Pretorius recalls pivotal moment
Former Wales international Andries Pretorius knew his rugby career was over when he could not prevent himself from falling down the stairs.
As Pretorius lay in a crumpled heap at home, the ceiling above was not his only view.
He was finally facing up to the warning signs which had flashed soon after his move from Cardiff Blues to Worcester last summer.
"Sportsmen are very good at not telling physios or club officials the full story when it comes to injuries," Pretorius said.
"You see it with concussion now, mental toughness tells you to keep going, but I knew rugby was over at that moment. I was only hurting myself and my family if I tried to carry on. It had to stop."
This week Pretorius might have been settling into Wales' World Cup training camp in the Vale of Glamorgan, instead he is coming to terms with a life-changing auto-immune condition called neuromyotonia. Or Isaacs Syndrome, to give its more common name.
Except there is little common about Isaacs Syndrome. It is so rare, in fact, it can often be years before a correct diagnosis is made.
Yet its effects can be crippling with constant muscle cramps leaving patients immobile in more serious cases.
Even in its mildest form it is nothing short of disastrous for a rugby player, as Pretorius can testify to, with training sessions replaced by lengthy trips to hospital and the inevitable end to a career which peaked with two caps on Wales' tour of Japan in 2013.
Pretorius told Press Association Sport: "Your antibody score should be between nought and 10 - mine was 166. They'd never seen it that big before.
"The first signs were when I pulled my calf in my second training session at Worcester. When you pull a muscle you're either running at full tilt, you've got an explosive movement in those first two steps, or it's the last five steps to slow down.
"But in my case it happened just before the halfway point of warming up, I started getting a cramp which just wouldn't let go.
"It was a bit unusual but I just powered through until I got the cramp again in Portugal on a pre-season trip. I had it scanned back in Worcester and a small tear in the calf was detected and the following week I did the other side.
"A week after that I was doing weights and I tore a muscle in my pec (pectoral muscle), again it was not as if I was exerting myself."
He went to see a nerve specialist who observed that even when Pretorius was relaxing his muscles were twitching.
At the time he was still training, getting on the bike and spending time in an altitude chamber as he tried, in his own words, to "push through" the problem.
But then came that nasty fall when he was unable to save himself from tumbling backwards down the stairs.
"I'd torn my calf and was limping and as I was climbing the stairs my other calf cramped," Pretorius said.
"I tried to grab onto the rail but my pec cramped and I fell head over backwards and down the stairs. That was the moment I realised this was something I wasn't going to be able to manage.
"I was at home on a day off and wasn't even fatigued. Until then I had been saying 'I can win this' but now it was so bad I had to accept what was happening. I was in a bad place mentally and physically."
Pretorius was sent to see a neurologist and a blood test confirmed Isaacs Syndrome. After four months of not knowing what was going on there was relief a diagnosis had finally been made, yet the news informed him of the challenges ahead.
The 29-year-old was first prescribed tablets to manage the condition. Then there was a five-day hospital stay on a drip for seven hours at a time to bring down his antibody count, but the scores just kept climbing.
In March he went into hospital again for a nine-day spell and higher dosages for a longer period but still his muscles twitch, and the future remains uncertain with steroid injections and dialysis drastic courses of action should the condition worsen.
"Some people have the twitching in their face and hands and it's quite debilitating," said Pretorius, who has a Masters degree in psychology and who has recently been working with the Highlanders franchise in New Zealand, focusing on player-development off the field.
"Like me, the majority have it in their calves and feet, even though the twitches I have are all over my body. It means my body doesn't relax. Even when I'm sleeping it's not recovering and my muscles are fatigued when I wake up.
"So if you keep training the muscle is going to cramp, and if it keeps cramping it tears."
Isaacs Syndrome ended a career which began in Pretorius' native South Africa but really took off when he came to England to study at Hartpury College in Gloucestershire.
Pretorius joined the Cardiff Blues in 2009 and made 59 appearances for the Welsh region, captaining them during the 2012-13 season, and was named in Wales' 2013 Six Nations squad after serving a three-year residential qualification.
A dislocated shoulder prevented him making a Six Nations debut but he eventually won two caps on Wales' mixed tour of Japan that summer, Robin McBryde's side drawing the series 1-1 with head coach Warren Gatland and most of the senior players away on British and Irish Lions duty in Australia.
"There weren't many back rowers at the time as Dan Lydiate and Toby Faletau were only in their first or second season and hadn't really solidified their places," Pretorius said.
"I had back-to-back shoulder operations before I joined Worcester and I would have needed a run of, say 20-25 consistent games, to get into World Cup contention this year.
"I was always competitive and my target would have been to be the player of the Championship.
"If you achieve that it's hard for people to ignore you and then all it takes is for them to pull you into a squad and do exactly the same."
Sadly Pretorius never had the chance to realise that World Cup dream and is now confronting a bigger battle than any he faced on the pitch.