Bukayo Saka is once again among the substitutes for England's second World Cup group stage match against Ghana. The Arsenal winger was left on the bench for the opener against Croatia in Dallas last week, with his club teammate Noni Madueke starting ahead of him. Saka did come on as a second-half substitute that evening but has not been deemed fit enough to start for the Three Lions this evening, with Madueke once again getting the nod.
Tuchel's Changes and Saka's Fitness
Thomas Tuchel made two changes to the side that beat Croatia 4-2, with Djed Spence and Marc Guehi coming in for Nico O'Reilly and John Stones. Saka has been carrying an Achilles injury since the end of March, one that saw him miss five games during Arsenal's Premier League title run-in. Tuchel explained on Tuesday that the 24-year-old is fit and available tonight but suggested another role off the bench was the more likely scenario.
'It's another big thing on the right wing between Noni Madueke and Bukayo Saka and the beautiful thing is they do it for Arsenal as well,' the manager told a pre-match press conference. 'Bukayo is getting better and better, feels no more pain and he is ready to go – without telling you if he starts or comes from the bench.'
Managing a Chronic Condition
His current Achilles tendinitis issue ruled him out of five matches in April, including both Champions League quarter-final legs against Sporting CP and the Premier League showdown at Manchester City. While there was some concern behind the scenes, he was deemed fit enough to play and have a real impact in the season run-in. Saka's issue is a chronic one but is being carefully managed by the England medical staff.
'It isn't about taking him out of the picture for a prolonged period and treating it, it is about managing it,' Stephen Smith, CEO and founder of Kitman Labs which specialises in injury welfare, told Metro. 'We know it's a chronic issue that can persist for a number of seasons that players must learn to manage, we know that from how Arsenal have managed him. It is going to be something he is carrying through the competition but it is clear from a club perspective they were able to manage that.'
Daily Load Management
They [Tuchel and England's medical staff] are not expecting a condition like this to be resolved mid-tournament. So it is about managing his load day by day. Typically what you would see is the medical staff, physio staff and the coaches monitoring his response to every training session, looking post-session stiffness, looking at swelling, looking at pain and how he is moving the morning after.
'If he is moving freely with no reactivity they will keep loading him. But if there's any level of pain, stiffness, discomfort, then they will monitor and manage him through that. My expectation is they would be looking at him all the way through the tournament to manage that reaction.'
