Outrage, Controversy and the Use & Abuse of Medical Time-Outs


Every year at every Grand Slam the issue of medical time-outs rears its head. Sports pundits, players and ex-players like myself have argued that the rules surrounding medical time-outs are too vague, contradictory, easy to abuse, and hard to enforce.

A best-of-5 set Grand Slam match is a marathon no matter how you look at it. Is there any other sport in the world that allows the athlete to take an extended break towards the end of a match/game/event when they are sore? Boxing, running, swimming or triathlon? What about other racket sports like Squash or badminton? Or how about team sports like cricket, football and hockey? I can’t think of one. So why tennis? Yet it wasn’t like that prior to the medical time out! So what’s going on? Doesn’t anyone notice this? I feel like I’m taking crazy pills.

Recently the outrage and controversy surrounding medical time-outs kicked into high gear for me in particular. I’ll get into the details about that below. However, I also want to take the opportunity to give some context and background information regarding the medical time-out rules themselves. Let’s start with basic medical time-out rules. Feel free to skip the following section if you already have a solid grasp on this.


Medical time-out rules in tennis

Here is a basic summary of the medical time-out (MTO) rules from one of my previous blog posts.

The rule is that a player can not receive treatment for loss of conditioning / fitness or fatigue. Loss of conditioning basically means tiredness, cramping, sore muscles, and so on. Essentially anything but an accident such as a twisted ankle, cut, sickness (not due to being tired), etc.

The following are excerpts from the official Grand Slam Rule Book regarding MTO’s. The rules are a little contradicting and confusing. Feel free to read the entire rule book for yourself. I’ve selected the most relevant points below (highlights are my own).

The purpose of the medical evaluation is to determine if the player has developed a treatable medical condition and, if so, to determine when medical treatment is warranted. Such evaluation should be performed within a reasonable length of time, balancing player safety on the one hand, and continuous play on the other.

Non-Treatable Medical Conditions:

  • Any medical condition that cannot be treated appropriately, or that will not be improved by available medical treatment within the time allowed.
  • Any medical condition (inclusive of symptoms) that has not developed or has not been aggravated during the warm-up or the match.
  • General player fatigue.

The Medical Time-Out begins when the Physiotherapist/Athletic Trainer is ready to start treatment. At the discretion of the Physiotherapist/Athletic Trainer, treatment during a Medical Time-Out may take place off-court, and may proceed in conjunction with the Tournament Doctor.

The Medical Time-Out is limited to three (3) minutes of treatment.

A player is allowed one (1) Medical Time-Out for each distinct treatable medical condition. All clinical manifestations of heat illness shall be considered as one (1) treatable medical condition. All treatable musculoskeletal injuries that manifest as part of a kinetic chain continuum shall be considered as one (1) treatable medical condition.

Only in the case that a player develops an acute medical condition that necessitates an immediate stop in play may the player request through the Chair Umpire for the Physiotherapist/Athletic Trainer to evaluate him/her immediately.


The problem with the current medical time-out rules

There are a few core problems with the MTO rules as they are today. As you may have noticed, the rules are vague and slightly contradictory.

This combination of flaws make the rules hard to understand, open to individual interpretation and almost impossible to enforce. Rule enforcement is especially difficult when you consider the pressure trainers are under in addition to the fact that there are no consequences or incentives regarding how they perform their duty.

All this leads to a set of rules that are supremely easy to manipulate, bend or outright break without consequences. In a situation like this, some players are bound to take advantage. In fact one could argue that not taking advantage may be considered foolish as a less scrupulous opponent would gain a small edge by manipulating the system to his/her benefit.

I’m not claiming that all players do this. However some do and by subtle strategic bending or breaking of the rules they can gain an advantage at crucial times in a match, get some valuable rest or stop the momentum of an opponent.

Perhaps the overall problem is not so much about players breaking the MTO rules, but the fact that many of the rules are never enforced. The rules surrounding treatment of fatigue, continuous play and what constitutes an injury (to name a few) are essentially so flexible and malleable that even overt transgressions are almost impossible to punish.

