CONCUSSION

training load and whether players would benefit from restrictions.

It’s worth highlighting mental pressures as well as physical ones. Looking at the England structure from 2019-20 and those aforementioned breaks, Warburton insists it will still be hard to totally switch off in the middle of an intense season.

“There might be breaks but it’s a long time mentally,” he said. “Even if you’re physically helping a player, you’re not helping a player emotionally and mentally. It’s a long time in competition.”

The survey threw up similar concerns. One player said: “The season is too long mentally and physically.” Another said: “When you are on the fringe of your international side, doing the mental prep and playing limited minutes, then having to play in your break, it puts massive strains on relationships at home.”

You couldn’t describe Marler as a fringe international – he played 59 times for England between 2012 and 2018 – but the effect playing for his country had on his family life saw him call time on his Test career in September. How did that manifest itself?

“I’d be at home in a pretty dark place, not talking, not interacting with the kids or the wife,” says the 28-year-old. “My wife would say, ‘Any danger of you being here with us?’

“I’d be thinking about going away (with England) and having to leave Daisy and the kids. I’ve used the word anxiety because that’s how it felt. There’s a lot of pressure in any England environment and top-level elite rugby.”

He admits that when England opened their autumn campaign against South Africa, he woke up wishing he was playing at Twickenham. “But I quickly realised I didn’t miss it enough to do everything in order to get to game day – the three weeks beforehand, the time away from home. I make sacrifices for my club, for the team, but I also get to come home each night.”

Conversations around mental health are a lot more prevalent these days, not only in rugby but the world as a whole, with the sport’s player associations providing support programmes in this area. However, if changes in the game, such as the length of the season or number of Tests, would also help in this area, they must be addressed. HERE HAS rightly been an increased focus on head injuries in recent years and there is undoubtedly far more awareness of the issue. Yet this survey proves there is still work to do, with nearly a third of players admitting they’ve hidden symptoms in order to progress through the ‘return to play’ protocols after suffering a concussion. “These decisions need to be taken out of the hands of players,” says Omar Hassanein.

Players have raised further concerns about the Head Injury Assessment (HIA) protocols. One player said: “It needs to be changed. The list of word recalls needs to be increased because the same list of words are being used and doesn’t properly evaluate recall.”

Also, while 84% of those surveyed feel medical staff follow the HIA process to

Tthe letter of the law, others have shined a spotlight on the pressure exerted on medics – much like the pressure players themselves feel when not fully fit.

“Some allow players to get back to playing before they are fully recovered, sometimes due to pressure from clubs to perform,” said one. A second added: “Scared of head coaches, they sometimes move you through the HIA return to play faster than required.”

Measures to reduce the risk of players suffering head injuries have been introduced, such as the increased sanctions for high and dangerous tackles. Yet this has caused controversy of its own, with people, including some current players, bemoaning the game ‘going soft’ and questioning certain decisions as well as a lack of consistency in decisions and bans.

“Players need to understand that the laws and rules are in place to protect us,” says Ireland full-back Rob Kearney. “To ensure players’ safety is the upmost priority. If someone gets a shoulder in the head, regardless of how it happens, players will be penalised for that.

Players need to accept that.”

“Scared of head coaches, medics sometimes move you through the HIA return faster than required”