England paceman Chris Tremlett may need to have surgery on the back injury that has ended his participation in the Pakistan series.
The 30-year-old had only just returned to action following nearly six months on the sidelines after breaking down against India last summer.
He played in the first Test defeat to the Asians but was then forced to fly home as the problem that has kept him out of the game for so long resurfaced.
The giant fast bowler was put on a programme of rehabilitation after the problem first appeared but, as England team physiotherapist Ben Langley explained, it looks as though they will have to try another method to get Tremlett back on the pitch.
"Scans have revealed various issues with Chris' back but we have to find out exactly what is causing the current problem," he told The Sun.
"He will see two specialists to get two opinions. The programme he followed after breaking down last summer has not worked, so he might have to go down the surgery route."
Tremlett's career has been blighted by injury problems and, after making his Test debut back in 2007, the Surrey man spent three years back in county cricket as a series of niggles prevented him from taking the step back up to international level.
He returned to play a major part in England's 3-1 Ashes win last winter and looked to have finally established himself in the side.
But the latest setback must now cast doubt on his England future with the likes of Steve Finn, Graeme Onions, Tim Bresnan and Jade Dernbach all fighting for one spot in the side.