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The sight of new Tottenham Hotspur head coach Roberto de Zerbi watching in anguish as captain Cristian Romero walked past him in tears may yet become the lasting image of a season slowly sliding towards the Championship.

De Zerbi's hopes of a fast start after succeeding Igor Tudor, the madcap experiment of the Croatian's appointment lasting only 44 days, ended brutally as Spurs failed to show any significant response to the Italian's arrival.

Amid another flatlining display, the tearful departure of De Zerbi's leader on the field with Spurs 1-0 down with 25 minutes left and on the way to deserved defeat at Sunderland was yet another harrowing chapter in this sorry tale of the fall of a giant club.

The question of whether Spurs are too good to go down was consigned to the dustbin long ago. A team without a win in 14 Premier League games stretching back to 28 December at Crystal Palace answers that.

A more pertinent question now is - are Spurs too bad to stay up?

On the grim evidence that unfolded in the Wearside sunshine, it looks like they are.

De Zerbi's reputation has been forged as a visionary coach at Brighton and Marseille, but he now needs to act as a psychologist as much as training ground strategist to coax something from this subsiding Spurs team.

"My job now is not to coach a style, with or without the ball, but try to give the players what they need in terms of mentality," he said.

"My style is to trust the confidence of the players. During the week, they play better because they are clean in their heads, but in the game it is different. My work must be to get them to show what they are doing during the week in a game."

De Zerbi agreed the stress and fear of relegation could be the factor consuming the Spurs squad – but he has no time to lose getting his message across. In football terms, this is now a critical emergency for Spurs.

He must also wait to see how long he is without Romero, whose downcast departure wiping away tears was yet another twist in this harrowing season.

Romero appeared to have a knee injury, although De Zerbi said "we have to see in the next few days", adding: "I hope that it is not too important a problem. He's a crucial player for us. He's a good guy and a good player with a big personality. We need him to finish the season."

Whatever the prognosis, former England goalkeeper Ben Foster questioned whether Romero's downcast manner as he left the pitch sent the right message to a Spurs team already a goal down after Nordi Mukiele's shot deflected past keeper Antonin Kinsky off Micky van de Ven on the hour.

It was a moment of misfortune, the sort that is often the fate of a team, and indeed a club, in crisis.

"Romero's probably the one player who has got a bit of character in that team, a bit of grit and determination," said Foster, a pundit on Sunday's Match of the Day. "If I was one of his team-mates there, I want him to be walking off the pitch grabbing everybody, getting everybody firing.

"They've still got 25 minutes there until full-time. But the tears, I feel, send the wrong message. As a captain you shouldn't be doing that."

In Romero's defence, his injury was caused by a reckless intervention from Sunderland striker Brian Brobbey, who pushed him into keeper Kinsky, who sustained a head wound but was able to carry on.

Troubles are already piling up around De Zerbi's feet like rubble and he has barely got his feet under the desk. And he will know it.

Spurs are a very poor team, shorn of confidence and self-belief, looking on course for the Championship. De Zerbi only has six more games to turn this predicament around.

Such is the extent of the rot that has set in at Spurs, this may not be enough.

The Europa League win under Ange Postecoglou – even his presence seems an age ago now - provided glory and long-awaited silverware for the first time since 2008, but it has been exposed as a flimsy fig leaf disguising fundamental deep-seated problems running through the club on and off the pitch.

No wonder television cameras panned in on concerned expressions on the faces of Spurs chief executive officer Vinai Venkatesham and sporting director Johan Lange as they looked on from The Stadium Of Light's directors' box.

Venkatesham and Lange will struggle to survive if Spurs suffer the humiliation of relegation, especially as they must take responsibility for the left-field appointment of Tudor.

Tottenham manager Roberto De Zerbi says he needs to be a "big brother" and "father" figure to his players, after Tottenham's 1-0 defeat to Sunderland leaves his side in the bottom three of the Premier League.

MATCH REPORT: Premier League - Sunderland 1-0 Tottenham Hotspur

Roberto de Zerbi has no time to waste if he is to save Spurs from the ignominy of the drop, but he was unable to make the clouds of relegation hanging over this giant club lift on another dismal day.

Spurs now have to make up that two-point gap on West Ham United with only six games left, and he witnessed a display desperately lacking in inspiration on Wearside.

Sunderland were by far the more organised and threatening side, with Dominic Solanke wasting Spurs' best chance right on half-time when he was blocked at the near post.

De Zerbi was preparing to make changes when Sunderland went ahead with a goal that often sums up the fate of the struggling team, Nordi Mukiele's routine shot taking a huge deflection off Micky van de Ven to beat Antonin Kinsky.

Spurs were also unlucky to lose key defender and captain Cristian Romero following that clash with keeper Kinsky, the Argentine in tears as he went off.

De Zerbi would have been concerned at the lack of reaction from Spurs to going behind, a clear indicator of their lack of self-belief and confidence.

