The cramping and medical treatment debate

[jrachiever]

During slam coverage for the last however many years, the debate over medical treatment and cramping seems to be rehashed over and over. Most recently on ESPN they were going over the typical arguments after the Hewitt-Gonzalez match. The pro- no treatment camp's viewpoints seem to be summarized basically as this:

1) Cramps are caused by lack of fitness
2) It is often a strategy for one player to attempt to attack the fitness of his opponent
3) When a player cramps, the other player has succeeded in breaking him down
4) Allowing treatment for cramps is tantamount to negating this rightfully earned advantage

Anyways, I basically think this is a bunch of crap. First of all, as far as I know, there is no definitive mechanism for cramps, but it's generally accepted that they can be caused by a number of factors, the most common of which are:

- muscle hyperflexion (I'd imagine most of us have experienced pushing/pulling too hard or going beyond our typical range of motion in some activity and experiencing a cramp)
- oxygen deprivation due to excessive fatigue (what the anti-cramp treatment camp is alleging happens in tennis)
- electrolyte imbalance due to excessive sweating

In my opinion, the overwhelming majority of cramping in tennis is due to electrolyte imbalances and not due to fatigue. I competed as a junior, and I sweat like no other, and had plenty of instances of cramping during my second match of the day during summer tournaments. Never once did I feel like I was physically broken down, or had my legs taken out from under me. I always had plenty of energy to keep playing hard, if my muscles would just stop locking up on me. I train for running and triathlons these days, and have plenty of experience cramping in the late stages of endurance training or races, when I'm trying to push through on totally fatigued legs. It's a completely different ballgame. Get cramps to subside and I'm still going really slow.

It's pretty obvious to me that if you're truly cramping due to fatigue, you aren't going to be back at it as good as new after a medical timeout. Even if a trainer can massage out the cramps temporarily, if you were that fatigued, court movement, power, etc... will still be severely limited. If a player is cramping, gets treatment then starts looking and playing great again, I'm going to say with 99% certainty that the cramps were due to excessive sweating and not fatigue.

Anyways, I just get tired of commentators repeating again and again how if you're in shape you don't cramp. I think it's close to dead wrong. Vent over.

 

[TheTruth]

During slam coverage for the last however many years, the debate over medical treatment and cramping seems to be rehashed over and over. Most recently on ESPN they were going over the typical arguments after the Hewitt-Gonzalez match. The pro- no treatment camp's viewpoints seem to be summarized basically as this:

1) Cramps are caused by lack of fitness
2) It is often a strategy for one player to attempt to attack the fitness of his opponent
3) When a player cramps, the other player has succeeded in breaking him down
4) Allowing treatment for cramps is tantamount to negating this rightfully earned advantage

Anyways, I basically think this is a bunch of crap. First of all, as far as I know, there is no definitive mechanism for cramps, but it's generally accepted that they can be caused by a number of factors, the most common of which are:

- muscle hyperflexion (I'd imagine most of us have experienced pushing/pulling too hard or going beyond our typical range of motion in some activity and experiencing a cramp)
- oxygen deprivation due to excessive fatigue (what the anti-cramp treatment camp is alleging happens in tennis)
- electrolyte imbalance due to excessive sweating

In my opinion, the overwhelming majority of cramping in tennis is due to electrolyte imbalances and not due to fatigue. I competed as a junior, and I sweat like no other, and had plenty of instances of cramping during my second match of the day during summer tournaments. Never once did I feel like I was physically broken down, or had my legs taken out from under me. I always had plenty of energy to keep playing hard, if my muscles would just stop locking up on me. I train for running and triathlons these days, and have plenty of experience cramping in the late stages of endurance training or races, when I'm trying to push through on totally fatigued legs. It's a completely different ballgame. Get cramps to subside and I'm still going really slow.

It's pretty obvious to me that if you're truly cramping due to fatigue, you aren't going to be back at it as good as new after a medical timeout. Even if a trainer can massage out the cramps temporarily, if you were that fatigued, court movement, power, etc... will still be severely limited. If a player is cramping, gets treatment then starts looking and playing great again, I'm going to say with 99% certainty that the cramps were due to excessive sweating and not fatigue.

Anyways, I just get tired of commentators repeating again and again how if you're in shape you don't cramp. I think it's close to dead wrong. Vent over.

Totally agree. I am so sick and tired of past players and commentators spouting nonsense. I seriously doubt Cahill would not have wanted a trainer if he had cramps. Sometimes their "commentary" comes off as thinly veiled jealousy. Especially those that haven't achieved that much in the game.

If a player cramps they should have medical attention. What's so great about getting hurt in the struggle?

