Once again, England's most talismanic player is to go under the knife.
Andrew Flintoff enters hospital this weekend for yet another operation on his left ankle, and facing the possibility of missing another entire summer of Test cricket.
What are the implications of this latest operation? What are the reasons for this endless stream of injuries? And can Flintoff ever really expect to be injury-free again?
WHAT CAUSED THE INJURY?
England say Flintoff's injury is different to the bone spur problem which ruled him out last summer.
But its cause may be the same, according to Mark Gillett, a sports doctor at the English Institute of Sport in Birmingham.
Flintoff is facing a third operation on his left ankle
"A fast bowler puts enormous strain through their joints, so they're getting repetitive micro-traumas through the ankle joint," Gillett told BBC Sport.
"That can lead to wear and tear, and the bone forming strangely and forming impingements."
Former Lancashire physio Craig Smith - who now works with Nottinghamshire - says Flintoff's earlier operations may be part of the problem.
"Partly, it's the nature of fast bowling," says Smith.
"England are now playing all year round, and Andrew is the first name on the team sheet.
"He's probably bowling in excess of 1,200 overs a year, and that's just in matches - not including county cricket or in the nets.
"But he's had two operations on that ankle already, so there could well be some scar tissue left from a previous op.
"When you have a primary injury, it's often two or three structures that are actually damaged, but they only repair the most obvious one.
"So you can recover to a certain point, but you'll then begin to feel soreness again from something that wasn't picked up the first time."
WHAT DOES THE OPERATION INVOLVE?
Flintoff is due to undergo an arthroscopy on Saturday.
And as Gillett explains, the main aim is to find out what's causing Flintoff pain, rather than fix anything immediately.
Flintoff could miss the rest of the summer with his injury
"Sometimes an MRI scan doesn't give you all the information you need to make a proper diagnosis - to be 100% sure, you need direct vision, which is what an arthroscopy does," he says.
"In the old days if you wanted a look, you'd have to make a big cut and have a look with your own eyes. An arthroscopy involves much less trauma - it's a day-case procedure.
"It's keyhole surgery, where the consultant looks inside the joint with a camera about the diameter of a pencil.
"You make a cut, make a hole into the joint and camera goes through into the joint.
"Andrew would be sedated while they do it, but it would be a very light anaesthetic.
"The consultant will be able to see the state of the joint, whether there's any obvious wear and tear or any obvious areas of inflammation that they can treat.
"If there's obvious damage, they can try to treat it there and then.
"If there was anything major - the sort of thing that would require a long period of rehab - they're more likely to take the scope out and bring the patient back in for a consultation before going ahead."
HOW LONG WILL FLINTOFF BE OUT FOR?
One prognosis is relatively optimistic for Flintoff.
"If they do just have an explore, you could have him on his feet in three to four days," says Gillett.
But Smith fears that Flintoff's arthroscopy will lead to a much longer lay-off.
"I suspect they're going to find something, so they'll yank it out or repair it," he says.
"And if he's going to have the surgery, he mustn't be rushed back.
"He needs a good four months to get the right rest and rehab so that he can come back with no ankle issues in the future."
THE LONG-TERM SOLUTION
Flintoff has a long, painful history of injury.
The solution, says Smith, is for England to protect their prime asset to a much greater extent than they have in the past.
FLINTOFF'S INJURY WOES
1999 Returns early from South Africa with broken foot
2000 Back injury ends Pakistan tour
2002 Hernia operation and later returns from Ashes tour with groin problem
2003 Misses Zimbabwe series with shoulder injury
2005 Ankle surgery in January
2006 Out for 12 weeks after ankle surgery
2007 More surgery to left ankle
"He's susceptible to injury - after all, he's undergoing his third ankle operation," he says.
"He has to be managed in his own cotton-wool way so he comes back ready.
"He needs long enough after the operation to rest, and to do the rehab so that his ankle is strong and the tissue is healed.
"If he comes back too soon, he'll simply extend the achiness and soreness.
"Maybe the ECB need to take a closer eye at his rehab work, rather than letting Lancashire look after him."
Gillett would like to go back further, to address the root cause of Flintoff's problems.
"Most bowling injuries occur in the front foot," he says.
"They could video his bowling action and see what the position of the foot is when it comes down in the delivery stride.
"Depending on what they find, you might be able to reduce the impact, make the foot more stable, or change the position of the foot when it's planted."
THE LONG-TERM PROBLEM
Flintoff is 29 years old. That is young by most standards, but not for a fast bowler.
This is a man who has shouldered a heavy burden for England, pounding away on hard pitches for month after month, year after year.
Even if he comes back fit, England's relentless schedule will soon be forcing him through the same pressures.
"The bones, ligaments and tissues in the ankle are pretty resilient, but you do get to a stage where things start to creak and break," says Smith.
"England play so much cricket, and Andrew's the star man - the first name on the team sheet.
"If India come over here later this summer and hit their form, the selectors will be asking for him, and Andrew will want to come back.
"But he needs time. They really must give him time to recover."