The Brutal Game: Elite clubs playing in injury time

The English Premiership is seen as the toughest rugby union competition in the world and thrives on the gladiatorial image. But many are fearful that a growing injury crisis is ruining the sport's image and believe laws must be changed. In the first of a three-part investigation, Chris Hewett asks if the risks are too great

Phil Vickery, three back operations and a bout of neck surgery into a career punctuated by orthopaedic catastrophe, is preparing himself for one last return to big-time rugby; Lawrence Dallaglio has just had a metal plate the size of a small door removed from his leg; Richard Hill may or may not resume his day job after more than a year of mind-numbing rehabilitation from a knee reconstruction; Jonny Wilkinson is ... let's just say he's injured. Again.

These men won a World Cup for England less than three years ago, yet there is no great likelihood that any of them will make the next tournament 12 months from now. Along with dozens - dozens of dozens - of fellow players on casualty lists up and down the country, they are paying a heavy price for successfully establishing a new professional winter sport in this country, and the unprecedented volume of injuries in English rugby union, now nearing 1,500 a season at the élite end of the game, is causing such concern among administrators that law changes are being discussed as a matter of urgency.

A range of radical ideas aimed at improving player safety, thereby reducing the risk of serious physical harm that many highly placed officials fear is ruining the image of the sport, is under debate and may be implemented in the months following next year's global gathering in France.

Yet senior players in the Guinness Premiership - the English domestic league considered by a majority of members of the International Rugby Board to be the most attritional competition of all - are passionately against any plan to depower the scrum, one of the principal areas of concern. What is more, they are deeply worried that efforts to address the tackle area, where the vast majority of injuries occur, will result in fundamental changes to the very nature of the union game, to the point of rendering it unrecognisable. In addition, any move to decrease the workload on players will cause another outbreak of political argy-bargy of the kind that has bedevilled rugby since the game embraced professionalism more than a decade ago.

The Premiership community, who need a full season of activity to keep the money rolling in, are uncomfortably aware that the injury rate in their tournament gives the likes of the IRB and the Rugby Football Union a stick with which to beat them in the eternal club-versus-country argument - an issue that forced its way on to the back pages last week when more than half the players invited to an England get-together at Loughborough turned up with sick notes.

Largely as a result of events in the East Midlands, the professional clubs are more sensitive than ever before about the game's casualty rate. Last week, The Independent made simple enquiries to each of the 12 top-flight clubs in respect of their current injury lists. An employee of Premier Rugby, the umbrella organisation representing the interests of these clubs, advised officials of each team to "think very carefully about responding to this request", saying: "Injuries will always be an issue for us. However ... the blame is often laid at the door of the Premiership clubs and I think this fails to take into account a number of factors. If the boot were on the other foot and we started the season with the autumn internationals, would the media be aghast at the number of players prevented from joining their clubs due to injuries caused whilst on international duty?"

One glance at the figures contained in the most recent fully evaluated injury audit, the details of which were published in the British Journal of Sports Medicine, establishes the scale of the problem facing this most demanding of team games. More than 2,000 injuries were recorded by Premiership clubs over the two seasons between 2002 and 2004; or, to put it another way, 92 injuries per team per campaign. At the same time, there were 263 injuries affecting players on England business - the Test side, the second-string A side, the Under-21s and the seven-a-side team - causing a total of 5,161 days of absence.

On average, one in four players from each club was under treatment, or undergoing rehabilitation, every day of every week during the course of the study; indeed, each player spent 19 per cent of the calendar year injured. Meanwhile, a player on international duty was shown to have a 29 per cent chance of picking up a knock sufficiently serious to incapacitate him for a fortnight. Just over half the injuries occurred in tackle situations, and a disproportionate number happened in the last 20 minutes of matches. Intriguingly, a quarter of all injuries were suffered in training, and by and large, these were more severe than those picked up in competitive games.

This is an alarming fallout in anyone's language - alarming, but far from mysterious. Modern-day forwards are almost a stone and a half heavier than their direct counterparts of a decade or so ago, while backs have gained more than a stone, and a greater proportion of this weight is lean body mass - an improvement in conditioning that, allied to advances in pace and dynamism, has inevitably led to collisions of far greater force. In addition, the ball-in-play time in an average match rose by 30 per cent between 1995 and 2003. More game time equals less rest and more injury opportunity.

