Hopefully there will still be one or two fit players available to kick off the upcoming Rugby World Cup next month. The list of warm-up casualties, however, is already rising steadily. Poor Romain Ntamack of France and England’s Jack van Poortvliet will both miss the tournament. Other influential figures such as Handré Pollard, Lukhanyo Am and Cyril Baille are also sidelined, their hopes and dreams in the overworked hands of their respective medical teams.
It is by no means a new phenomenon. History is littered with names who might have illuminated the global game’s ultimate stage but for untimely injury. Not to mention reserves who ended up stealing the show. Remember the 2011 World Cup when the All Blacks, having lost Dan Carter (groin), Colin Slade (groin) and Aaron Cruden (knee), had to whistle up the unsung Stephen Donald? Not only did Donald end up supplying the winning points in the final but his local club in Waiuka even renamed their home ground ‘Beaver Park’ in his honour.
Good luck, then, to everyone lying on a treatment table; may all your recoveries be smooth and successful. Amid all the intensifying fitness conjecture, let’s also hear it for the physios, masseurs, surgeons and doctors who do so much to put rugby’s wounded Humpty Dumptys back together again. If any group of individuals have their fingers on the sport’s collective pulse – from brain injury prevention to contact load – it is them.
When you track some of them down, as I have recently done for a new book, their testimony proves both educational and, occasionally, eyebrow-raising. The pressure to rush players back ahead of schedule, for example, can be particularly tough. “It’s not only the pressure from the player, it’s the coaches, the agents, everybody,” says Bill Ribbans, the renowned orthopaedic surgeon who has treated many top sportspeople from Paula Radcliffe and Jessica Ennis-Hill to Michael Schumacher and the rugby men of Northampton Saints and England. “It’s that balancing act: getting them back too early and risking re-injury or getting them back too late and risking the wrath of the coaching staff.”
His longtime friend and colleague Phil Pask, respected throughout the game for his tireless rehabilitation work on behalf of countless leading players, recalls the case of Richard Hill, now England’s team manager, who made it back in six months after rupturing his ACL in 2004 only to suffer the same injury to the same knee in the first Test of the 2005 British & Irish Lions series in New Zealand.
Pask and his colleague Barney Kenny, with the assistance of Bill Knowles, the renowned US-based athletic trainer and rehab specialist, did a remarkable initial job of rebuilding Hill but the former now thinks a lengthier period of recuperation could have been beneficial. “The evidence now is that for every month over 10 months you can prolong their rehab it reduces their injuries by 25%,” says Pask. It might also have helped someone like South Africa’s Joost van der Westhuizen, who required major knee surgery three times in four years and, by his own admission, played in the latter stages of the 1999 Rugby World Cup on one good leg. Van der Westhuizen, who was subsequently diagnosed with motor neurone disease, died at the age of 45 in 2017.
Over the years, however, Pask says he has encountered a fair amount of pushback, both with club and country, whenever he has proposed delaying a player’s return. “I did get a bit fed up with coaches saying, ‘You’re always keeping the players back.’ So in the end – and I did this with England as well – I’d produce a copy of the team sheet and write down the ongoing injuries and niggles that players were carrying. We were probably fielding about 10 out of 15 starters who, while they could still play, probably had something we could have pulled them out with. The coaches got fed up with me doing that after about a year.”
Two-thirds of a matchday squad kicking off a game in England in significant pain? It is a stat that should make all connected with the game wince. In his autobiography the former England captain Dylan Hartley estimated he missed 1,320 days – almost three and a half years – of his 15-year career due to significant injuries. It chimes with figures Pask has seen at Northampton in more recent times. “Twenty five per cent of our playing squad are injured at any one time, according to our ongoing RFU injury audits,” continues Pask. “We’ve got 21-year-olds who have had multiple operations already. The game’s not soft. I once got told off for comparing it to being in a 25mph car crash twice a week. These days I would suggest it’s much higher than that. People like big hits … but it comes at a cost.”
As the next couple of months will further underline. While medical science is improving all the time – the Springbok captain Siya Kolisi will shortly return having had knee ligament surgery less than four months ago – it is impossible to eradicate injuries entirely. “I don’t think we’ve topped out yet,” cautions Ribbans, when asked to assess rugby’s medium-term outlook from a medical perspective. Now more than ever, rugby needs to look after its battered gladiators.
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