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Royal sources said her back injury, which would have made it difficult and painful for her to travel by car from Windsor Castle to London and then stand on a Foreign Office balcony for up to half an hour watching the service below, was unrelated to an unexplained medical condition that has led her to cancel a number of other important engagements since October 20.

That unexplained condition means doctors have ordered her to rest and stick to light duties such as holding virtual audiences by video link and going through her state papers, for the foreseeable future.

Palace officials declined to comment on whether the Queen’s injury was caused by a fall but they hope she will be well enough to continue with light duties this week.

Her advisors are expected to issue a photograph or video of her holding an audience in an attempt to reassure a nation ncreasingly anxious about her health.

It is understood she has no external public engagements in her diary for the next few weeks after previously cancelling a planned visit to the Church of England’s General Synod this week. It is the first time she has missed her five-yearly visit to the Synod in its 51-year history.

There are no plans currently to add any in-person duties for her away from her current base at Windsor and some royal insiders have warned the nation may have to get used to seeing its longest reigning monarch out and about far less often in the run-up to her Platinum Jubilee next year.

It was the first time in 22 years that the 95-year-old monarch had missed the national service of remembrance at the Cenotaph in Whitehall, one of the key events in the royal calendar, and only the seventh time in her reign.

Her trip to honour Britain’s dead yesterday – so important for the Queen in her role as head of state, head of the Armed Forces, and as somone who served in the Auxiliary Territorial Service, the women’s branch of the Army, during the Second World War – had been intended as an exception to the current rule. She had insisted it was her “firm intention” to go to the Cenotaph and Buckingham Palace had officially confirmed only on Thursday that she was attending.

But less than two hours before the service yesterday, the palace said: “The Queen, having sprained her back, has decided this morning with great regret that she will not be able to attend today’s Remembrance Sunday Service at the Cenotaph.

“Her Majesty is disappointed that she will miss the service.”

Palace and government officials were issuing further details about the service and her involvement in it only on Friday so it appears that the Queen suffered the injury over the weekend.

A source said: “Her Majesty’s back sprain is unrelated to her doctor’s recent advice to rest. It is obviously incredibly unfortunate timing, and nobody regrets the Queen’s absence today more deeply than Her Majesty.”

With the Queen absent all eyes were on Prince Charles, who wearing the uniform of Admiral of the Fleet, laid a wreath on her behalf -as has been the custom since 2017 – before laying his own floral tribute.

He was followed by the Duke of Cambridge in RAF uniform, Prince Edward, and Princess Anne, before Prime Minister Boris Johnson, Labour leader Sir Keir Starmer, and other politicians placed their own floral tributes at the foot of the monument created by Sir Edwin Lutyens in 1920.

Above them, the Queen’s cousin the Duke of Kent, who served as a career Army officer for 21 years and normally lays a wreath at the service, stood in her usual spot on the central Foreign Office balcomy yesterday after himself deciding at 86 not to go on parade. With his sister Princess Alexandra, 84, beside him, the Duke, in Army great coat and uniform, saluted as the royal party emerged into Whitehall.

To one side on the balcony next to them Duchess of Cornwall, the Duchess of Cambridge, and the Countess of Wessex stood solemnly watching the ceremony, while on the other side Princess Anne’s husband Vice Admiral Sir Tim Laurence stood with the Duke and Duchess of Gloucester.

As with last year, the Royal Family’s two most recent members to serve in the military during a war, Prince Harry and Prince Andrew, stayed away after being told that they could no longer lay wreaths because they have stepped down from official duties supporting the Queen and do not currently represent her with honorary positions in military units.

Andrew, 61, a Royal Navy helicopter pilot in the 1982 Falklands conflict, has stepped down “for the foreseeable future” to deal with the fallout from his friendship with billionaire paedophile Jeffrey Epstein, while Harry, 37, who served two tours of duty in Afghanistan with the Army, is living in exile in the United States after quitting royal duties.

In Whitehall, veterans lamented the Queen’s absence and wished her well.

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Elsewhere, royal biographer Penny Junor suggested the Queen was entering a new phase of her life in which she will not be seen as much in public.

Ms Junor said: “It’s very sad for the Queen because this is the one event in the year that she really, really likes to be at.

“Remembering the war dead is a very, very important part for her annual calendar.

“The public will be very sad and anxious to hear of yet another setback but clearly she must follow the advice and get herself well.”

She added: “We’re so used to seeing her out and about and looking years younger than she is that I think we’ve been lulled into thinking she can go on at this kind of pace forever.

“Clearly she can’t. There comes a time in everybody’s life when they have to admit that they are getting older and can’t do the things that they perhaps want to do.”

The author continued: “I think we will see more of her on video and probably less of her in the flesh. They should keep her warm and tucked up at home and not exposing herself to the possibility of infections.”

The Prime Minister said the Queen was “very well”, after the 95-year-old monarch missed the Remembrance Sunday service at the Cenotaph due to a sprained back.

Boris Johnson told a Downing Street press conference: “I know that everybody will be wanting to offer their best wishes to Her Majesty the Queen and I just wanted to reassure everybody by saying that I did see the Queen for an audience last week on Wednesday in Windsor and she’s very well.

“It shouldn’t need saying but I just wanted to say it anyway.”

The Queen has missed several other key events, including the Festival of Remembrance at the Royal Albert Hall on Saturday evening.

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