Keith Earls: ‘I told him I was quitting. I was drained mentally and physically’

Book extract: Munster star on nightmare years of pain before a chance diagnosis

That try against England in the 2021 Six Nations. It wasn't as good as I thought it was in real time. The build-up was slick all right but looking back at the finish on video, I could've stepped Jonny May a bit sharper. It was sharp enough to get the job done but it was more a shuffle than a step.

I took my time about cutting inside him! Thrilled to score it, delighted to get it, a career highlight. But the cameras don’t lie and when I reviewed it later that evening, I’d have liked the step to be a bit more lethal than it was. I know I should enjoy these moments more because they don’t come along very often. But I’m in the habit of being self-critical. Any sportsperson serious about their trade will be self-critical because that’s the road to self-improvement.

At the same time you can be too hard on yourself. I’m trying to get the balance right but it’s still a work in progress. I’m definitely not as hard on myself as I used to be. I’ve spent most of my career punishing myself for not being better. And if I wasn’t beating myself up in my mind, I’d be beating myself up in my body. In fact the physical toll got so bad in the previous three years that if I had my way, I wouldn’t have scored that try against England because I wouldn’t have been on the field. I’d have been retired.

Six months earlier I'd told Johann van Graan I was retiring with immediate effect. It was a Monday morning in September 2020. Leinster had beaten us in the Pro 14 semi-final a few days earlier. That result hadn't improved my mood either but it ended Munster's season and I was sure it was the end of my career too.


The truth is that from about 2017 to the end of 2020 my lung capacity was only functioning at about 50 per cent

Myself and my wife, Edel, had discussed it over and over in the previous months. We’d both agreed it was time to pull the plug.

Edel will tell you the previous three years were hell. I was at the end of my tether and I think she was at the end of her tether dealing with me. Something had to give and it was going to be my career.

The truth is that from about 2017 to the end of 2020 my lung capacity was only functioning at about 50 per cent. Maybe it was more than that but it felt about half of it had been cut off.

Like, I couldn’t fill my lungs with air. I couldn’t take the deep gulps of oxygen you need to take when you’re running round a field for 80 minutes. It felt like there was a small soccer ball sitting in my chest and it wouldn’t let my lungs expand. It felt like a bear was hugging me. I just couldn’t get my ribcage to expand. So I was constantly gasping for breath. One piece of action and I’d be flahed. One carry and I’d be praying the ball wouldn’t come near me for another couple of minutes.

Keith Earls touches down to score a try in the Six Nations game against England at the Aviva Stadium back in March. Photograph: James Crombie/Inpho

I was covering it up, I was hiding the problem and getting through game after game on pure desperation and stubbornness and match experience. The irony is that I was playing some of the best rugby of my life in that period. I started every game in the 2018 Grand Slam campaign. I received the Players’ Player of the Year Award for that season, which was a huge personal honour.

But to give you an idea, the following summer, in a pre-season camp before the 2019 World Cup, we were doing a sort of grappling session one day in training on the grounds of Carton House. The idea was that you'd have the ball and your man would have 30 seconds to try and rip it away from you. My partner this day was Johnny Sexton. Johnny started wrestling with me and after about 10 or 15 seconds I had to give up.

It was the first time in my life I gave up on anything on a rugby field. But I wasn’t able to keep going. I couldn’t get the air into my lungs. I couldn’t hold on to the ball. I was just too weak and fatigued. I had to go down on my hands and knees to get my breath back. Then we had to do a run after the wrestling session but I wasn’t able to. I stayed down on my hands and knees. One of the physios came over to me and I was close to tears.

I was living with this situation every day for maybe four years in all. It was an absolute torment. I was getting huge amounts of physio but all it was doing was patching me up to survive the next game.

Walk the dog

I had all sorts of scans and X-rays and medical opinions but nobody could get to the bottom of it. The best they could come up with was that it was related to my back. I'd always struggled with back issues anyway, probably because I'd damaged it doing weights too young. My father Ger was playing with Young Munsters in the All-Ireland League and he had a makeshift gym in our back yard. I used to sneak in when he was away at work and be lifting various weights. I had kyphosis as well, a slight curvature on my upper back.

By the time the problem became a crisis I was regularly getting back spasms. I couldn’t even pick up the kids for fear of causing a spasm. If they wanted to go rollerblading or on the trampoline, Daddy couldn’t join in cos he was minding his back. I couldn’t even walk the dog.

On top of that I was dealing with an undiagnosed hiatal hernia that was churning up acid reflux in my stomach. The food I was eating was driving it mad. I’d be belching and burping all the time, the sick would be coming back up in my mouth. A few months ago they put a scope down my throat and found that my oesophagus was burnt from the acid, it was red raw.

Physically I was a mess which meant that mentally I was a mess too. It was a complete mind bender. But because the medical people couldn’t get to the bottom of the problem, a few of them started dropping hints that it could all be in my head. This pissed me off even more. I was unbelievably frustrated about that.

