Leicester back still recovering from pectoral muscle injury as head coach Stuart Lancaster awaits result of scrum-half Danny Care's ankle scan

England suffered a blow on Monday night when it emerged that Manu Tuilagi is almost certain to miss the entire Six Nations this season.

The setback was confirmed the day before Stuart Lancaster, the head coach, learns the results of a scan on Danny Care’s ankle injury.

Care sustained the knock during his superb display for Harlequins in their 16-13 defeat by Clermont Auvergne at the weekend. The initial prognosis is that the scrum-half could be able to return to training by next week in time for England’s Six Nations training camp.

Tuilagi, however, has admitted that he is unlikely to feature in the competition as the Leicester centre is still some way from completing his recovery from a pectoral muscle against Newcastle in September, which was initially misdiagnosed.

He had hoped to return in November but suffered another setback before undergoing surgery, and has now said he will not return to action until mid-February, by which point England will have played two of their five games.

He could return for the final two matches, against Wales and Italy, on March 9 and 15 respectively, but to play him would represent a risk having missed so much of the season.

The development means that Lancaster will have to press on with his plans for a new centre partnership, having used Billy Twelvetrees and Joel Tomkins with little success in the autumn internationals.

Tuilagi has retained his place in Lancaster’s EPS squad, however – as have all other injured players – but Lancaster will have to choose from Twelvetrees, Brad Barritt, Luther Burrell and Kyle Eastmond, although there is the possibility that he could play Owen Farrell at 12 with George Ford at fly-half.

Tuilagi explained that a complete recovery was his priority. “My body isn’t too bad,” the Leicester centre said. “I feel fresh but I can’t do anything. I’m training and doing rehab, physio and massage every single day, hopefully so I can be back playing in mid-February.

“Being realistic I’ll probably miss the Six Nations, because I’m aiming to get back in mid-February. I want to take my time, get my injury right and get my body right. Then I’ll worry about playing.

“It has been hard – I’ve been doing more work than when I’m playing, which is not what you want! I’m doing Wattbike three times a week.

“It is tough because you go into the club, you see your mates, you see the boys, but you don’t really see them properly because they are training outside and you are stuck inside. But you have to look at the positive side; it’s resting up your body because there’s still a lot of rugby to be played. I just want to play, I just want to get back on the pitch. Hopefully I’ve not forgotten how to play rugby!

“It’s tough watching the boys. They played really well [in the autumn] but it is hard to watch when they are doing really well but you’re not part of it, but you still support them 100 per cent.”

Tuilagi struggled to hide his frustration after revealing the severity of the injury was not initially diagnosed. “When I first went to see the specialist up in Manchester, he had a look at it and said there’s a chance I could be back in six weeks.

“Eight weeks later, I had another scan and it [pectoral muscle] was completely off the bone. I don’t understand why he didn’t see it the first time. I had to go in straight away the next day, in London, to have the operation.

“I was still doing weights. It didn’t really hurt. I had a bit of soreness afterwards, but you can’t really tell from that.”

Meanwhile, Care underwent an MRI scan on Monday as a precautionary measure after twisting his ankle and leaving the Stoop with his leg in a protective boot. Harlequins are expected to receive the results of the scan on Tuesday.

The 27-year-old scrum-half, who delivered a breathtaking display before his injury, producing a sublime piece of skill to set up a try for Matt Hooper, faces stiff competition from Ben Youngs and Lee Dickson for the No 9 shirt.

The extent of the knee injury to Tom Wood, the England flanker, should also become clearer on Tuesday. Wood required ice treatment after taking a knock to his knee during Northampton’s victory against the Ospreys at the Liberty Stadium on Sunday.

Jim Mallinder, the Northampton director of rugby, was hopeful that the injury was not serious.