Smith’s tennis elbow condition is so severe that it is being suggested he may have to rest for 12 weeks to ensure he is fit enough to tour Australia in December. He would therefore have to miss one-day matches against Kenya and a Test series against Bangladesh, while Cricket South Africa are trying to finalise an event for next month in place of the postponed Champions Trophy.

Left-handed opener Smith, who has only recently surrendered his position at the top of the world one-day batting rankings to India’s Mahendra Singh Dhoni, has been troubled by the problem since the start of the England tour at the end of June.

South Africa physiotherapist Shane Jabbar was quoted as saying by Supersport: “A tennis elbow is a chronic problem and one can't say how long the rehabilitation will take.”

“We want to avoid surgery but if rehabilitation does not work we'll have to think again. I've been treating him since the first tour match (at Taunton in June) and he has been taking painkillers.”

Jabbar believes the elbow injury surfaced during Smith’s stint with the Rajasthan Royals in the Indian Premier League, where he had to miss the final because of a hamstring tear.

“He had five weeks out of the game which helped both injuries,” Jabaar added, “but we weren't told how serious the tennis elbow was. During our first tour match at Taunton it flared up while he was batting in the nets, and our job has been to somehow keep him on the field for the rest of the tour.”

England, which lost the Test series 2-1, are currently 2-0 up in the five-match series with games remaining at The Oval on Friday, Lord’s on Sunday and Cardiff Tuesday.