Confusion abounds about the rules and standard practices for medical treatment during professional tennis matches. Let’s dispel some common myths, many of which are perpetuated by commentators who ought to know better.
Myth: Players Ask for MTOs
Players have the right to ask the chair umpire to call the physiotherapist (also commonly called the trainer, or the Primary Health Care Provider in official WTA jargon). The physio conducts an evaluation, and may also elect to call the tournament doctor for assistance with the evaluation and advice. The physio then makes the decision about whether to grant a medical time-out (MTO, referring to treatment occurring beyond the time normally allotted for the change of ends).
MTOs are allowed only for medical conditions that arise or are aggravated during the match, and which can be effectively treated within the time limit (in most cases 3 minutes) by the physio and/or doctor. When players believe they have an acute medical condition, namely one that arises suddenly during the match and requires immediate treatment, they can say so and stop play immediately to wait for the physio to arrive. If the physio agrees that the condition is acute, then the MTO is granted immediately. Otherwise, play must resume and treatment, if any, occurs at the next changeover. WTA rules say expressly that a player who stops play but is not “forthright” about her belief that she has an acute condition is subject to a code violation for unsportsmanlike conduct.
MTOs are not allowed for “general player fatigue”, or for cramping. However, the physio is allowed to treat cramping during the time allotted for the changeover. WTA rules also leave open the possibility that a physio could treat cramping during an MTO granted for heat illness or another illness, of which cramping is “one of the manifested symptoms.”
Myth: Players Ask for Specific Treatments or Evaluative Techniques
Players ask for the physio, and communicate their symptoms and understanding of what the problem is. The physio determines what kinds of evaluation and treatment are appropriate, if any. Probably the most common example of this myth is when people say something like, a player “wants her blood pressure checked.” Indeed players complaining of symptoms like dizziness, weakness, or nausea that might indicate an illness will often have their blood pressure taken by the physio or doctor, but this occurs at the physio’s discretion. Of the vital signs commonly measured in such circumstances, blood pressure is the most obvious, because checking it requires obvious equipment and takes a significant amount of time. But if you watch closely, you’ll notice that when measuring blood pressure, the physio/doctor will almost always also check pulse rate and temperature (usually with an ear thermometer).
Myth: Players Often Take “Long MTOs”
MTOs are limited to three minutes, with certain narrow exceptions. This does not include the length of time it takes the physio to reach the court, which can be a few minutes in itself, especially if the tournament venue is spread out or the physio was with another player when called. It also does not include the evaluation period after the physio arrives. The physio determines how long the evaluation takes, under the general directive that it “should be performed within a reasonable length of time, balancing player safety on the one hand, and continuous play on the other.” WTA rules also say the evaluation period is “recommended not to exceed three minutes.”
Also, MTOs can be performed off-court at the physio’s discretion, “for reasons of privacy and modesty,” as WTA rules put it. When this happens, the three-minute limit for the MTO does not include the time it takes for the physio and player to walk to the therapy room after the evaluation, or the time it takes the player to return to the court once treatment is completed.
Unfortunately television graphics often confuse these considerations by putting a live clock graphic on the screen, counting the “time since last point” and encouraging viewers to conclude that play is being unreasonably delayed. It’s important to remember, among other things, that most MTOs occur when there would have been a changeover anyway—which means at least two minutes would have elapsed between points even if the physio had never been called.
WTA rules also say that after an MTO, a player “should be given the time necessary to put on her socks and shoes before ‘Time’ is called,” if necessary, presumably following treatment to a foot or ankle.
If a player is bleeding, an umpire or supervisor can extend an MTO to a maximum of five minutes to stop the bleeding and therefore eliminate the biological hazard it could potentially pose to others on the court. If blood or vomit has spilled onto the court, play has to be stopped until it can be properly cleaned up. If bleeding or vomiting cannot be controlled within the length of time allowed by these guidelines (and the player still wants to continue) the supervisor or tournament referee is confronted with deciding whether to force a retirement to protect the player’s health.
Myth: Players Often Take More than One MTO for the Same Injury
A player can take only one MTO for “each distinct treatable medical condition,” where “all treatable musculoskeletal injuries that manifest and are assessed as part of a kinetic chain continuum shall be considered as one treatable medical condition.” This means, for example, that if a player’s gait is thrown off by a thigh injury and that in turn causes back pain, the two issues are considered together as one condition. Rarely, two consecutive MTOs may be granted (during the same interruption of play) for two separate conditions—for example, blisters on both feet, or an ankle injury and an illness.
In addition to the MTO, a player can receive further treatment for a given condition during the time normally allotted for up to two other changeovers. These changeovers need not be consecutive, and need not occur after the MTO. In all, it is possible for a player to call the physio during one changeover, get evaluated during a second changeover, take an MTO that draws out a third, and receive further treatment during a fourth and fifth.
Sometimes television feeds confuse all of this by misleadingly showing “Medical Time-Out” on the screen when the physio hasn’t even arrived yet on court, let alone conducted an evaluation or decided to grant an actual MTO. It’s important to remember once again that the placement of a call for a physio, or the appearance of a physio on court, does not necessarily mean an MTO is taking place, or ever will.
This post is based on the Medical Procedures section of the 2019 WTA Official Rulebook, pp. 359–370, and the Medical subsection of The Competition section of the 2019 ATP Official Rulebook, pp. 151–157, as well as my observation of these procedures in practice during thousands of matches. When I quote from a rule book without specifying which one, it’s because the language is substantially the same in both.