The past fortnight has seen a spate of concerning injury news. Dylan Hartley will miss England’s summer tour due to ongoing concussion problems. Dragons centre Adam Hughes has been forced into retirement over the same issue. Northampton’s Rob Horne suffered life-changing nerve damage in his arm 13 seconds into the East Midlands derby and will never play again. Jonathon Joseph’s season is over, too.

Yet this is not unusual now. This season has seen club and international sides decimated by injuries, and England’s physio room is increasingly looking like a morgue. Hartley, Joseph, Watson, Lawes, and Hughes won’t play again until at least September. Others must be rested.

Season by season, Rugby Union is becoming more physical. Players coming through are bigger, stronger and faster than they have ever been, and the impact? More forceful collisions. Add to this the new ruck laws which allow teams to commit fewer men and put more in the defensive line, and not only do you have high impact collisions, but there are also more of them.

World Rugby have tried to control the concussion epidemic by lowering the height of the tackle through more severe sanctions and with Head Injury Assessments, but it is not enough. A large proportion of concussions suffered come not from being tackled high, but from tackling too low. The tackler is far more likely to be concussed colliding with a hip or knee than the tacklee is when caught over the shoulder. Indeed, when Danny Cipriani collided with Faf de Klerk’s forearm in a recent Premiership game, he was out cold for several minutes in what was a troubling incident to watch. But what can be done?

With the casualty rate so high, clubs and unions need to start taking player welfare seriously

Dr Willie Stewart has recently called for tackling to be banned. Indeed, this would be the only way to eliminate concussions from the game entirely. When scientific studies are warning that suffering severe concussion in your 20s can increase the chance of dementia by over two thirds, it is surely time to sit up and take notice. Of course, concussion is nothing new but as we become increasingly well-informed, governing bodies must take action. What’s more, as the NFL has demonstrated, the spectre of liability looms large.

Removing tackling would end Rugby Union as we know it. Indeed, many would argue that the positives of playing the game outweigh the risk of injury, concussion, and the potential complications in later life. So there must be less drastic alternatives.

Banning tactical substitutions could be one. Back before the days of professionalism, players could only be replaced if they were injured. While it would be difficult to police – especially with concerns over invisible brain injuries – it would mean players would need to be more durable and would change the focus on size and power to a focus on skill and stamina. It could reduce the force of collisions.

If any side in the world can afford to rest players it is England, given the great depth they possess

Another way is to improve tackle technique. If tacklers get their heads in the right position more consistently, they are far less likely to be concussed and, if they hit at the right height, there is less danger to the tackled player. This needs to be a focus from grass-roots right up to international level.

Lastly, at elite level, the playing load must be reduced. Fewer games means fewer chances to get injured and means players will be fresher – injuries are more likely for fatigued bodies. The Rugby Football Union (RFU) has in place limits on the number of matches England squad members can play in a season (32), and rules about rest after the Six Nations; but both have been breached. This season Mako Vunipola was not given his mandatory rest after a gruelling Six Nations, and last season it is thought Maro Itoje exceeded the playing limit due to the Lions tour. This is simply unacceptable. With the casualty rate so high, clubs and unions need to start taking player welfare seriously. More stringent regulations should be put in place, the playing limit reduced further, and fines handed out for breaches.

Unfortunately, there is a limit to what the RFU can do. In England, it is the clubs that hold all the power: they own the players and make the Premiership what it is. In Ireland and New Zealand (the only sides above England in the world rankings) it is the unions which have control. This allows them to dictate when their players play. For example, going into the 2018 Six Nations, Jonny Sexton had played just 435 minutes for Leinster this season compared to Owen Farrell’s 1084 minutes for Saracens. It is a startling comparison and is part of a trend throughout the respective squads which may go some way to explaining the poor showing of England in the Six Nations and of their club sides in the Champions Cup.

This is an age-old problem in England. When rugby union was on the verge of professionalism, it was the clubs that acted first when the RFU hesitated. The clubs took the initiative and the RFU have been playing catch-up ever since. The club vs country struggle is unlikely to go away, but both need to come to their senses about the welfare of their greatest assets. If that requires huge financial investment by the RFU, then that’s what they need to do.

In the short-term, England must rest some of their stars for their summer tour of South Africa. Owen Farrell, Maro Itoje, Jamie George, Mako Vunipola, George Kruis and Dan Cole have barely stopped playing since September 2016 and, going into a World Cup season, are at high risk of burning out. If any side in the world can afford to rest players it is England, given the great depth they possess. The likes of Danny Cipriani, Luke Cowan-Dickie, Dave Attwood, Ellis Genge and Harry Williams are ready-made replacements.

The only time players seem to get a break these days is when they have an injury. This needs to change – starting this summer.