When Sarah Hunter first injured a nerve in her neck in October 2020, all she could think about was when she would be back on a rugby pitch captaining England.

Hunter will lead England out against Italy for her 124th cap on Saturday after 13 months away from international duty.

The 35-year-old's last Red Roses appearance came against Wales in March 2020. She was unable to play in their postponed Six Nations Grand Slam-winning game against the Azzurre eight months later because of a hamstring injury.

But it was the nerve issue that would eventually become what Hunter describes as "the toughest injury I have ever had", with doctors unable to find the cause for five months.

"No one knew what it was," she explains.

"I went to see different specialists, had numerous MRIs and numerous tests - electric tests and neurologists, all sorts of different things.

"You would go to an appointment hoping you would get an answer and there was no answer."

'I lost power in my hand'

Hunter says doctors stopped looking at her "as a rugby player", instead worrying what impact the injury might have on her entire future.

Despite the terrifying effects the injury was having on her motor skills, Hunter's main concern remained when she would be able to play rugby again.

"I lost power in my hand and it was affecting day-to-day stuff like doing my shoelaces, holding things, eating," she adds.

"They start having conversations with you around your long-term day-to-day life.

"As a rugby player, that becomes quite worrying. You think, 'what happens if I don't get to play rugby?'"

Avoiding conversations on 'hanging up boots'

Eventually that dreaded word began to be discussed: retirement.

It was particularly unthinkable with England due to compete at the World Cup in September - an event which has now been postponed until 2022 - but Hunter's family wanted to raise it.

The Loughborough Lightning number eight says she avoided giving her loved ones "all the information" because she knew they would worry.

"I just thought, 'I'll get back, do my rehab and be fine'," she continues.

"Your loved ones start to have more serious conversations with you. I think I was a bit blase at times wanting to just give it a go.

"If it didn't work, we would have a proper conversation about whether I needed to hang my boots up. Fortunately it all worked out well in the end."

Hunter is '100% or nothing' leader

Hunter says doctors eventually "got to the bottom of it", allowing her to finally return to the game that she loves.

Despite not being able to play for over a year, she remains a shining example of leadership for her team-mates to follow.

When head coach Simon Middleton decided she was not quite ready to return in last weekend's 52-10 win against Scotland, she immediately asked whether she could be the water-carrier for the game to stay involved.

It is behaviour like this that leads Middleton to describe Hunter as a "fantastic leader" and someone England have "missed massively".

"It is the quality and spirit that she brings for someone who has so many caps," Middleton says.

"Every training session is exactly the same. It is 100% or it's nothing."

Those qualities may be essential if England are to claim a first World Cup win since 2014 in New Zealand next year.

Hunter knows that she will have to manage her body to be in optimum condition for the competition and that may well mean begrudgingly playing less in the meantime.

"I'm at a stage in my career where I don't need to do certain things," she says.

"That acceptance probably comes with a bit of a grudge. My ultimate goal is to play in that World Cup next year.

"If that means potentially not playing every game or every minute but I get to go and live the dream and win another World Cup I'll take being selective over the games I play to keep me going for a little bit longer.

"Most people want to play every game and every minute but I'm at the stage where I recognise that might not be possible or our medics would have a tough job."

'I will cherish every moment'

The first step on the journey to New Zealand will be Saturday's game in Parma, where victory would put England in the Women's Six Nations final.

Hunter knows her return to the field will bring plenty of emotion and after such a tumultuous 13 months away she will be savouring every second.

"It means everything to get back out there," she continues

"Not knowing whether this opportunity was going to come, it does get me at times.

"Quite often people take things for granted sub-consciously and it's made me realise to cherish all the moments because you don't know when it's going to be your last."