The only option was a fourth and, surely, final bout of surgery last October. But even when that proved successful and Flintoff appeared ready to play a Test against New Zealand two months ago, a side strain brought more misery.
Taken in isolation, the past 18 months are hardly a basis for optimism. But, at still only 30 and with plenty of miles left in the legs after too many periods of inactivity, there is good reason to feel that 'Super Fred' could be right when he insists the best is still to come.
According to Lancashire, and opposition batsmen who have faced him in domestic cricket this season, Flintoff is bowling at least as well as ever and maybe even better. And when it comes to the big man's batting, there has always been room for improvement at Test level because five centuries, in 67 games, and an average of 32 do not do him justice.
"He's not a wizard. He's not going to come in and sprinkle magic dust," warned captain Michael Vaughan.
Maybe not. But who would want to bet against Flintoff doing something special on Friday? Certainly not those fans who believe there is now an extra reason to look forward to the Second Test against South Africa.
Ian Botham used to have the best scriptwriter in the business. Last week at Lord's it looked as though Kevin Pietersen had started to employ him, judging by that century against South Africa. But maybe it is time he wrote a glorious new tale for Flintoff.
