A back problem has hampered Lee Cattermole throughout a season where the Teessider has faced the familiar scenario of trying to help Sunderland avoid the drop.
Cattermole has faced two periods on the sidelines with the condition, twice visited a specialist in London and continues to receive treatment to keep him in the firing line.
Perhaps it was a factor in Cattermole’s display at Liverpool. Perhaps he struggled to adapt to a more advanced position. Perhaps he just had one of those days when everything he touched failed to come off.
But there has been debate this week among supporters over whether Sunderland can field three defensive-minded central midfielders, even if that didn’t hamper an excellent performance against Manchester City less than a fortnight ago.
Is this a case of Cattermole’s long-term contribution being overlooked after a couple of mediocre displays though?
Certainly, when Sunderland have managed to put points on the board over the last two or three seasons, then it has invariably been with Cattermole in the middle of the park.
He remains the on and off-the-field leader of this side, who sets the tempo and provides an intensity which is immediately noticeable by its absence when he is not involved.
Those are assets which are particularly invaluable in a relegation battle.
It would be a surprise too if Sam Allardyce diverted from three battling players in the middle of the park against both Manchester United tomorrow and the trip to sixth placed West Ham a fortnight later.
But even if Allardyce is open to the idea of a midfield change, does he have the options to do it?
Seb Larsson remains on the sidelines with a knee ligament injury which has proved to be problematic in healing.
The Swedish international is just the kind of player Sunderland could do with at this stage of the season, yet an original five-week lay-off has now dragged on for more than two months.
That leaves just Jack Rodwell or one of Wahbi Khazri and Jeremain Lens as alternative midfield options.
Rodwell netted the equaliser in last season’s corresponding fixture with tomorrow’s opponents Man United, but Allardyce has been unable to alter the £10million man’s pattern of struggle.
Whether it’s confidence, persistent injuries, or a combination of the two, Rodwell is approaching the end of a second successive distinctly under-whelming season as a Sunderland player.
Using Khazri or Lens as a ‘number 10’ is more of a genuine option and is surely an attack-minded switch which Allardyce will have to make when Sunderland face a Crystal Palace or West Brom at home over the next two months.
Sunderland need to win games and will have to chance their arm with a gung-ho approach sooner or later.
That won’t necessarily happen this weekend though.
This is one where Sunderland will need the bite and dedication of a Cattermole, if they are to take the scalp of one of the Premier League’s heavyweights.