If England coach Steve McClaren had an injury headache before the opening games of the season, it might just have turned into a full-blown migraine.
Less than a month before his side face Israel in a crucial Euro 2008 qualifier at Wembley, McClaren has been rocked by a succession of injuries that have left England's already fragile hopes close to breaking point.
Concerns over the fitness of John Terry, Michael Owen and David Beckham were already causing the coach sleepless nights.
But on Sunday came the news McClaren must have feared most - Wayne Rooney, his undoubted star player, had suffered a hairline fracture in his left foot.
BBC Sport examines the implications of the 21-year-old Manchester United striker's injury and what the latest situation is with England's other walking wounded ahead of a critical autumn for McClaren and his under-pressure players.
THE HAMMER BLOW
It is difficult to overstate just how much of a blow Wayne Rooney's injury is for McClaren. Arguably the most talented English footballer for a generation, he would be the first name on any manager's teamsheet.
According to Dr Craig Panther, specialist sports doctor at Pure Sports Medicine, he could miss the October qualifiers against Estonia and Russia as well as September's double-header with Israel and Russia.
There are too many games and one too many competition in English football
BBC Sport's Mark Lawrenson
"It is a hairline fracture so it is not as bad as it could have been but he will have to stabilise his foot in some sort of aircast boot or plaster for at least six weeks and possibly eight," said Dr Panther.
BBC Sport columnist Alan Hansen admits Rooney's absence gives McClaren a real headache.
"England are struggling for centre-forwards at the moment, so his injury is a big problem," said Hansen. "Rooney gives them something extra in the final third and that is what you need to win games."
Hansen's former Liverpool defensive colleague and fellow BBC pundit Mark Lawrenson says Rooney's injury once again highlights a major problem in English football.
"Last year when players got injured, everyone said it was because it came after the World Cup and players were tired," said Lawrenson.
"They have just had the summer off and it is happening again. There are just too many games and one too many competitions in the English game. Until that changes, it will ever be thus.
"For McClaren, if Rooney can't play he can't play. You have got to get on with it. If you are the manager you have got to manage. Unfortunately."
If only England had Manchester United's resources. With Rooney out, they will draft in £30m-rated Argentine superstar Carlos Tevez for the Premier League game at Portsmouth on Wednesday.
THE BIG HEADACHES
McClaren's bad luck goes way beyond Rooney, though.
If Steven Gerrard, David Beckham and Michael Owen are his other world-class players, only midfielder Gerrard is looking in any sort of shape for the crucial ties that lie ahead.
Having been left out of McClaren's first nine squads, former England captain Beckham was sensationally recalled for June's friendly with Brazil and the 3-0 Euro 2008 qualifying win in Estonia.
He was breathtaking, creating three goals in the two games, and looked to have secured his place in the team for the foreseeable future.
England cannot afford to be without either Beckham or Owen
But after ending his four-year spell with Real Madrid by helping the Spanish club win La Liga in June, he has been dogged by a persistent ankle injury that has so far wreaked havoc on his career with Los Angeles Galaxy in the United States.
Beckham made his Major League Soccer debut as a late substitute on Thursday but had to sit out Sunday's 1-0 defeat by New England Revolution.
McClaren, who travelled to the US last week to watch the midfielder, will monitor proceedings from across the pond with apprehension.
As for Owen, the injury-hit Newcastle striker's run of bad luck has lasted almost as long as his St James' Park career.
Signed nearly two years ago for £16m, Owen has made just 13 starts and after a serious knee injury kept him out of all but three games last term, he picked up a thigh problem in pre-season.
Owen played an hour of a friendly on Monday - but can McClaren rely 100% on his fitness for the two most important matches of his managerial life?
He may not quite be as irreplaceable as the other three but John Terry is the England skipper and his presence would be sorely missed if he were ruled out of September's double-header.
A knee injury picked up during training stopped his season before it had even begun but Chelsea's captain marvel should be back in time to wear the armband on 8 September.
ENGLAND'S EURO QUALIFIERS
8 Sept: Israel (Home)
12 Sept: Russia (Home)
13 Oct: Estonia (Home)
17 Oct: Russia (Away)
21 Nov: Croatia (Home)
There must also be doubts over 85-times capped Gary Neville, with the Manchester United right-back also deemed unavailable for the start of the new campaign.
Neville is on the way back but his persistent ankle problem again suggests he cannot be relied upon by McClaren.
Adding to the defensive woes, perhaps rather predictably, is Middlesbrough defender Jonathan Woodgate.
I spoke to Woodgate just before the end of last season and he told me he was going to have knee surgery - but he said it would not keep him out for the start of this term.
Sadly for Woodgate, that optimism has proved to be misplaced and he has not featured at all in pre-season.
Tottenham winger Aaron Lennon might just regain fitness in time for the September qualifiers after having knee surgery this summer - but if he does, the 20-year-old flier will be cutting it a bit fine.
Scheduled to return to training at the end of August, Lennon will have one Premier League game - at Fulham on 1 September - in which to prove his fitness.
THE DEFINITE ABSENTEES
McClaren might want to wrap up Ashley Cole in cotton wool, with his Chelsea colleague and fellow left-back Wayne Bridge facing another two months out after hip surgery in July.
Any sort of problem with Cole and Reading's Nicky Shorey will be a shoo-in to win his second cap.
Tottenham captain Ledley King has had more than his fair share of injury problems in the past couple of years and his luck is out this season too.
Unavailable until at least October after undergoing knee surgery in the close season, England look like they might have to qualify without King.
Add to the mixer that beanpole striker Peter Crouch is suspended for the match with Israel on 8 September, although he will be available to face Russia four days later.
MCCLAREN'S MOMENT OF TRUTH
With so many players already ruled out or struggling to make it, McClaren faces difficult decisions over the make-up of his squad for September's all-important games.
On Friday, he must name a squad to take on old foes Germany in a friendly at Wembley on Wednesday 22 August.
But it is the games against Israel and Russia in September that will occupy most of McClaren's thoughts as a disastrous start to the season begins to sink in.
The former Middlesbrough manager has some big decisions to make:
Does he beg Liverpool's Jamie Carragher to come out of international retirement?
Does he recall Portsmouth defender Sol Campbell?
Does he gamble on the fitness of Terry/Beckham/Owen?
Does he risk relatively untried strikers in the shape of West Ham's Dean Ashton and Portsmouth's David Nugent?
Only time will tell but McClaren is short of that precious commodity as his short tenure reaches its most critical phase.