'I know how common ACL injury is. I was on my period for the game. You start questioning things.'

Sport can be cruel. Imagine having over three months of intense, lung busting, leg burning, World Cup pre-season training. Knowing the lineout calls inside out, set piece tactics drilled into you, team building and the dream of playing on the biggest stage in the world, only to suffer a serious knee injury in the first game as you break away, on course to score a crucial try for your country?

Enter flanker Alisha Butchers. Considered by many as Wales’ best player heading to New Zealand last year, the 25-year-old’s World Cup dream was cut short against Scotland in the first pool game in Whangarei. Ending with the Bristol player sat on a lonely 20-hour plane journey home, only five days into the tournament.

“I remember breaking the line and being very close but one of the Scottish girls came last minute and I felt my knee collapse inwards and I knew something had gone wrong,” recalled the back rower.

“The physios and I knew just by watching the footage back that my Anterior Cruciate Ligament (ACL) had been torn, but you want to stay away from those words until the scan is in front of you. In the end I learned I completely tore my ACL, I had a grade one tear in my Medial Collateral Ligament (MCL) and I had torn my meniscus as well.

“I got injured on the Sunday and left on the Thursday. Having to leave was just a part of the process of my recovery. I think it was really important that I left, and I was able to focus on myself and overcoming what had happened and moving on to my surgery.

“I touched down on the Saturday and was in with the surgeon that week for my first consultation where we went through my scan results. It was another three weeks until my surgery date but still quite a quick turnaround. With the injury I had it was important that my knee was in a good condition going into surgery, so we had to wait an extra week to make sure the swelling was down before they operated.”

Only having to wait three weeks for surgery is an experience Butchers will never take for granted. Back in 2021, she needed ankle surgery, but later discovered her insurance didn’t cover her due to a technicality around sustaining the injury whilst training for Bristol and not Wales. This resulted in her having to crowd fund to raise money for the operation to be done privately and not placed on an NHS waiting list.

“It was completely different circumstances,” recalls Butchers. “The first time having all the stress and uncertainty around not knowing whether I could actually have the surgery or whether I’d be waiting years for it, and now it’s the complete opposite.

“But I think it’s good I’ve been able to experience both sides of it. I know other players, who are not professional but playing at elite level, going through similar, but for myself, I feel the game has taken a big step forward in that area and I can only credit Wales and Bristol for that.”

Butchers has suffered her fair share of injuries and setbacks throughout her playing career, but through this has developed an optimistic outlook.

“With a long-term injury like this, it’s really important that you have to love everything that you do, otherwise every day is going to be a chore and a drag and it’s hard enough being injured!

“Over the past five months I’ve taken the time to really focus on myself, focus on getting stronger and fitter and it’s meant I’ve had a lot more time to study the analysis side of things, so it has come with gains and benefits. It’s not ideal, but I have learnt a lot about my myself over the past five months.”

And those past months have included some testing times, including the isolation of being away from the team environment, learning to walk properly again and being placed on heavy medication to handle the pain, as Butchers recollects.

“The first four weeks after surgery were tough, it was very painful, and I did a lot of laying around on painkillers trying to ease the pain. What was really important in the first part of my rehab was trying to get my leg straight again which was a real struggle. I was in with my physio two times a week initially, and she was trying to push it straight for me which was really painful and probably the worst part of the whole process.

“Then it was about coming off the crutches and doing laps around the physio room, trying to plant my foot and stride out with my legs straight, which is really difficult when you haven’t done it for a few months.

“I also had to work on my hamstring because with the surgery, they take a bit of your hamstring to make a new ACL, so my hamstring was really weak. It is kind of like repairing two injuries. My main focus was getting my hamstring really strong and running again.”

ACL injuries are unfortunately common in women’s sport, with this type of injury currently plaguing elite women’s football. Research has suggested female players could be up to eight times more likely to suffer an ACL injury than males, as covered by Telegraph Women’s Sport.

Three Wales players have suffered ACL damage in the team’s last six games. Gwen Crabb being the latest, being carried off in Wales’ opening game of the Six Nations against Ireland, following both Butchers and Megan Webb at the World Cup.

Butchers recognises the increased risk in women and admits she wondered whether where she was in her menstrual cycle played a part in sustaining the injury.

“I knew how common it (the injury) is. I was on my period for the game when I got injured. Did that have an impact on the laxity of my ligaments? Did it have an impact on my ACL going? Did I do enough prehab exercises beforehand? You start questioning things.

“But I had a long conversation with the head medic Jo (Perkins), who had to reassure me, as I did my ACL through a contact situation rather than twisting it, it was just unfortunate.”

As with many areas of women’s sport and health, more research is needed around these career threatening injuries and their connection with the menstrual cycle. With Wales Head Coach Ioan Cunningham telling the BBC that they are “looking at everything” for answers.

“Jo (Perkins) knows a lot about women’s health and she is teaching us how to optimise our training throughout the month around our cycles,” added Butchers. “She gave a presentation which was very beneficial and educational for us as a squad, and great to see we’re being treated as women now and not as little men.”

The number of professional players at Wales’ disposal increased to 25 ahead of Women’s Six Nations with the team flying on the pitch since their World Cup quarter-final defeat to New Zealand, having beaten Ireland and Scotland in the opening two rounds.

Butchers suggests what she would like to achieve personally, and where she’d like to see the team go in the next few years.

“As a team we would like to win something, a Triple Crown or a Six Nations, that would be amazing for the development of rugby in Wales.

“Personally, I’d like to get 50 caps, I’m on 39 right now. I’ve missed a couple of Six Nations and missed an Autumn campaign, so injury has meant I’m a little bit off.

“I like having a leadership role within the team and have developed that over the years as the lineout leader, I was vice captain for the Scotland game at the World Cup and I’m enjoying learning off the more experienced girls in the team and working alongside Hannah (Jones, Wales captain). It’ll be nice to see what happens next!”

Wales next face England in round three of the Six Nations at Cardiff Arms Park in front of a sell-out crowd. Despite having to watch from the side lines, Butchers can feel proud of her own progress and that of her nation, and the exciting path ahead.