Once is a fluke. Twice is a coincidence. Three times is a trend.

For the third straight season, injuries have crippled the Eagles. Injuries are up across the NFL, likely because of the truncated offseason, no preseason, and COVID-19 precautions, but the Eagles are once again among the league’s most injured teams.

They’ve already had 25 players miss at least one game, and that number will increase by four if tight end Zach Ertz (ankle), defensive tackle Malik Jackson (quadriceps), tackle Jack Driscoll (ankle), and safety K’Von Wallace (shoulder) are unable to suit up Thursday night against the New York Giants.

In all, Eagles players have lost 77 games to injury in the first six games. There isn’t a current NFL database for games lost to injury for every team, but in terms of reserve lists, the Eagles are behind only the 49ers in games lost, 72 and 76, according to Pro Football Reference.

Coach Doug Pederson and his players have declined to use injuries as an excuse, and to some extent, rightfully so. The Eagles haven’t performed well. Substandard preparation, game planning, play-calling, and execution have factored into a 1-4-1 start.

Personnel decisions and roster construction have been dubious, as well.

But the number of injuries, especially on offense, have been seemingly insurmountable. By the end of Sunday’s 30-28 loss to the Ravens, quarterback Carson Wentz and center Jason Kelce were the only regular starters who were healthy, relatively speaking. That the Eagles nearly overcame the losses is a credit to Pederson.

The same could be said about the 2018 and ’19 seasons. Two years ago, the Eagles finished last in the NFL in Football Outsiders’ formula with 117 adjusted games lost to injury. Last year, they finished 21st with 84.4. And yet, they still finished 9-7 each season and made the postseason.

“The last two years, the injuries have really hurt our football team,” general manager Howie Roseman said in January. "There is a part of that that is natural during the game. Injuries are going to happen. But we have to figure out a way to get better here.

“We can help from a front-office perspective by looking at the players that we bring in. Hope is not a strategy when it comes to injuries. When you bring in guys that are injured, it obviously increases the risk that they will get hurt again.”

And yet, Roseman brought back over 30 veterans who have been prone to injury like tackle Jason Peters and wide receivers DeSean Jackson and Alshon Jeffery. Peters has already missed three games to a toe injury, Jackson has missed three to a hamstring strain, and Jeffery has missed all six following December foot surgery.

While Vinny Curry had been relatively unscathed over his career, the 32-year-old defensive end, who was re-signed just before training camp, has already missed four games to a hamstring strain.

Roseman addressed the injury concerns by making several changes to his medical staff in the past offseason. The most significant ones were hiring Tom Hunkele as director of sports medicine/head athletic trainer, and Ted Rath as director of sports performance.

It was the third straight offseason that Roseman made alterations to the staff. The most notable came after the 2017 Super Bowl-winning season when the team’s top two doctors, Peter DeLuca and Gary Dorshimer, and head athletic trainer, Chris Peduzzi, departed.

Jerome Reid was hired to replace Peduzzi, and a year later, Arsh Dhanota became chief medical officer and team head physician, essentially replacing Dorshimer. Christopher Dodson and Matthew Pepe have been the head orthopedics who have stepped into DeLuca’s shoes.

DeLuca, Dorshimer, and Peduzzi each had around 20 years of NFL experience. From 2013-17, when the trio were together, the Eagles finished first (32.2), fifth (48.6), sixth (52.0), fourth (39.6) and 13th (53.5) in FO’s adjusted games lost rankings.

Pederson, pointing to several coaching changes and new players, has used the offseason restrictions the entire league has faced as an excuse for the Eagles' slow start. Of course, many teams with more coaching, scheme, and player turnover faced greater obstacles.

But the coach said Monday that he saw no correlation between the additions of Hunkele and Rath during the shortened offseason and the Eagles' rampant injuries. Earlier Monday, he was asked on WIP 94.1-FM if he had any theories for why the Eagles have been snakebitten by them.

“It’s something I think about quite a bit,” Pederson said. "I think about the injuries just yesterday that we had in the game. Listen, these are all football injuries. These aren’t practice injuries or weight-room injuries or anything of that nature.

“These are in-game ankles, a knee, or a shoulder. … It’s a physical contact sport.”

But the Eagles have had weight-room and practice injuries. The first major one occurred in June when Pro Bowl guard Brandon Brooks ruptured an Achilles tendon while doing 60-yard shuttles at the team facility.

During the ramp-up period before camp, running back Miles Sanders (hamstring), defensive end Derek Barnett (hamstring), and defensive tackle Javon Hargrave (pectoral muscle) suffered injuries that would keep them out until Week 2.

In camp, tackle Lane Johnson (ankle) re-injured an ankle early and needed surgery. Tackle Andre Dillard (biceps) and tight end Josh Perkins (shoulder) suffered season-ending injuries. Safety Will Parks and receiver Quez Watkins missed five and four games, respectively, with hamstring strains sustained just before the season.

Every team has injuries during camp and in-season practice. As Pederson noted, football is a physical game. And in the NFL, the athletes need to be able to perform at peak levels. But there have been few examples of Eagles players returning early based on projections the last three years.

The only recent case that comes to mind was receiver Jalen Reagor being ready by the opener after injuring a shoulder. The rookie would get injured in Week 2, however, when he tore a thumb ligament. He isn’t expected to return until next month.

Most injuries are unavoidable. But the Eagles have had abnormalities in how various injuries have been handled, dating back to 2018, in particular as it relates to soft-tissue injuries. There has been either recurrence or extended absences in several cases.

Jackson, for example, was initially given a “day to day" timetable for return by Pederson.

The Eagles carried Jeffery on their active roster because Roseman said that if he was on the physically unable to perform list, he wouldn’t be able to return until Week 7. But the receiver has yet to play and the Eagles wasted a roster spot for six weeks.

Johnson was clearly rushed back. He said after Week 2 that he wasn’t 100% and would just have to play through pain. But by Week 4, he was in and out of the lineup and would need to have a cyst drained after the game. And by Week 5, he failed to finish the game and needed to have a second opinion on the ankle.

Johnson sat out Sunday’s game, one of six offensive linemen sidelined. The Eagles have been relatively unaffected by COVID-19, at least directly, but guard Matt Pryor was also out after coming in contact with someone who had tested positive.

His replacement, Jamon Brown, played even worse than Pryor has when active. But it’s so far the only virus-related circumstance that has affected the Eagles on game days. The other absences have been injury-related and unfortunate.

But after three years of mass injuries, can it be considered either a fluke or coincidence?