Manu Tuilagi is facing a minimum of six to eight weeks out with the hamstring injury sustained in England’s victory over South Africa on Saturday, putting his participation in the Six Nations in doubt.

Tuilagi suffered a grade three tear while scoring the opening try of the 27-26 victory at Twickenham. He hobbled off after just six minutes. Sale director of rugby Alex Sanderson confirmed the 30-year-old centre is due visit a specialist over the coming days to learn if he requires surgery, which would result in a lengthier lay-off, and could possibly rule him out completely of the Six Nations depending on the severity.

The injury could cause headaches for Eddie Jones’s Six Nations plans if Tuilagi is out beyond eight weeks with Owen Farrell already ruled out for up to 12 weeks.

Sanderson said: “I’m really gutted. I’m gutted for him and gutted because we were managing him well and then something like that happens. We hope and we think it won’t go to an operation. It will be months if it doesn’t but six to eight weeks is the initial prognosis but we will find out after the consultation later this week.”

Tuilagi had a hamstring issue the week before against Australia but the scans showed it to be a grade zero tear. England’s and Sale’s physiotherapy and strength and conditioning teams were in constant dialogue while the player was on international duty. Sanderson explained that due to Tuilagi’s long injury history, which included an Achilles tear in September of 2020, which kept out for eight months – the player is always treated with caution.

“The communications between our physios and strength and conditioning guys and vice versa are wide open, transparent and honest. They know exactly how much loading he does on a weekly basis. I can’t dictate or assume a group of people with over 100 years of medical experience. Of course I am frustrated but I can’t say it is England’s fault because all the medical advice would suggest this is a one off,” said Sanderson.

“Manu is injury prone as we all know. I think it is a case of regardless of where he is at because the scan said nothing you got to pre-empt injury with Manu. That is the tactic we took with him and rested him as much as possible. You have to pre-empt the fact that regardless of how he is playing he is prone to injury.”

Sanderson added the player was in relatively good spirits due to his previous experiences. “He has taken it in his stride, it is not a career or season defining injury for him. It means he is off now for seven or eight weeks before international duty, so for him personally it shouldn’t affect the back end of the season for him, which is going to be big for him, us and England. He should be able to recover pretty strong.”

Analysis: What does Tuilagi’s injury mean for England?

Just weeks ago, the debate was over how congested the England midfield was with impressive performances in the opening Test against Tonga while Owen Farrell was isolating due to a false positive PCR test result.

Tuilagi started on the wing for the Test against Australia alongside a midfield of Farrell and Henry Slade with Marcus Smith starting at fly-half. However, with Farrell sustaining an ankle injury in the 40-16 win over the Wallabies – Eddie Jones’ midfield first choice picks for the Six Nations are rapidly reducing.

Slade put in a commanding performance against South Africa and Smith continues to show his composure at fly-half in the infancy of his Test career and it is now imperative they stay fit. One alternative for the midfield if Tuilagi and Farrell were to be both out would include Worcester’s Ollie Lawrence to slot in at inside centre between Smith and Slade. Gloucester’s Mark Atkinson, who earned his first England cap off the bench for England against Tonga, would be another option but with Slade and Smith it could be seen as too lightweight a midfield. Another possibility for Jones to examine would be Joe Marchant of Harlequins who started on the wing against South Africa, setting Raffi Quirke up for a try after a relatively quiet game.

The domino effect of Tuilagi’s and Farrell’s injuries also opens up debate around fly-half choice and whether Jones would recall the Premiership’s form player in Leicester’s Sale-bound George Ford to the England squad for added depth.