Nottinghamshire paceman Ryan Sidebottom will miss the remainder of England's one-day series with a side strain, and is a major doubt for the Test series.
Scans have revealed a tear to muscular tissue in his back, but he will remain in India in the hope that he recovers before the first Test on 11 December.
Sidebottom, 30, has barely bowled since featuring in the third Test against South Africa at Edgbaston last August.
He played two of the four Tests in that series but has not been 100% fit since.
He has suffered from calf, Achilles and lower-back injuries, with his recurring back problem the main cause for concern.
Peter Moores's decision to pluck Sidebottom from the county circuit in his late 20s, rejecting the notion that he lacked the necessary pace to cut it at England level, reaped handsome dividends for around 12 months from the summer of 2007.
But cranking up his pace to the mid-80s so late in his career, in a manner that his body was not accustomed to, appears to have harmed his long-term fitness.
Moores, however, rejected the notion. He was quoted by The Guardian as saying: "Fast bowlers go through bad times. Andrew Flintoff had several operations and has come back.
"We also know it is tough playing international cricket and the schedule we have to go through, and they have to get used to that.
"Ryan is training very hard and, because of the benefits of that, he could come back stronger than ever before."
"It's been really tough for him. He is desperate to play. His body is saying, at the moment, that it doesn't want to play cricket."
Despite his injury-ravaged summer, Sidebottom was named in the squad for the Stanford Super Series in Antigua.
But he broke down after just two overs, and is yet to feature in any sort of match since England's arrival in India nearly three weeks ago.
"He's having a bit of an unlucky run," said his Nottinghamshire and England team-mate Graeme Swann.
"It's a bit like [Newcastle United footballer] Michael Owen back home - it's taken him so long to get back from a serious injury, and little niggles are keeping him out."
England could look to players from the Performance Programme squad, who are in Bangalore, for a possible replacement in the Test squad.
Yorkshire's Tim Bresnan, Lancashire's Sajid Mahmood and Durham's Liam Plunkett are waiting in the wings. Of those, Bresnan was easily the most impressive in county cricket last summer.
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