England batsman Kevin Pietersen was ruled out of the ICC World Twenty20 opener against the Netherlands at Lord's in London on Friday with a recurrence of an Achilles injury, a team medical officer said.
The ex-England captain missed the recent one-day series against the West Indies with the problem, which originally flared up in the Caribbean earlier this year.
He played during England's World Twenty20 programme but was troubled again by the injury on Friday which led to him being left out of the first match of the tournament proper less than an hour before play was due to start.
England chief medical officer, Nick Peirce, said: "Kevin had been making excellent progress with the management of his right Achilles injury and had shown substantial improvement.
"However on Friday he has experienced a degree of pain which medical assessments have suggested may be related to some aggravation from his lower back," Peirce added.
"In order to continue maximising his recovery for the remainder of the tournament and the summer ahead, he will undergo a scan and an injection on Friday to help determine any contribution from his lower back and to provide both short term and long term benefit."
Peirce refused to rule South Africa-born Pietersen out of England's second match of the tournament, against Pakistan at the Oval on Sunday, saying: "Provided this injection has the expected result Kevin may well be available for selection for England's match against Pakistan on Sunday.
"He will continue to be assessed and receive treatment over the next 48 hours before a decision is made on his availability for Sunday's match."
Pietersen's withdrawal came after England had been forced to leave out another star player in Andrew Flintoff for the whole of the tournament because of the all-rounder's knee injury.