Munster’s Keith Earls dejected in the closing stages of the Champions Cup semi-final against Saracens at the Aviva Stadium in April 2017. Photograph: Billy Stickland/Inpho

Like, I’ve learned enough about my mental condition to know my brain and to know when I’m in a bad place emotionally and psychologically. This time there was something definitely wrong with me physically.

One of the running repairs was acupuncture, putting needles in my chest and my abs to try and get a bit of relief from the spasms. At half-time in games I’d be getting needled to loosen up the back spasms I’d picked up in the first half. Sometimes it worked, sometimes it didn’t. There were days I went out and felt okay and thought I’d maybe put it behind me only for it to flare up again the next day.

A couple of X-rays showed I had degenerative discs in my spine so they guessed that this might be the root of the problem.

Arthritis or something like it. So I was sent to a rheumatologist and he prescribed Enbrel, a medication for arthritis. I was injecting it into my thigh for a year. Nothing improved. Coming up to the 2019 World Cup I was on the physio bed first thing in the morning, after training in the afternoon, and evenings too. I was taking two or three hot baths a day. In Japan I was soaking myself in their Onsens every day, their mineral baths, all just trying to survive from day to day.

Lots of days I did no training at all. I ended up feeling guilty and paranoid about that. Was I losing the respect of my team-mates?

For years I had physios working on me who went beyond the call of duty trying to fix me. Ray McGinley in particular stuck with me through thick and thin. If I was earning soccer player wages I’d put Ray on my payroll and keep him for myself, he’s been that important to me. A lot of the time their treatment would work for a short while too and afterwards I’d feel great, but once I went training again the next day, I’d be knackered all over again. It was all maintenance work but it was very high maintenance and ultimately unsustainable.

Every day going into training, I was dreading it. Would I be able to get through the session? I wanted to do every session. I didn’t want to be hanging around just doing a few laps and a few warm-ups. I didn’t want to be treated as a special case. But a lot of the time I had to ease off and not share the same workload as everyone else.

Lots of days I did no training at all. I ended up feeling guilty and paranoid about that. Was I losing the respect of my team-mates? I was still getting picked at the weekends but I wasn’t doing the same amount of daily graft that they were doing. It didn’t seem fair to me and that troubled me.

I'd usually manage to hang in in games and get through them but there were games when I wasn't even able to do that. I remember when Munster played Saracens at the Aviva in the European Cup semi-final in 2017, they were on the attack early doors. I blasted into a ruck trying to disturb their ball. The effort lasted about 10 seconds and I was gasping for air after it. I just felt my chest cavity closing in on me like there was this big pressure sitting on my chest. And I remember thinking, 'Oh my God, there's another 70 minutes of this to go'. I was taken off after an hour or so.

In hindsight it was stupid of me trying to keep going, especially in the big games. I think I should have just bailed out and told everyone I wasn't able anymore. But in Limerick and Munster rugby the golden rule growing up was that you didn't give up. You never gave up. You played through the pain barrier, no excuses. I was old-school like that too so I just bulled along and said nothing. But at home I'd unload it all on Edel. Many a night in bed I'd be telling her I can't do this anymore and every morning I'd get up and do it again.

But by September 2020 I’d run out of road. The 2019/20 season had been suspended in March because of the pandemic and I’d plenty of time to mull it over during that spring and summer. When it resumed in August I was still battling with the same problems. There was still no sign of a solution and I was just sick of the whole damn situation.

And that’s what brought me to Van Graan’s door a few days after the 2020 season ended. It was in one of the Munster rugby offices at our high performance centre in UL. I told him the whole story, I told him I was quitting. I told him I was drained mentally and physically. Johann sat and listened. He was very understanding. I think he was a bit shocked as well.

He asked if I could give him 36 hours to think about it. He came back to me a few days later and laid out his reasons why I should reconsider. He was rebuilding the Munster squad, there were exciting times ahead, a lot of young talent was coming through and he’d love to have me onboard as one of the experienced voices in the squad.

I wasn't right in myself

That was definitely something that was giving me a quandary all right, the prospect of playing with the new generation. Johann also said that they’d review my whole medical experience with this condition and try to get to the bottom of it once and for all. They would do a sort of full NCT on me. In the meantime the physios would work on my right ankle and knee and hips because they’d been giving me a lot of gyp too.

A few weeks later Andy Farrell rang me. The 2020 Six Nations was resuming in October, would I be available for training camp? We had two games left, against Italy and France. I appreciated the call but I turned him down. I didn't tell him what I'd told Johann but I told him I wasn't fit, I was as well to continue with my rehab in Limerick. Andy was sound about it. But then Jordan Larmour got injured playing for Leinster after the Ireland squad was announced so myself and Andy had another conversation and I said I would go in. I'd been having second thoughts anyway. Like, who was I to be turning down my country? When the Ireland head coach comes calling you say yes every time.