Lets not beat around the bush. MTO’s are can often be used the same way diving and faking a foul in football is. We have all heard commentators and fans alike outraged when a player fakes a dive in football (soccer) yet only the bravest referee will pull out a yellow or red card. Why? Because he opens himself up to criticism and abuse. Yet, at the end of the day, diving is illegal and technically cheating.

A few years ago I was invited to a Chelsea FC dinner  to talk about the clubs charity work and discuss issues in football. The most passionate debate around the table was about how to stop diving, cheating and abuse.  Many including myself thought CFC could lead by example to help usher in a new era of honesty.  But some argued that this behavior is just part of football. When I asked “is cheating an acceptable part of the game?” the responses were “yes and no”…. I happen to disagree, cheating is cheating no matter how you dress it up.


How players bend, manipulate or break MTO rules

Firstly, keep in mind that “fatigue” or “loss of conditioning” is not a valid reason to call for a MTO. It doesn’t take a sport scientist to understand that any player in the later stages of a match can be considered ‘fatigued’. We all get tired, especially during gruelling five set matches.  So almost any manual work from a trainer (massage, stretching, etc.) at this stage of a match is needed because of “general player fatigue” or ‘loss of condition’.

Ok so what if a player has hurt themselves, over stretched, felt a sharp pain or a pulled muscle? Well the rule states:

Only in the case that a player develops an acute medical condition that necessitates an immediate stop in play may the player request through the Chair Umpire for the Physiotherapist/Athletic Trainer to evaluate him/her immediately.

With that in mind, the most obvious way a player can bend/break the rules is to fake or exaggerate an injury to gain extra recovery time, stall momentum or give themselves time to clear their head and think.

There are of course many shades of “faking an injury” and when I use this term I mean that a player may be exaggerating a minor “nagging” issue from before or pretending a muscle is injured when in fact in simply hurts due to fatigue or close to cramping.

But how do you prove that a player is faking an injury? How can a medico, in just a few minutes, determine if something is a legitimate injury versus simple pain from a fatigued muscle? And what exactly qualifies as an “musculoskeletal injury” anyway?

The worst abuses of the rule I have witnessed was when American/Canadian Jesse Levine was two sets to love up against Marcel Granollers in 42 degree Australian Open weather. At this point the Spaniard decided to go for a toilet break. He sauntered off from an outside court only to return from the distant bathroom 10 minutes later and call a medical time out. By the time the doctor and physio saw him and treated his exhaustion (illegally) it was over twenty minutes between sets. Needles to say, Jesse’s rhythm and momentum was disrupted. Refreshed Marcel regrouped and went on win the next two sets. At which point he again took a series of MTO’s before eventually defeating the rightfully upset Levine.

Unfortunately, this type of stuff happens all the time during smaller matches and lower level tournaments. Most people just never see it. Until something is done at the top players further down the rankings like Jesse will continue to be at a disadvantage for following the rules.


My 5 suggestions to help solve the MTO problem

Is there a foolproof solution? I don’t think so. A determined player will always find a way to manipulate, bend or break the rules in one form or another. This however does not mean there is nothing we can do. I believe there are a few simple steps we can take to improve the situation.

  1. The 1st step is to clarify as deeply as possible what constitutes an injury. Is tweaking your back in the final set when you’re tired from serving 200km serves for 4 hours a legitimate injury? Or is it  just fatigue from serving 200km serves for 4 hours?  We need to set some parameters at the very least.
  2. The 2nd step is to have an independent medico such as a doctor going on court with the trainer to supervise and diagnose the treatment. This doctor does not have to deal with the pressure of seeing and treating these players every day in the locker room. He or she would be more unbiased in their decision. However these medico’s will, through the natural course of being employed by the tournament, still be extremely reluctant to default a star player or start point penalty charges.
  3. The 3rd step is to investigate amending the rules to ensure players can only take injury time-outs before their own service games. If they want a timeout before an opponent is about to serve, they should immediately forfeit that game (unless it’s an acute injury such as a twisted ankle, cut etc).
  4. The 4th step is to unify and shorten the time limits on MTO’s and the evaluation to keep time between play at a minimum. This to me is the most crucial issue with the rule as it is being implemented at the moment, “balancing player safety on the one hand, and continuous play on the other.”
  5. The 5th step could be to stop allowing medical time-outs from the 3rd set onwards and making “general player fatigue” the first physical issue a medico considers (Assuming a player is not in great pain from an accident).