"Health and safety issues are the key criteria for us," said Dr Mick Molloy, the IRB's medical officer, "and we are taking the injury issue very seriously indeed. I confidently expect the law-makers on the board to make the necessary changes on safety grounds, once they have considered all the available evidence-based information.

"There is definitely a strong sense of concern, because we are always looking for the next generation of players and it is essential to ensure the game remains appealing to young people.

"I have some knowledge of the scene in England, having spent 10 years playing for London Irish, and I would say the word 'attritional' is a very good one in respect of what is happening there now. The Premiership is the toughest competition in the world, week in and week out, and the guys who play in it are under enormous pressure. The structure of the season has to be looked at very closely because the potential consequences are very considerable indeed."

Dr Molloy was at pains to stress that advances in sports medicine, allied to a comprehensive series of intensive studies into all aspects of player welfare, had the potential to make the future a lot less bleak than the present. But with the Premiership clubs wary of any move to reduce the number of matches - their slow progress towards profitability depends on a high-quality home game every fortnight from September to May - and many front-line players adamant that they want the sport to remain every bit as gladiatorial as it is at present, the battle lines are being drawn.

Bath's David Barnes, one of the most durable front-row forwards in Premiership rugby, also happens to be the chairman of the Professional Rugby Players' Association - in effect, the shop steward of the men who earn their money at the coalface. He readily accepts that the degree of carnage is greater than ever before - "I've never seen injuries on the scale we're currently experiencing at Bath, and many of them require surgery," he said - but, in common with many of those he represents, he is keen to defend his sport from any notion that the body count is making it unsustainable.

"No one seriously doubts that the intensity has increased, but I don't believe we've reached a point were the risks are unacceptable," he insisted. "There has been a lot of talk about the dangers of the scrum, but I'm not aware of any front-row forward in the Premiership who would agree with a word of what is being said. It's a red herring, quite frankly. The tackle area is different because the scale of contact there has increased out of all recognition, but I can't for the life of me imagine any law changes that wouldn't totally change the way rugby is played.

"We have to be sensible here. For one thing, injuries are a cyclical thing - last season at Bath, we had one of our best years for a long time in terms of people staying fit. For another, training practices have improved. When I first turned professional, I was doing two contact sessions a day, four days a week. I was destroying my body. Now, people are more aware of the consequences of doing too much. I've seen the graphs relating to over-training and they're frightening." The statistics show that players training for more than 10 hours a week suffer injuries twice as severe as those who spend 7.5 hours in active physical preparation.

"Yes, we're getting more injuries at the moment. But we're learning more about ourselves at the same time. There is a much wider appreciation of the fact that rugby is a squad game, not a 15-man game. I used to play in every fixture on the list. Realistically, those days have now gone. The general mood amongst the players is positive because the understanding of so many issues has improved. Every player accepts the risk rugby presents because he's more confident than ever before that he's being properly looked after."

But Barnes ended on a low note. "One thing that does concern me is the long-term effects of what we're inflicting on ourselves," he admitted. "We're the first group of players to have spent our whole careers in the professional game, and there's a lot we don't know about future trends. I'm sure I'll have problems later in life as a result of what I'm doing now. I'm happy to live with it because I want to play rugby, and play it at this level. But it's disturbing, none the less."

As a direct result of what Donald Rumsfeld might describe as the "known unknowns", the PRA is spending a good deal of time and effort building up its benevolent fund. The day the number of retired players tapping into it equals the number of players currently doing themselves a mischief on a weekly basis, will be the day rugby really has a credibility problem on its hands.

Crocks away: Big names still on the sidelines

* NORTHAMPTON

Bruce Reihana: The Maori back is out until the new year after injuring his knee in a routine tackle at Gloucester 10 days ago.

* NEWCASTLE

Jonny Wilkinson: Rugby's Mr Injury, England's fly-half tore knee ligaments in the second game of the season, when a team-mate fell on him. Still facing another month out.

Mathew Tait: England centre had knee surgery at the beginning of last month. Out for six weeks.

* SALE

Andy Titterrell: Hooker injured his neck during England's summer tour to Australia and had surgery on his return.

* GLOUCESTER

James Simpson-Daniel: The England wing broke a collarbone in a pre-season match. Could be back in a month.

