There were days last year when Tom Croft wondered if he would ever play rugby again, let alone for England. A broken neck kept him out for eight months and his specialist told him he came close to being paralysed.

His recall to the national squad ahead of Sunday's Six Nations game against Italy is, consequently, no ordinary fitness update. It is certainly a tribute to Croft's mental strength and reward for the unseen hard work which has seen him transform his previously slender frame into a 109kg powerhouse.

He still has a metal plate, four screws and other bits of metalwork holding together the C6 vertebra he fractured in three places but, crucially, his confidence and form have now been reinforced as well. He was outstanding for Leicester Tigers on Saturday and, after less than five hours of first-team rugby since January, England's head coach, Stuart Lancaster, has seen enough. If Croft shows up well in training over the next couple of days he could even start against Italy, with Lancaster's only concern being the flanker's lack of recent familiarity with the team's calls. Fitness-wise all the necessary safety boxes have been ticked. "He's in great physical shape and I thought his 80 minutes at the weekend proved it," said Lancaster. "He was a British Lion in 2009 and he was outstanding in the Six Nations last year ... He brings a lot. It's a big plus."

The 27-year-old, who played his100th game for Leicester at the weekend, won the last of his 36 England caps against Ireland almost exactly a year ago. He was subsequently injured at Harlequins that spring and returned only in the first week of January.

"Even a month before I came back it was still a case of: 'Is this going to be all right?' he revealed. "I did worry when, after the operation, the specialist said I'd come as close as you can to being paralysed. You start thinking: 'Is this the right thing to do?'"

Those doubts, happily, have been erased, helped by the sympathetic professionalism of Leicester's medical staff who initially agreed a week-on week-off playing schedule.

All parties will now be hoping for a happy ending in rugby terms, although one or two of England's other back-row contenders may dispute that description. If Croft is propelled straight back into the starting XV – and Lancaster gave every indication he stands an excellent chance of featuring in the matchday 23 if he trains strongly – it will stick a rocket up the rest of the back-row candidates.

With Ben Morgan, as well as Owen Farrell, definitely missing the Italy game, Croft's return threatens to edge out not only Courtney Lawes, who wore six against France, but James Haskell as well. Then there is Tom Wood, who has been playing at eight in the absence of Morgan. Another option open to Lancaster is to pick the explosive Billy Vunipola at No8, with the 20-year-old also now fully fit and due to train. In that event Wood may start at six with Croft coming off the bench.

Decisions, decisions. Mako Vunipola, Tom Youngs and Danny Care will be hoping to start against Italy, with David Strettle pushing hard for a wing recall. There is only a six-day turnaround between the Italy game and England's potential title decider against Wales in Cardiff, but Lancaster is also mindful of the danger of tinkering for the sake of it.

"I don't want to make too many changes because I think continuity is also important. I'll place a lot of store in what I see over the next couple of days."

Farrell, though, has run out of time and his thigh strain will not be risked. Gloucester's Freddie Burns limped off with cramp at Bath on Friday night but will be fit to train with a view to understudying Toby Flood, who will start against Italy.

England, who will not confirm their starting lineup officially until Friday, would have a slight dilemma if Burns suffers a setback but, as things stand, Lancaster believes Alex Goode and Billy Twelvetrees provide adequate fly-half cover.

Farrell, according to the management, will be back fit and ready to face Wales at the Millennium Stadium.