A groin injury looks likely to force Manu Tuilagi out of England's upcoming internationals against South Africa, Fiji, Argentina and Australia.
The Leicester Tigers centre is expected to be out of action for up to eight weeks with his latest setback, meaning he will miss out when England return to action in November and December.
Leicester director of rugby Richard Cockerill told BBC Radio Leicester: "His groin is tight and we want to rehab that and get it right so it is done with.
"It is a little bit frustrating for him obviously but he's working really hard in his rehab - he's in good nick, his weight's good and his attitude is brilliant at the moment.
"We've just got to be patient and when he's right he'll play."
Tuilagi has been capped 26 times for England.