Having turned an overnight 77 into 141 for a first Test century in two years to propel England to 669 and a 311-run first-innings lead on Saturday, Stokes was then conspicuously absent for the 63 overs India batted.
He claimed 5-72 in India's first innings but restricted himself to fielding duties as Shubman Gill and KL Rahul helped the tourists recover from 2-0 to 174 without further loss.
Stokes has pushed himself to the limit this summer but there is a suspicion this is catching up with him, having struggled with cramp in his left leg when he was batting on Friday, briefly retiring hurt.
Asked if he will be fit to bowl on the final day, with England looking to move into an unassailable 3-1 series lead, England assistant Marcus Trescothick said: "We're hoping so.
"We're hoping another night's rest and physio work overnight that he'll be back. It's just a build-up (of things). He's had quite a big workload in the last few weeks. It's just trying to monitor it."
Stokes underwent surgery on his left hamstring at the start of the year, but he has already bowled the most overs he ever has in a series, even if he leads the wicket-taking charts with 16 at 24.75.
He has proved his all-round worth in Manchester by becoming the fourth Englishman - after Tony Greig, Ian Botham and Gus Atkinson - to record a century and five-for in the same match.
Ashes 2005-winning captain Michael Vaughan said on the BBC's Test Match Special: "Ben is a super-human at times. He was probably hoping that they would get the wickets and he wasn't going to be required.
"Maybe the medical staff just said 'Ben, have a day off'."
Chris Woakes dismissed Yashasvi Jaiswal and Sai Sudharsan with successive deliveries in the first over but Gill survived the hat-trick ball and overcame being dropped on 46 by Liam Dawson to reach 78 not out.
KL Rahul is unbeaten on 87 to give India hope of avoiding defeat and setting up a decider at the Oval next week but Trescothick remains upbeat about England's chances, with or without Stokes.
He added: "We've got 10 other guys who are capable of doing special things also.
"It's never great when bowlers go down or you don't have someone available to do the work you need them to do, it's then just up to everybody else to pick up the pieces and do the extra work."
10°C