There is no escaping just how serious Spurs' predicament is – and they will have to produce much better than this in their next game at home to De Zerbi's old club Brighton.

Sunderland manager Regis Le Bris believes his side can secure a top half finish in the table come the end of the season, after Sunderland's 1-0 win over Tottenham Hotspur moved them to 10th in the Premier League.

MATCH REPORT: Premier League - Sunderland 1-0 Tottenham Hotspur

Sunderland boss Regis le Bris speaking to BBC Match of the Day: "It's the Premier League and we expected a tough opponent in difficult situations. It was a must-win for them and we did well with good energy. It was really important to have our principles and we found a way to score which was still important."

On Sunderland's goals: "We want to improve our style of play, we still want to enforce our ideas and we still have room for improvement in the final third. Top 10 is a good aim and we have to be consistent. The most important is the improvement."

On next season: "We will prepare next season with the way we play now. After three weeks it was a difficult game and I was a bit worried because you never know what can happen. The lads were consistent and for me that is the next layer."

Sunderland captain Granit Xhaka, speaking to Sky Sports about his side's win: "After four weeks of not being at home, it was so important to give the fans what they needed. We knew before the season that we can beat everyone if we stay like this with the hunger and desire and take the three points."

On facing Spurs with a new manager: "Not the first time we are playing against a team who have changed manager. He [Roberto de Zerbi] has the mentality to win but we knew what we had to do and it was nearly a perfect game."

On Sunderland pushing for Europe: "Before the season, nobody expected us to be where we are. When I signed it was 2% chance of us staying up and now it is over 100%. Give this football club respect. We stay humble and see what we can do until the end."

On whether he is surprised about Spurs being in the relegation zone: "It's not my job to speak about Spurs. I am not a Spurs player. I look after these boys and this football club. We look after ourselves and let's see where we get to."

Sunderland defender Nordi Mukiele also spoke to Sky Sports, about his goal: "In football you have to take a chance and that's what I did. I took the shot and it went in so I am really happy for the performance of the team. The energy is very important after we lost three games in a row. We were at home, it was our tempo and our rules.

"We started very strong and the season is very long. We deserve where we are today because we work hard. Now is a bonus and now we have six games to show where we are. We have to stay humble."

Tottenham manager Roberto de Zerbi speaking to BBC Match of the Day: "Sorry because we didn't deserve to lose the game. We played a good game, maybe not enough to win but we were unlucky in a few situations in the first half.

"I cannot say anything to players because they gave their best in terms of attitude and spirit. We can play better for sure and you can feel better. We have to work on that. My work is not so much on the pitch because they are good guys and I am sorry for them. I want to give them confidence in what they need.

"Tactically, we played a good first half. With the ball and without the ball. We don't have confidence to play great football but we did what we have been working on this week. The players can play better if they are feeling confident."

On keeping spirits high: "I can be a big brother, father, they don't need a coach. They don't need to improve football. They can play better and they will play better once we reach a different level of confidence."

On looking forward to the challenge: "Absolutely, I'm sure if we are able to win a game then everything will change."

Whether you were at the game or following from elsewhere, we want to know what you learned.

Have your say on Sunderland's performance

What did you make of Tottenham's display?

Sunderland make four changes from the side that won at Newcastle United in the Tyne-Wear derby.

Robin Roefs returns in goal in place of Melker Ellborg, while Nordi Mukiele, Reinildo and Enzo Le Fee replace Lutsharel Geetruida, Trai Hume and Chemsidine Talbi.

Sunderland XI: Roefs, Mukiele, Alderete, O'Nien, Mandava, Xhaka, Sadiki, Le Fee, Diarra, Rigg, Brobbey

Subs: Ellborg, Cirkin, Geertruida, Talbi, Mayenda, Isidor, Hume, H Jones, J Jones

Tottenham XI: Kinsky, Udogie, Romero, Van de Ven, Porro, Gray, Bergvall, Gallagher, Kolo Muani, Richarlison, Solanke.

Tottenham will start a Premier League match in the bottom three for the first time since September 2011, when they travelled to Wolves in their third match of the 2011-12 season, having lost their first two fixtures.

They won that game 2-0 to move up to 13th place in the Premier League table.

In fairness, they had played just two games to everyone else's three games as their season-opener against Everton was postponed due to riots in Tottenham.

So, given how early on in the season that result was and the game in hand situation, what's far more relevant is the last time Tottenham were in the relegation zone beyond the first few games of a top-flight season.

The last time Tottenham started a Premier League match in the bottom three more than three games into a season was in January 2009. They started that home game against Portsmouth bottom of the table, but a 1-1 draw - thanks to Jermain Defoe's equaliser - moved them up to 16th place in the table.

It was the game where Harry Redknapp famously criticised Darren Bent for missing a late big chance to clinch all three points for Tottenham, saying: "My missus could've scored that one!"