Autumn Nations Series: England v New Zealand

Venue: Allianz Stadium, Twickenham Date: Saturday 2 November Kick-off: 15:10 GMT

Coverage: Listen to live commentary on BBC Radio 5 Sports Extra and BBC Sounds and follow live text commentary on the BBC Sport website and app.

Professional athletes are used to dealing with setbacks, but for England and Sale hooker Luke Cowan-Dickie the last few years have been especially turbulent.

Go back to 2021 and Cowan-Dickie was one of the best hookers in the world, a starting British and Irish Lion and a double winner with Exeter.

But a neck operation at the start of 2023 went wrong, causing nerve damage in his arm that took more than a year to heal.

And then, as he tried to work his way back to his former self, his heart skipped out of rhythm playing for Sale in January.

“I’ve had a bit of a terrible time,” he tells the Rugby Union Weekly podcast in the sunshine of England’s training camp in Girona.

Capped 41 times, fitness and health has meant Cowan-Dickie has not added to that tally since November 2022.

“The neck operation was quite a routine decompression, but I came out with a damaged nerve and my arm took about 16 months to get back to actually playing OK,” he explained.

“For the first four or five months I couldn’t really get my arm off my side, I couldn’t eat with a knife or fork, and I was only really bicep-curling 5kg.”

Cowan-Dickie did join England’s training camp before the Rugby World Cup, but was released early when it was clear he was some way off a full recovery.

“They say after nine months you hopefully see 70% strength, but I definitely didn’t have that.

"It was a decision we all made that I was able to play, but performance-wise you need a strong arm, so I didn’t perform as well as I wanted to last year, which got me down a bit I think.

“Last season I was playing but nowhere near as well as I could have due to my arm, and then my heart in one of the games [Sale against La Rochelle in January 2024] flipped into AF (atrial fibrillation) and went out of rhythm.

“I went to the hospital and they put me on a drip, hoping it would flick back by itself, which it did over 24 hours.

“Then I had the tests, MRIs and I had a portable ECG machine on me for a while, and they didn’t get anything back from it. Touch wood, everything has been fine ever since.

“They said it’s not really common, but more common in elderly people and athletes.”

Cowan-Dickie should never have been at Sale in the first place, having signed a deal to join Montpellier in the summer of 2023. But that move broke down after the French club cancelled his contract, citing concerns over his fitness.

There were also reports of an alcohol-fuelled incident while having his medical in France, something Cowan-Dickie puts down to a “misunderstanding”.

The move to Sale kept alive his England career. Lifestyle-wise, though, things had to change.

Cowan-Dickie was a renowned gamer, once topping global leaderboards in Call of Duty. But those 10-hour gaming sessions had to go.

“I’m a very addictive person in most things I do, so when I game, I game for ridiculous hours,” he explained.

“I was number one in the world at Hardcore Search and Destroy. That was back in the time I was injured with my knee and was playing 10 hours a day.

“When I was younger, it was fine, but now I am getting a bit older, routine-wise it just wasn’t good for me. I would game until the stupid hours.

“I would go to bed late, wake up just about on time, not train very well. And I would be tired. So I got into a better routine in the off-season, and my arm has come back, so that might have helped.

“My mind is just better, I just think clearer and am not as erratic in everyday life.”

Alcohol, too, has bitten the dust.

“I haven’t drunk in about four and half, five months,” he said. “I normally have a nice cold beer after the game in the changing room. Now it’s a nice cold coke.

“It’s erratic and I don’t like how I feel after it, so in terms of everyday mood and mental health, I just feel happier.”

Physically and mentally, Cowan-Dickie feels he is in as good a place as ever. At the age of 31, there might yet be time to rediscover the form that made him a world-beater.

With captain Jamie George and up-and-comer Theo Dan commandeering the number two jersey of late, he faces a battle to force his way into the 23-man squad.

But when Cowan-Dickie says he is just thankful to be in the squad again, you definitely believe him.

“I feel like I am back more like myself,” he added.

“I haven’t really been performing for a long time, so I feel like I am improving game to game and I definitely feel like there is more to come. I am excited."