Warning: Cup could damage your health

World Cup countdown: The running and tackling, the rucking and mauling, will be harder than ever - at what cost?

The good news for players competing in the fifth World Cup is that the level of medical care in Australia will be second to none. The not-so-good news is that the doctors and nurses expect to be busy.

Reviewing data from previous tournaments and matches, Dr John Best, one of Australia's medical co-ordinators, predicts an average of four injuries per game: 20 per cent to the head and face, 45 per cent to the lower limbs. It is anticipated that an ambulance will be used at one in 10 matches. An injury is defined as a player leaving the field or receiving significant medical attention.

At every stadium there will be a sports doctor, an ortho-paedic surgeon, a plastic surgeon, an anaesthetist, a dentist and an X-ray nurse. In each city there will be a sports doctor on 24-hour call.

"The Australians will provide a comprehensive level of medical provision,'' Dr Simon Kemp, the Rugby Football Union's head of sports medicine, said. "When England played Australia in Melbourne we had a trial run, and everything was first-class.''

One of the strengths of the International Rugby Board is that they have almost 100 members throughout the world; one of their weaknesses is that the game's power and wealth is concentrated in so few countries. When the Ivory Coast qualified for the 1995 World Cup in South Africa, the celebrations of the West African country were completely overshadowed by the spinal injury suffered by the wing Max Brito against Tonga. A tetraplegic, he received specialist treatment in South Africa before being flown home.

"We became involved in money-raising events for Max, but there was very little support from Rugby World Cup,'' Damian Hopley, the head of the Professional Rugby Players' Association, said.

Harvey Thorneycroft, the former Northampton wing, organised a tour to Ghana and the Ivory Coast to raise funds, and South Africa also played their part. "At the professional end, players now have good cover at club and international level,'' Hopley said. "They are fully aware of the fragility of their careers. At the other end, there's no such cover, and we are very concerned about the potential effect of mismatches.''

When Brito was paralysed, the system was that the cost of emergency treatment was borne by all the unions from a general fund. This time it is the responsibility of the individual country. They are being encouraged to take out insurance cover, but it's a low priority for the likes of Romania, Georgia, Samoa and Uruguay, who struggle to keep a squad together.

In this World Cup, as in every other, there will be one-sided contests, although it does not necessarily follow that weaker teams will suffer a disproportionate number of injuries. "We don't have information relating to one-sided matches,'' Dr Kemp said, "but my view is that the physicality of a match will drive up the injury rate. I would expect it to be higher for England against South Africa than, say, England against Uruguay. The game, of course, has got harder and faster, and with more powerful players you expect the collisions to be more ferocious.

"Intuitively you feel there is an increased risk of injury, but there's a counterside. Players are better conditioned to cope. Catastrophic injuries, like the one suffered by Max Brito, are very rare at the élite level. The statistical average is that they shouldn't occur more than once in every four World Cups."

Dr Kemp, not to mention the RFU, the Premiership clubs and Leicester University, is involved in a world-leading injury audit that records injuries sustained in play and training. The aim is to produce a definitive study leading to a programme of prevention. "This is 20 times bigger than any previous study, and the report will be published in 12 months,'' said Dr Kemp. "What we have already discovered is that the injury rate is higher at Test rugby than in the Premiership.''

As for insurance cover, England Rugby, worried by rising premiums, are looking at forming a discretionary trust to serve the specific needs of professional competitors. In the meantime, the players are wearing more protective gear.

"I just hope,'' said Hopley, "that everybody has learned something from the Max Brito affair.'' The PRA run a benevolent fund and have worked closely with Andy Blyth, the Sale centre who suffered a spinal injury at Saracens three seasons ago and who has recovered the use of his legs.

Hopley has first-hand experience of a career-threatening injury, and the frustrations of dealing with the authorities. A Wasps threequarter in 1996, he captained England in the Hong Kong Sevens and was invalided out with a knee injury. He spent 15 months in rehab, made a brief return, suffered a recurrence and was forced to retire at 27.

Hopley sought compensation from the RFU. "I never received a penny. They didn't feel they had any responsibility, even though I was captain of England when I got injured. I was one of the first casualties of professional rugby. I had some insurance, but I struggled to pay my medical bills. I'm still disgusted at the RFU's archaic attitude. Basically they told me to sling my hook. Still, every cloud and all that. If it hadn't happened I wouldn't be doing the job I'm doing now.''