
It could well get worse for Moyes too. Arthur Masuaku was again another to miss out through injury with Dawson suspended following his red card last week. The last thing the West Ham boss needed here was Fabian Balbuena being sent off for something as foolish as kicking a ball - a baffling decision from referee Chris Kavanagh.
West Ham will no doubt appeal Balbuena’s red card before their trip to Burnley Monday week, but it is another bout of bad luck; it appears to be coming all at once for Moyes and West Ham.