And so it goes on. Another day, another injured England international struggling to play any part in the forthcoming autumn series. It has been feared for some time that Simon Shaw would be a doubtful starter against Australia on 7 November and today brought confirmation of the Lions lock's unavailability for most, if not all, of next month's Tests because of a lingering foot problem.
Almost half of Martin Johnson's first-choice side will be missing for the opening date against the Wallabies. More worrying is that the sidelined Phil Vickery, Lee Mears, Andrew Sheridan, Shaw, Tom Rees, Riki Flutey and Delon Armitage represent the tip of a large iceberg. One-third of the 64 players in England's senior and Saxons squads are out of action with a mangled joint, broken bone or twisted ligament of some description. A bruising trade grows ever more brutal.
Interactive guide: The pain game - English rugby union's injury log
Even if you set aside the recent spate of high-profile casualties, the underlying facts make stark reading. According to Simon Kemp, the Rugby Football Union's head of elite medicine, top-level professionals in England have a one-in-eight chance of suffering a significant injury when they lace up their boots on any given weekend. At any one time a Premiership or national coach will be minus almost a quarter of his first-team squad. Johnson, statistically, can expect to lose at least a couple more players before Sunday's national squad gathering.
How can this be in an era when fitness, rehabilitation and diet have never been so zealously monitored? It depends to whom you talk. Both the RFU and the clubs say the injury trend is not, as yet, an epidemic. From 2002 to 2008, the casualty rate across the 500-odd professionals plying their trade in England has remained largely unchanged. Shaw does believe something is amiss and expressed strong feelings on the subject in the City of London today at the launch of a multimillion pound sponsorship deal between QBE, the insurance company, and Premier Rugby.
Shaw, 36, openly questions whether the next generation will enjoy his longevity. "I don't necessarily think the game itself is the cause. It's not even the number of games we are expected to play. I would argue it has more to do with the length of time people are expected to remain at the peak of their fitness. The stresses and strains you put your body under, not just in games but week-in week-out at training, are enormous. If you do that over a long period of time you're going to break down. It's the Jonny Wilkinson syndrome. People questioned why he got injured so often but it might be a result of the fact he would train through his holidays and never let go. The structure needs to be looked at."
This afternoon, with a neat sense of timing, officials from the RFU and the clubs were at a meeting to receive the preliminary injury figures for the 2008-09 season, painstakingly collated at Nottingham University. According to Kemp, there is unlikely to be a significant increase. Assuming he is right, – and he knows more about it than anyone – what conclusion should we draw?
Is the current carnage a blip or does it reflect an unpalatable truth: that the country's leading players, regardless of position, have never been more vulnerable? The bigger and stronger they become, perversely, the greater the risk.
The Lions doctor James Robson has warned that players are growing "too muscle-bound and too bulky" and the 6ft 8in tall Shaw agrees with him. "There is an argument that people spend too much time in the gym, creating more of an athlete than a rugby player. By doing that, you take your body to a state where it is more liable to suffer tears and strains. While there's a lot of pressure on young guys to be stronger, faster and fitter, they should look at people like Serge Betsen and Lawrence Dallaglio. Serge doesn't lift many weights but on the pitch he'll never stop. Lawrence was never great in the gym but you're not creating gym bunnies, you're trying to make rugby players. We've got to start looking at the skill side of the game more than the physical element."
Kemp pleads for patience and stresses that two or three high-profile injuries" can mitigate against "statistically robust conclusions". Nor is it, self-evidently, just an English problem. Wales are without Lee Byrne, Adam Jones and Mike Phillips. New Zealand are about to tour without seasoned front five forwards Ali Williams and Keven Mealamu. Only Samoans seem to be made of impenetrable granite.
At least Shaw, yet to play this season because of issues relating to his fourth metartarsal, hopes to return soon. "In a perfect world I'd hope to play against Leeds next weekend but I can't say for definite because I was in this position three weeks ago. You have to tread very carefully, literally. Assuming I play against Leeds I'd want two or three games under my belt before I thought about playing internationals." He freely admits, though, that his lay-off came as something of a relief. "When I was injured, to be honest, my first thought was: 'I'm happy to have a few weeks off.'" If ever there was a cry for help, Shaw's candid admission is surely it.
