Britain’s Queen Elizabeth did not attend Sunday’s Remembrance Day Service at the Cenotaph due to a sprained back, Buckingham Palace said, extending the 95-year-old monarch’s absence from public life after she was ordered to rest following a stay in hospital last month. 

A palace source said the sprain was unrelated to the unspecified ailment that caused the queen’s hospital visit, calling it an “incredibly unfortunate coincidence.” 

But Elizabeth’s absence from an engagement she sees as one of the most significant of the year will increase concerns about her health. 

The ceremony would have been the queen’s first in-person public engagement since she was advised to rest after spending a night in hospital on Oct. 20-21. 

“Her Majesty is disappointed that she will miss the service,” the palace said in a statement. 

In her 69 years on the throne, the monarch has missed the event at the Cenotaph War Memorial in central London only six times, four while on tour abroad and twice while pregnant. 

Held on the nearest Sunday to Nov. 11 to mark the end of World War One, the sight of the queen at the annual event has been one of the defining images of her reign through the decades: head bowed, wearing black and displaying a red poppy. 

The queen is the world’s oldest and longest-reigning monarch. Since being advised to rest, she has missed events such as the COP26 climate conference in Glasgow and a festival to remember the nation’s war dead on Saturday evening. 

The palace source said the queen hoped to continue as planned with her schedule of light official duties this week. The queen has recently been photographed meeting dignitaries online. 

At the Cenotaph the royal family joined leading members of the government, military and veterans to commemorate those who lost their lives in conflict by laying wreaths. 

In recent years, the queen’s son and heir, Prince Charles, has laid a wreath on her behalf while she watches from a balcony at the Foreign and Commonwealth Office. 

Attending the event would have required the queen to make a car journey from her residence at Windsor Castle, west of London, and to stand for a period of time. 

In April her husband of more than seven decades, Prince Philip, died aged 99. 

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