England’s World Twenty20 campaign began without Kevin Pietersen yesterday after the batsman was withdrawn on medical advice.

The ECB will wait to find out how he responds to treatment before deciding whether he will be available for tomorrow’s match against Pakistan at the Brit Oval.

Pietersen had played in England’s warm-up matches, against Scotland and West Indies this week — unlike Robert Key, who replaced him in the XI — but he felt some pain in his right Achilles tendon yesterday and it was decided to rest him as a precaution.

Nick Peirce, the England chief medical officer, said: “Kevin had been making excellent progress with his right Achilles injury. However, today he has experienced a degree of pain which may be related to some aggravation from his lower back.

“He will undergo a scan and an injection to help to determine any contribution from his lower back and to provide short-term and long-term benefit.” England may replace a player on medical grounds during the tournament, but he will not be allowed to rejoin the squad.

Pietersen missed England’s NatWest Series against West Indies last month because of his sore Achilles. It was revealed that he had been suffering with the problem during the winter, but the ECB had not sought to prevent him playing in the Indian Premier League.

His absence, added to that of Andrew Flintoff, who is recovering from a knee injury, meant that England began the biggest global cricket tournament to be held in this country for a decade without the two players who are household names.

As well as Key, the big winner in the England XI yesterday was Adil Rashid, the 21-year-old Yorkshire leg spinner, who was a replacement for Flintoff and made his international debut. While Graeme Swann, the off spinner, has had recent back problems, it is understood that he is fit but Rashid was preferred.