My head wasn’t in the right place when I said no the first time but I was clear about it this time. I said to him, yeah, I’ve got through this the last few years so I might as well do it one last time. He said there’d be no pressure to play in the Italy game, just come in and do the rehab with us.

Then Garry Ringrose got injured playing against Italy and Andy asked me could I make myself available for the France game. I just told him straight out that I wasn't right in myself and I'd be a liability to the team. Even to say that was a big deal for me. It had taken me 10 years to win something with Ireland and now there was a chance of us winning another championship, depending on the results on the day. Normally I'd have been desperate to play in a game of that magnitude but it was a sign of how bad I was feeling.

Keith Earls: ‘Lots of days I did no training at all. I ended up feeling guilty and paranoid about that. Was I losing the respect of my team-mates?’ Photograph: Morgan Treacy/Inpho

I rejoined the lads in Carton House. As it turned out, France beat us in Paris and England took the title. Two weeks later we had Wales in Dublin in the Autumn Nations Cup. I was put on the bench for that one. I was sent out to warm up behind the goals with about 15 minutes left to play. And I remember cursing and swearing with vexation. One of the lads asked me what was wrong and I was like, for fuck's sake, this fuckn thing is back again. I couldn't even manage the warm-up without seizing up inside. They sent me on for the last nine minutes and it was plenty, I was just about able to survive.

We were playing England in Twickenham eight days later. It turned out to be a very lucky break. Professor Phil Glasgow, head of physiotherapy and rehabilitation with the IRFU, was looking after me at Carton House. Phil has huge experience in his field, he was chief physiotherapist for Team GB at the Rio Olympics in 2016. I had discussed my whole medical history with him. Phil would go through our routine and loosen me out and do all the soft tissue work. He'd have his fingers buried in my diaphragm trying to stretch it all out.

And because we were going to London he decided to contact the breathing specialists he knew there and set up an appointment for me. I’d be travelling over with the Ireland squad so we’d be exempt from the Covid-19 quarantine.

We flew over on the Thursday. I got straight into a taxi from the airport with Stephen Mutch who'd just started as lead physio with the national team. At this stage the team for England had been announced and I was selected. So my anxiety levels were starting to escalate again.

I was taking in huge gulps of oxygen right down to my guts. It was hitting the sweet spot. I could feel the satisfaction of filling my lungs. Hallelujah!

We arrived at the Institute of Sport, Exercise and Health on the Tottenham Court Road. I got all the MRIs done and various ultrasounds as well. The consultant we were meeting had all my reports and scans from Ireland too. Another doctor spotted something in a scan that she wanted to have a closer look at. The two of them conferred and came to a conclusion. It was my liver that was possibly at the root of the whole problem.

The consultant said he’d seen the same symptoms in a cyclist and a rower he’d worked with. They figured that the ligaments holding it in place had been loosened over the years, probably from getting banged up playing rugby. As a result the liver was sort of floating a bit, it was sliding up into my chest and pushing up against my diaphragm and that’s what was affecting my back and breathing. It was a breathing dysfunction caused by the liver not being held in place. It seemed to make sense. I was just relieved they didn’t find some sort of terminal disease because that was a thought that had crossed my mind more than once over the previous three years.

But I had a game against England 48 hours later. What was I supposed to do about that? They said the only thing I could do was strap it up. Strap up the ribcage as tight as possible and hope it would keep the liver tied down. It wasn’t a very high-tech solution but it was the best they could come up with.

Stephen Mutch taped me up about an hour before the game. He used this really strong medical strapping. It felt like a straitjacket and there were times in the previous few years when I was close enough to being put in one.

I jogged out for the warm-up and a miracle happened. I was breathing free. I was filling my lungs. I was taking in huge gulps of oxygen right down to my guts. It was hitting the sweet spot. I could feel the satisfaction of filling my lungs. Hallelujah!

The strapping was doing its job. It was holding everything in place. I could feel the tension of it against my ribs every time I breathed in and breathed out. Christ, I was buzzing. I was suddenly feeling 10-foot tall. I was like, here we go, this is class. Bar the few minutes against Wales, I hadn’t played a game in 10 weeks but I didn’t care. I could run, I could tackle, I could hit rucks and I could do it over and over without feeling I was asphyxiating.

We lost to England but I was just delighted to be back on a field feeling normal again. I lasted the full 80 minutes. That was the game where I left this long black tunnel behind me and came back into the light of day. It felt life-changing.

It was definitely career-changing. All of a sudden I was mad for road again. The retirement chat with Johann van Graan was a fading memory. Instead of quitting I was back starting in the 2021 Six Nations and capping it all off with the try against England – and a win against the old enemy too.

I suppose it’s the old cliche come to life. The darkest hour is before the dawn. It was fairly bleak the day I walked into Johann’s office to tell him I was finished. A few months later I was raring to go like a young fella. It wasn’t the end of the story, it was the turning of a new page and the start of another chapter just when I thought the book was about to be closed for good.

Fight or Flight My Life, My Choices by Keith Earls and Tommy Conlon is published on October 26th by Reach Sport.