Injury management has become a way of life for Sam Warburton

Sam Warburton's latest setback adds to a long list of injury frustration. Stu Forster/Getty Images

I was chatting to Sam Warburton in the summer of 2015, a few months before the World Cup. We were talking flanker to flanker about injuries and, having just had a total knee replacement, I commented on the fact that it was my first such surgery and that the knees had done pretty well to last until I was well into my 60s.

Sam grinned then grimaced and said there was no chance his knees would last that long. "I cannot remember the last time I went upstairs at home without using my arms to haul myself up using the banisters," he reflected ruefully.

He was only 26.

He is not yet 29 but it is estimated that he has had at least 20 serious injuries, six of them resulting in surgery. Now he faces another operation on a 'longstanding neck injury' that flared-up again when he returned to full training at Cardiff Blues having taken time off post Lions' Tour. He is not expected to be back in action for four months.

"He has undergone scans and has been reviewed by a consultant who confirmed the management plan," read the Blues statement. Management is the big word here -- it has become a way of life. The reality is that Warburton will never recover completely and it is an indictment of the modern game that a player who is a model athlete -- nobody works harder at making sure he is in peak condition -- is almost literally falling apart before he is 30 without ever having incurred the sort of single catastrophic injury that can finish any rugby player's career.

Fortunately, the medical team at Cardiff and the WRU are second to none but being one of the main ball winners at the breakdown is a hazardous business these days -- there is enormous stress on the neck and knees. It is a massive blow for the player himself -- he was really looking forward to rejoining the fray and taking on New Zealand again in November after a well earned rest post Lions -- but it is also a huge setback for Warren Gatland and Welsh rugby.

Warburton is a natural leader and Gatland trusts him completely as a player and a captain as he demonstrated on the Lions' Tour. After the final Test he was quick to praise his diplomacy at the final penalty/non-penalty incident that could have cost the Lions the series. "We've probably got the captain to thank in the end,' he said. "He's not always in the referee's ear and that means the referee listens when he does suggest he might want to review a decision - it worked. If he had been talking non-stop he would probably have ignored him."

Fortunately, Wales are not short of leaders. Alun Wyn Jones took over whilst Warburton concentrated on his rehabilitation after another injury last season and commands great respect from the players. I have no doubt he will continue as captain for the Autumn internationals and make a good job of it.

However, Wales cannot replace his work at the breakdown and they now have a real problem with back-row options as Ross Moriarty is still sidelined by that back injury he picked-up on the Lions' Tour. As a result Justin Tipuric will get an extended run in the No. 7 jersey -- he did not have much of a chance to shine in New Zealand and I feel this will be a make or break season for him. His work rate and mobility are excellent but he needs to show he can make a real impression at the breakdown a la Warburton and not just shine when the game opens up.

Losing Warburton suddenly makes November look daunting for Wales -- as always there is no great strength in depth and four Tests in four weeks is a big ask -- but the most important factor in the long run is the health and fitness of the skipper.

Hopefully, the operation will be a complete success and the 'management programme' gets him back for the Six Nations. Then we have to hope he stays injury free so that we can enjoy a genuine national treasure while the knees last.