 

[herosol]

cause Michael Chang cramped.

and SHOOO MAYNNN! WAS HE OUTTA SHAPEEEEEEEEEEEEE

 

[miniRafa386]

it does have something to do with being in shape, but i think j put it perfectly about the electrolyte imbalances. i have had cramps in easy matches before, it was definetly not because of being out of shape, but for an electrolyte imbalance or something along the lines of that. but i think its part of the game and it shows a true champion if you can come through the cramps, or if your opponent is trying to throw you off. if you can come through in both, while playing fairly, then you more than deserve the win.

 

[skip1969]

i think it's cyclical. because the rule was changed, it seems like more and more players are taking a timeout. for some players, it has become (or was, at some point) a running joke: when is so-and-so gonna call for the trainer? uh-oh, so-and-so just went down a break . . . here comes the trainer.

so now every call for the trainer is viewed with total skepticism by fans and posters (unless the player actually falls on the ground or something obvious happens). it's like the boy who cried "wolf" syndrome, and the players have only themselves to blame for trying to get away with as much as they can. some fans think it's gamesmanship or unsporting or whatever. some see it as downright cheating. and all it takes is a few bad apples on the tour to spoil it for the rest.

the end result is that the importance of calling for the trainer has been diminished, and that is the backlash of some of the 'shady' things that have taken place in tourneys over the past years. you can hardly get through a match nowadays without seeing a trainer, regardless of the weather conditions. it's sort of ironic since today's athletes are supposed to be smarter and fitter than ever before. that's a pill that some fans find a little hard to swallow.

maybe it's because it makes all us tennis geeks look like a bunch of wimps?

 

[dh003i]

i think it's cyclical. because the rule was changed, it seems like more and more players are taking a timeout. for some players, it has become (or was, at some point) a running joke: when is so-and-so gonna call for the trainer? uh-oh, so-and-so just went down a break . . . here comes the trainer.

so now every call for the trainer is viewed with total skepticism by fans and posters (unless the player actually falls on the ground or something obvious happens). it's like the boy who cried "wolf" syndrome, and the players have only themselves to blame for trying to get away with as much as they can. some fans think it's gamesmanship or unsporting or whatever. some see it as downright cheating. and all it takes is a few bad apples on the tour to spoil it for the rest.

the end result is that the importance of calling for the trainer has been diminished, and that is the backlash of some of the 'shady' things that have taken place in tourneys over the past years. you can hardly get through a match nowadays without seeing a trainer, regardless of the weather conditions. it's sort of ironic since today's athletes are supposed to be smarter and fitter than ever before. that's a pill that some fans find a little hard to swallow.

maybe it's because it makes all us tennis geeks look like a bunch of wimps?

I agree with this. Whatever the reason, why is that an excuse? In any event, I do tend to agree that cramps expose not being in as good shape.

But even if it is electrolyte imbalance, don't they have energy/nutrition drinks? Are they deprived of them during the match? No. And they are allowed to go to the bathroom between sets. So I don't see an excuse.

But if we are to have it, it ought to be controlled. A limit to how many "injury" timeouts you can take, and then thereafter maybe a point penalty for each one, or something. There needs to be a deterrent to abusing the system other than the player's own sense of integrity (as some players obviously are lacking in this category). Federer said, "the rules are there to be used, not abused," and that's a nice sentiment; but basic understanding of economics tells us that unless there is a deterrent, they will be abused by at least some players (until the age of saints arrives).

Just like taking too much time between points. It may be an unfair advantage to the player who does it, if he's playing against a player who doesn't expend much energy while playing.

 

[coloskier]

Cramps in AO are being caused mostly by the excessive heat causing dehydration. But, more than anything, it is being caused by your opponent running you into the ground. I do not think that you should be able to take injury timeouts for cramping so you can recover from the beating you are taking. It becomes a definite disadvantage for your opponent. If you can't stand the heat, stay out of the kitchen. If you have to take a timeout for cramps, you should be forced to forfeit a game.

 

[jrachiever]

Cramps in AO are being caused mostly by the excessive heat causing dehydration. But, more than anything, it is being caused by your opponent running you into the ground. I do not think that you should be able to take injury timeouts for cramping so you can recover from the beating you are taking. It becomes a definite disadvantage for your opponent. If you can't stand the heat, stay out of the kitchen. If you have to take a timeout for cramps, you should be forced to forfeit a game.

My main point is that if you are truly run into the ground, an injury timeout isn't going to save you. If someone starts playing great again after an injury timout, they probably weren't run into the ground.

