Jack Leach also returns to the side for the first time since he limped out of a Test match in Hyderabad in March. He will be paired for the first time with his Somerset colleague Shoaib Bashir.

“I tried my hardest to get myself fit for this game, but have taken the call to miss this one because I’ve not quite managed to get game-ready,” Stokes said.

“There is a lot that has to go into my rehab programme. We got to a certain point, but looking at the picture of what we’ve got coming up and physically where I’m at, I’m not quite ready to play. It’s always frustrating to miss out. I’ve got some good things to focus on, so even though I’m not playing I’ve got a goal in mind.”

When asked if he will be fit for the second Test, also in Multan, that starts on October 15, Stokes was non-committal.

“Not sure. I’ve pushed myself incredibly hard and worked really hard with the medical team to get to where I’m at now. I think I’m further ahead than what we expected. I’ll be working just as hard over the next 10 days to try to get myself fit for the second Test.”

It makes life a little easier for England when Stokes is categorically ruled out of the side rather than play as a batsman, which ruins the balance of the team and forces them to choose between being a bowler or batsman light.

Carse bowled his way into the Test side with a good performances in the white-ball series against Australia when he touched 90mph, but Multan in 36C heat, rather than September in England, will be a tough challenge for all the seamers. Woakes has not played in Asia since 2016 and Atkinson is appearing in his first Test overseas.

England team: Crawley, Duckett, Pope (c), Root, Brook, Smith (wk), Woakes, Atkinson, Carse, Leach, Bashir.