Daniel Brettig is an assistant editor at ESPNcricinfo. @danbrettig
CWC League 2 (2)
ENG v NZ (1)
SLCD-XI in ENG (1)
Charlotte Edwards (4)
Vitality Blast (6)
4-Day Championship (3)
T20 Challenge (1)
In the weeks since the 27-year-old Pattinson's most recent breakdown with the beginnings of a back stress fracture, the fourth such time he has been diagnosed with the injury in more or less exactly the same spot in his back, Cricket Australia's medical team has looked exhaustively at options to end a sad saga of rehabilitation, brief international appearances and then re-injury.
What they are in the closing stages of settling upon - some further tests on Pattinson remain to be done - is surgery to provide a protective covering on the part of the back that has been constantly re-injured. Alex Kountouris, CA's head of sports science, explained that the re-injuries were likely to be related to the fact that Pattinson has four old stress fractures from his youth.
"He has got four old stress fractures that haven't healed since his teenage years. What he's doing is getting bone stress on one part of a healthy bone and that one part of the bone keeps breaking. It has broken four times in the one spot [since 2013]," Kountouris said in Sydney on Tuesday. "He has broken it in the same spot again, that's the bad thing. Once you heal from a fracture it shouldn't break in the same place. It should become stronger than it ever was before. The fact he is going in the same place means there is a lot of stress in that one area.
"We've obviously reviewed this to death... looking at how much he bowled, all the technical stuff, there is a whole bunch of stuff we're looking at. We're hoping to learn from some of the things that have happened and what he can cope with and what we can't cope with. He wants to play Test cricket and he's obviously a very good Test bowler, so our goal is to get him back to Test cricket.
"He has been great. We've engaged him in these conversations with the specialists in New Zealand and stuff like that. We've had meetings, we're discussing all the options. We haven't 100% confirmed we're going to do this, but we're certainly a long way down the track of looking at it. And if anyone's going to have this surgery, it'll be him. It doesn't sound like there is a lot to lose to be honest. It's going to help that area. There are some complications that could possibly happen with any sort of surgery, but I think that's the way we are probably going to go, give him every chance."
Richard Saw, who replaced Peter Bruckner as the Australian team doctor earlier this year, said that CA had been moved to look towards surgical options for Pattinson after numerous failed attempts to bring him back to full fitness without the need for the physical trauma of an operation.
"We're looking into some other things for James including exploring surgical options and, because in Australian cricket we get stress fractures to heal with a conservative treatment, it's not something which has been pursued often," Dr Saw said. "As a doctor speaking, it's always better to do things without surgery than with surgery because there are some inherent risks from any operation. But we are exploring surgical options for James because of the complexity of his case.
"That's included looking into having some conversations with surgeons overseas, in particular there is a surgeon in New Zealand who has operated on a few of the New Zealand fast bowlers including Shane Bond, who came back to play Test cricket, and Matt Henry, who is playing at the moment. The reason why we're exploring international options is because some of those surgeons are a bit more experienced with fast bowlers and have got them back to playing at the elite level.
"There are different surgical techniques, which is part of what we're looking into. But basically using things like screws and wires to stabilise the fracture. One [of the techniques] does involve putting a screw through it but there is another way which involves supporting the ring of the vertebrae. We're still nutting out some of the finer detail but it's not far away. In the next couple of weeks we'll have a firm decision on this."
Taking Pattinson to New Zealand was geared at putting him in the hands of a surgeon who had done the procedure with fast bowlers before, rather than a first-timer in Australia. Kountouris said: "There's a lot of people in Australia who do this surgery, it's reasonably common, but none of them have done any fast bowlers that have come back to the elite level.
"We don't know how they're going to cope with bowling at 150kph: all that force. It's easy to do [the general] public, who would go back to their normal job and play a bit of recreational sport, but we want someone who has got experience in this [professional sportsperson] area."
In addition to Bond and Henry, the procedure has also been carried out on Andrew Ellis and Hamish Bennett among New Zealand fast bowlers. Bennett played for New Zealand earlier this year and took five wickets in his most recent first-class appearance for Wellington last week. Ellis, meanwhile, made the last of his 20 ODI and Twenty20 appearances for New Zealand in 2013 but has continued playing first-class matches and was last summer named the domestic cricketer of the year.
CA's medical staff also spoke on Tuesday about their hopes for Pat Cummins, who if he plays all five Ashes Tests this summer will have doubled the number of Test matches he has played in his career. Kountouris compared Cummins favourably to Ryan Harris, who entered the 2013-14 Ashes summer with a chronic knee problem but was able to take part in all five Tests in Australia then another three in South Africa as Michael Clarke's team clinched both series.
Australian success and matches not going the full five-day duration will naturally help Cummins' cause. "Our goal is to get them to the first Test and there's no set goal beyond that. Harris was going in [in 2013-14] with an injury so we knew there was something wrong with him," Kountouris said. "Pat, there's nothing wrong with him, we just know that in this series if he plays all five Tests he has doubled the amount of matches he has played in his Test career. So it's uncharted territory for him.
"Until March he'd played one Test in [over five] years. We want him to play all five, that's our goal, and we want to win the series, so getting him to the first game, prepared to play the first game and to play the whole series, is our goal right now. If the first game is over in three days it's easier, but if he bowls 60 overs in the first game and pulls up sore, further down the road we'll work that out."