I’ve said before I believe “nobody should be getting a medical time-out in the fourth of fifth sets unless it’s something serious”. Small muscle tweaks, minor nagging injuries and general discomfort is all part of the game of tennis and whoever manages it best on-court and off deserves their advantage. In fact this is what winning a Grand Slam is all about. It’s a battle of the fittest, strongest, toughest (sometimes luckiest) player over the two weeks.

OK, so a quick show of hands, who knows what it’s like heading into a fifth set of an Australian Open Final exhausted and injured after playing a gruelling five set semi final a couple of days before?

I do! Very well indeed!

I had beaten Ivan Lendl in five sets in the semi-final of the Australian Open and in less than 48hrs later I was heading into the fifth and final set against Mats Wilander. I was exhausted, nursing an injury and my socks were full of blood from open blisters. It was within my rights to call a medical time-out. However, there was a code amongst players that said you didn’t take an MTO unless it was something serious. Blisters, exhaustion and muscle soreness was part and parcel of winning the ultimate challenge over five sets. One just did not call an MTO for that!

In fact I can’t recall any players in my era getting a medical time out. I can only barely think of more than a few players defaulting matches during my career. When they did it was a really bad injury!

Vitas Gerialitis held on to win the 5th set against John Lloyd in sweltering heat at the Australian Open all while hiding his injury. What made the loss worse for Lloyd is that everyone in the packed stadium knew about the injury except for him. It was excitement personified. I wonder how Vitas and John feel about how MTO’s are used today? Actually, I doubt I have to ask…


Modern outrage & historical context

Hopefully at this point you understand the issues and problems regarding medical time-outs a little better. Good on ya for making it this far. Now it’s time to get back to the controversy I mentioned at the start of this post…

First let me give you some context. For years players and ex-players including Murray, Wawrinka, Federer, Wilander, McEnroe have expressed frustration regarding medical time-out rules.

McEnroe has called it among other things a “complete abuse of the rules” (he should know) and I’ve used the term “legal cheating” on multiple occasions.

Admittedly the term “legal cheating” is perhaps not the best choice of words as it an oxymoron but it illustrates the point and describes my feelings surrounding the controversial MTO rules as I’ve outlined them above.

Criticising MTO rules in the context of a particular match is generally speaking fairly uncontroversial. That’s not to say I and others don’t received some blowback. Each time we highlight this issue we hear from outraged fans who feel their favourite player has been slighted.

angry-djokovic-fan-twitter-blankedThis is, however distasteful, is not abnormal. Well apart from the fact many can’t even spell Djokovic correctly. But ultimately it’s simple ignorance and I find it somewhat amusing. Unfortunately many fans assume that I, or other people who speak out, are unfairly targeting their favourite player without understanding the rules or tennis history. Their attacks are generally based on a single comment, tweet or partial interview they’ve seen. Sadly many fans rarely step outside of their bubble to read past the headline to get some context. If they did they’d realise the our criticism is not really aimed at their favourite player, it’s generally aimed at the MTO rules and enforcement.

When a player takes a MTO I ask myself if he or she are within the rules.

