The look of agony on Alex Mitchell’s face was horribly familiar as the England scrum-half suffered another hamstring injury during Northampton Saints’ victory over Gloucester on Saturday night.

It is his fourth hamstring injury since February – three to his right leg during matches and one to his left in training – and looks likely to rule him out of England’s opening autumn Test against Australia at Twickenham on Sunday.

With Leicester Tigers’ Jack van Poortvliet expected to start against the Wallabies and Mitchell’s Northampton teammate Archie McParland also injured, England are likely to need to call up one or two scrum-halves. Bath’s Ben Spencer and Bristol Bears’ Harry Randall are among the contenders.

For Mitchell, it is another setback in a distinguished career that includes starring for England at the 2023 Rugby World Cup and representing the British & Irish Lions in 2025.

It also raises familiar questions about whether elite players are being asked to shoulder too heavy a workload during an increasingly congested season, and who ultimately decides when they are fit to play.

The i Paper spoke to Mitchell last Monday, five days before his latest injury setback.

The 29-year-old is one of 25 England players on enhanced contracts, with their welfare managed jointly by club and country.

He revealed that, after returning quicker than expected to feature in Northampton’s Prem final victory in June, he chose to tour with England despite being given the option to sit it out. He was injured playing against Fiji three weeks later.

Mitchell praised England head of performance Phil Morrow and his Northampton counterparts Tom Bullough and Ben Rhodes as “people at the top of the game”, describing a system in which the player ultimately has the final say.

“At the end of the day, they kind of make us make the decisions, which is really good and they’re really open,” he said.

“There’s no push or pull on either side. There are always opinions, but it’s never too much ‘he should do this or he should do that’.

“They’re very open and flexible with it, which I think was fantastic for me to have, instead of [the decision being] black and white.”

It is difficult to establish precisely what causes hamstring injuries, given the range of factors involved, from training and match workloads to individual anatomy.

England players can theoretically be rested after reaching 30 matches in a year, but Maro Itoje, Henry Slade and Tommy Freeman are among recent examples of players who have exceeded that threshold.

It was a rare example of a senior England player taking an extended break when captain Itoje sat out the recent summer.

Mitchell, meanwhile, had the statutory five-week break following England’s tour and appeared in fine form when scoring a spectacular solo try against Bath three weeks ago.

But on Saturday, at DPD Stadium at Franklin’s Gardens, he lasted just 19 minutes when the injury struck.

Read more

Defending in the backfield, Mitchell moved forward to confront Gloucester centre Will Joseph.

As he prepared to kick a bobbling ball, he pulled up sharply and immediately reached for his right hamstring.

He then put both hands to his face as the familiar feeling dawned.