Alex Brown: England's budding second row broke his right arm against Harlequins three weeks ago. Has up to three months out.

* BATH

Matt Stevens: A second shoulder operation has put the England prop out of the autumn Tests, after missing the summer tour to Australia.

* SARACENS

Richard Hill: Missed all of last season with a knee injury. But the England flanker could return this month.

* WASPS

Lawrence Dallaglio: Recovering from ankle surgery in May

Phil Vickery: England prop has been out of action since January when he underwent a third back operation.

Mark van Gisbergen: Broke his jaw in a pre-season game, ruling the England full-back out for eight weeks.

Danger zone - the pressure points that are crippling rugby

The tackle

As in any contact sport any tackle in rugby has an element of risk. Tackles have become more dangerous in recent years because tackling itself has changed. In the past defensive players would wait for the attacker to arrive before making the tackle, now however it is more common for defenders to run at attackers thus maximising the impact on both players. One aspect of this new style is the offensive two-man tackle.

The offensive two-man tackle

A spin-off from Rugby League the two-man tackle has three aims: to knock the wind out of the player carrying the ball; to dislodge the ball from the player's grasp and to push the ball carrier backwards. In a perfect two-man tackle, the first player tackles the ball-carrier around the legs while the second makes contact around the chest area. This method of tackling can potentially cause more injuries because of is the increased force caused by a second tackler, both during player contact and ground contact.

The scrum

In a correct scrummage the chances of injury are fairly slim. If the players maintain the correct posture then the bulk of the pressure caused by the two teams pushing towards each other is concentrated on the necks, shoulders and spines of the prop forwards. In recent years, at elite level, the scrum has not been the cause of very few major long-term injuries, with notable exceptions. In March 2005 Matt Hampson, the Leicester Tigers prop forward, was paralysed from the neck down after a scrum collapsed during England's Under-21 training.

The collapsed scrum

When a scrum collapses, the main areas of concern are the neck, shoulders and spines of the forwards. The head and shoulders are driven into the ground with the weight of their colleagues on top of them. Because the forwards' arms are bound they are not brace themselves for impact. The collapsed scrum is a greater problem in the amateur where prop forwards have not had the extensive training and preparation to perfect their scrummaging techniques.

Why does the scrum collapse

There are a number of reasons why a scrum could collapse at the point of engagement: if there is a too large a gap between the packs prior to engagement; if the front rows are positioned incorrectly; or if one pack engaging too quickly. After the scrum is engaged: any player losing their footing, or slipping; the front row dropping deliberately forcing a reset; or front row players being forced out of the scrum which weakens that side of the set piece.

A player's guide to Premiership survial: Mark Regan - Hooker, Bristol

What is it like to be tackle? Like a mini car crash. I've been trampled over and stamped on: that's tough.

And what about being tackled by two guys? It's tough, it's a contact sport and you come to expect it.

How do you prepare yourself for that impact? It's just the adrenaline flowing and you don't feel it, until next morning.

Is there any way that you can minise the impact of the tackle? You can use a bit of footwork and get onto a player's weaker arm then you wont take so much force.

Do you identify a player you think you can overpower? No not really, you just run as hard as you can.

What's it like to be in a scrum? It's tough, very tough in the front row, but your body adapts to it. You can live through the pain barrier, but really it all depends on if you get yourself in a bad position or not but I've been fine over the years.

Where's most of the pressure applied? The shoulders. My neck feels it sometimes in the morning but after a rub and a massage it's fine in two days time. You can feel the pressure coming through from them and you have to counteract that by being stronger yourself. If they're strong enough, you do your best to push them back. Of course It's a contact sport on the shoulders but there are ways and means to keep yourself safe: like having the right body angle at the moment of contact and scrummage correctly which we're all taught to do. You can't take the scrummaging content out of the game. That's part of the sport. It's a contest, everyone knows the risks, which are very minimal. If you take away the scrum, then it becomes Rugby League where the players are all lean and mean.

Where's the maximum pressure applied when the scrum collapses and what's it like to be in a collapsed scrum? Around the shoulders area, not on the neck. [Have you ever been scared that you might be injured from a collapsed scrum?] No, if you go in with that sort of attitude then you will get hurt. You've got to go into everything 100 per cent, because that is when you're going to get injured. There's an element of danger in every sport but you've just got to know it.