To whoever mentioned hydration being available so there's no excuse for cramping, well it's not exactly that easy. When you're dealing with massive fluid losses it's just about impossible to replace. After a bit of experimenting, I eventually found that I needed to drink 2 64oz Gatorades in between matches to have a good chance of holding off cramps. I could never take in electrolyte drinks during matches though, as they very commonly cause upset stomachs. And if you try to drink huge quantities on change overs of any drink, it'll be sloshing around in your stomach like crazy and be very difficult to deal with. The best strategy often is just to hope you're loaded up with enough before getting on the court to make it through.

I do agree completely about being forced to forfeit points based on causing delays. In general, I think the easiest thing to do would be to allot one 5 minute timeout to each player during the match. Use it whenever you want for whatever reason, whether for injury, to refocus or to try to break the other guy's momentum. Make it a new rule, just get it out in the open and get players used to dealing with it, as opposed to all these current constant accusations of abuse of the current rules, gamesmanship, etc... If you need additional treatment after the one timeout, fine, but get it done during the 90s changeovers or start forfeiting points for every additional 30s thereafter.

 

[NamRanger]

Tennis should introduce a new rule. 60 second timeouts. Players receive three of them per set. However, they are also tied to the challenge system. Should they incorrectly challenge, they also lose that timeout.

 

[oy vey]

I seriously doubt Cahill would not have wanted a trainer if he had cramps.

I can't stand that guy. He's the worst.

 

[skip1969]

maybe some kind of new rule is the answer, some new system . . . i don't know. something simple and straightforward like has been suggested: everyone gets one timeout for whatever. then, i suppose, no one can question your motives cos the motive is irrelevant. you are merely using your allotted break.

who knows. but in my time as a tennis geek, we've gone from (practically) nobody being able to take a break to (practically) everyone taking a break during every match. that's quite a leap.

before, things seemed a lot more cut-and-dried. if someone couldn't go on (for whatever reason) then they retired. end of story. and it was more a case of 'only the strongest survive' so to speak. in that 'survival of the fittest' battle, you admired the player who won, and even admired the player who gave until he couldn't give anymore. nowadays, fans question the heart, desire, fitness, or scruples of everyone on court.

i'm not a big fan of interference. i'm not big on timeouts, or coaching, or challenges. when i was taught, it was like . . . it's you against the other guy. figure it out. or lose.

 

[rolandg]

Don't know what the answer is. Rafter used to cramp a lot and he was the best athlete of his era. He used to sweat a lot though.

 

[boredone3456]

Whatever the cause of the cramping is the main problem is some players take forever to get back on court. Mary Pierce Famously did it in the 2005 US Open Semi's against Dementieva, she took I think almost 15 minutes with her trainer to get stretched out in her legs, back and such. that kind of thing is excessive and is the root of the medical timeout debate. Dementieva after the match said it was foolish and she should have been told to get back on court much sooner and finish the match, as at the time it happened Dementieva felt she was in control. In the end, whatver the cause of the cramping, there do need to be set rules for how long that trainer can be on court with the player who ever it is.

Now not every player takes advantage of the situation and in reality the majority of players due call the trainer for three minutes or whatever, get the cramp massaged and then get back on the court to finish the match. The problem is there needs to be more severe regulations for those who take to much liberty and keep the trainer out there forever and ever to the point where it seems almost ludicrous. I mean when Serena cramped at Wimby against Hantuchova, she went down, got through with the trainer in the course of a timeout, got back on court and hobbled out the win, but then you have a player due what Pierce did, and everyone says all the players are like that. There need to be strictly enforced rules and regulations, and if necessary fines and possibly dismissals for any player who seems to be excessively taking advantage, cause thats the only way to make it honorable.

 

[LuckyR]

During slam coverage for the last however many years, the debate over medical treatment and cramping seems to be rehashed over and over. Most recently on ESPN they were going over the typical arguments after the Hewitt-Gonzalez match. The pro- no treatment camp's viewpoints seem to be summarized basically as this:

1) Cramps are caused by lack of fitness
2) It is often a strategy for one player to attempt to attack the fitness of his opponent
3) When a player cramps, the other player has succeeded in breaking him down
4) Allowing treatment for cramps is tantamount to negating this rightfully earned advantage

Anyways, I basically think this is a bunch of crap. First of all, as far as I know, there is no definitive mechanism for cramps, but it's generally accepted that they can be caused by a number of factors, the most common of which are:

- muscle hyperflexion (I'd imagine most of us have experienced pushing/pulling too hard or going beyond our typical range of motion in some activity and experiencing a cramp)
- oxygen deprivation due to excessive fatigue (what the anti-cramp treatment camp is alleging happens in tennis)
- electrolyte imbalance due to excessive sweating

In my opinion, the overwhelming majority of cramping in tennis is due to electrolyte imbalances and not due to fatigue. I competed as a junior, and I sweat like no other, and had plenty of instances of cramping during my second match of the day during summer tournaments. Never once did I feel like I was physically broken down, or had my legs taken out from under me. I always had plenty of energy to keep playing hard, if my muscles would just stop locking up on me. I train for running and triathlons these days, and have plenty of experience cramping in the late stages of endurance training or races, when I'm trying to push through on totally fatigued legs. It's a completely different ballgame. Get cramps to subside and I'm still going really slow.