And if a player is strategically bending or breaking the rules, and allowed to do so, we as commentators are fully within our rights to point out the issue. In fact that is our job. Some fans feel it is perfectly fine to make their comments heard in public, (however abusive or childish), but we as experts who see an infringement, cannot? It may surprise fans that there are very few commentators who are even slightly biased. The truth is that I don’t care one bit who wins or loses. I just want to see good tennis. Yet, I receive abusive comments claiming bias for one player or another. Ironically often from fans of both players in the same match. Based on my Twitter mentions I apparently hate just about every player on tour! Or another explanation is that I simply call it like I see it regardless of who is playing.


Federer MTO controversy

Recently, during the 2017 Australian Open I used the term “legal cheating” during some broadcasts when referencing the debate surrounding MTOs. My big mistake however was not that I spoke about the problems surrounding MTO’s during a tennis match, I’ve done that many times before, it’s that I raised the issue when Federer was playing

Let me elaborate, I used the term “legal cheating” while talking generally about how I think the MTO rules need to be fixed. The reason the topic came up was because during Federers semi-final and final he took medical time-outs after losing the 4th set in both matches.

Federer’s medical time-out in the final against Nadal probably didn’t change the outcome of the match. However, without a shadow of a doubt, the 8 minutes off court during his semi-final vs Wawrinka drastically changed the momentum and possibly the end result.

Again, it comes down to balancing player safety and continuous play. In this case, I think the balance was wrong and I voiced my opinion. As I would have regardless of who was playing.But at the end of the day it is the official’s call to hurry a player up, tell them “no”, or simply do nothing. After all, they should know the rules best shouldn’t they?

After the matches Federer said he had some form of nagging issue in his leg but he also said the following after his semi-final match:

“These injury timeouts, I think they’re more mental than anything else,”

Perhaps I’m misinterpreting Roger’s meaning here but MTO’s taken primarily to clear your head or for “mental” reasons would be in direct violation of the current rules. I believe Roger, who has been critical of MTO’s before, would agree with me.

“I also think that we shouldn’t be using these rules or abusing the system” — Roger Federer on MTO’s

I’m not denying that Roger is within his rights to request a 3 minute medical time-out for a legitimate injury. He said he had a leg injury and that’s within the current MTO rules. And keep in mind that I know how rare it is for Federer to do this. He’s one of the players who takes the fewest MTO’s and is least likely to abuse the rules. If anything, Roger would benefit from stricter enforcement. He is possibly one of the best of his generation at upholding the tough Aussie traditions and principles of fair play passed down to him via his childhood coach, and friend of mine, Peter Carter or the great Tony Roach.

Judging by Roger’s comments after the semi-final he seemed fed up with the MTO system and how other players abuse it but felt that he could finally benefit from such a time-out. This may sound reasonable but I thought to myself “just because someone has a good record in regards to MTOs, does that mean we should ignore a possible infraction?”

Was his safety in jeopardy? Was it continuous play?

I admit, maybe because of his good record in this area, that I was a little disappointed at seeing Federer taking and being allowed to take such a long time out at that point in the match two matches in a row. As I said above, my opinion is that I don’t think anyone should be getting medical time-out from the 3rd set onwards.

But regardless of the context or my meaning the damage was done. Hyperbolic headlines popped up and zealous Federer fans who felt I’d slighted their favourite player unfairly flocked to social media to let me know what a terrible person I am.



I understand that some fans are…passionate (and often bad spellers who offer me unwanted sex ha ha). And my comments may not have been clear enough in the moment, leaving them open to misunderstanding. Especially when taken out of context like they were by a reporter during Roger’s press conference after the match. I know how reporters work. They will use a half quote from someone else instead of having the guts to make the claim themselves in front of the player. I’m used to that and so is Federer. However, I think it’s important for people to scratch a little beneath the surface. If they do they may find something that’ll show them that I don’t have some pathetic secret vendetta against Federer or any other player for that matter.


Look, this is not about who takes more or less MTO’s, how old/young they are or how hyped a particular match is. It’s the principle of the matter that’s important and fixing something that is broken in our sport.

As I’ve said before, The Grand Slams are a battle of the fittest over two weeks. Let’s keep things the way they were intended and let the fittest athletes and best players win.


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