It's pretty obvious to me that if you're truly cramping due to fatigue, you aren't going to be back at it as good as new after a medical timeout. Even if a trainer can massage out the cramps temporarily, if you were that fatigued, court movement, power, etc... will still be severely limited. If a player is cramping, gets treatment then starts looking and playing great again, I'm going to say with 99% certainty that the cramps were due to excessive sweating and not fatigue.

Anyways, I just get tired of commentators repeating again and again how if you're in shape you don't cramp. I think it's close to dead wrong. Vent over.

I agree that especially at the Aussie Open, that the heat leads to sweating which leads to electrolyte problems. However, this is a well known fact on the Tour so Pros should be taking steps both before and during their matches to compensate for this. I believe that this preparation and intramatch repletion strategy is as much of the game as serves and backhands. So I would penalize someone who needed more than a 20 second "timeout" to go to the side of the court and pound some pickle juice.

 

[woodrow1029]

The rule is that once the trainer gets to court, they have "reasonable time" to evaluate the injury. Once their evaluation is done, they have 3 minutes to treat the injury. Play *should not* be stopped for 15 minutes as then the players could be entitled to a re-warmup.

The ATP, WTA and ITF havetightened up on the abuse of the medical time outs a bit by adding the term acute medical condition in order to stop during a game or before the opponent's service game. If a player is cramping, or says he has an injury that is not visible to the chair umpire, and asks for the trainer, we make them wait until the changeover. If they insist that they have to see the trainer now, we need to call for the trainer because umpires are not doctors or trainers and can't be responsible for making a medical decision that the player can continue. Once the trainer comes to court, he will decide whether or not it is an acute condition that requires treatment right away. If not, he will instruct the player to continue and will treat it on the next changeover.

Medical Time Outs are never going to be eliminated, and allowing treatment for cramping is not going to be eliminated either. Keep in mind that there can only be one medical time out for all cramping in one match. If a player is cramping in their leg they can have a medical time out. Later, if they start cramping in the other leg, or wrist, or anywhere else, they must continue playing. They can receive changeover treatment only, but no more than the changeover time.

If Medical Time Outs were not allowed, especially for cramping, there would be a lot more retirements, and that is worse for the game.

 

[Moose Malloy]

Whatever the cause of the cramping is the main problem is some players take forever to get back on court. Mary Pierce Famously did it in the 2005 US Open Semi's against Dementieva, she took I think almost 15 minutes with her trainer to get stretched out in her legs, back and such.

It was well within the rules(and it wasn't anything to do with cramps)

Pierce called for the WTA Tour trainer, who worked diligently on Pierce's back and taped her thigh. At one point, Pierce was laid out on the court and appeared to be enjoying a massage at the spa. Dementieva, fuming in her changeover chair, watched the normal two-minute changeover time swell to 12 minutes.

Which begged this question: Was Pierce injured and, if so, badly enough to warrant a 10-minute break for treatment?

Pierce denied the charge, saying she injured her thigh in the previous match against Amelie Mauresmo and went against the trainer's request to tape it so she wouldn't give Dementieva the psychological advantage of seeing her opponent injured. Her back, she said, started bothering her at the beginning of the match, possibly because she was overcompensating for her leg. After conferring with the trainer, Pierce said, she opted to take care of both problems at the same time.

According to WTA Tour rules, Pierce was technically within her rights. When a player is injured, she is permitted a three-minute period of evaluation by the trainer and a three-minute treatment window. A second injury permits another six-minute block of time, but the 12-minute total is the maximum allowed during a changeover.

http://sports.espn.go.com/sports/tennis/usopen05/columns/story?id=2156997

If a player is cramping in their leg they can have a medical time out. Later, if they start cramping in the other leg, or wrist, or anywhere else, they must continue playing.

did you see the Bagdhatis-Agassi USO match? I'm almost positive he got 2 injury timeouts for cramping(one for his arm & then one later for his leg - he actually fell to the ground & was allowed to be treated then & there - not having to wait until the changeover)

I will take a look at the tape. I actually think the commentaors mentioned this & a reporter claimed that Bagdhatis tried to pretend it was a 'new' injury.

 

[Moose Malloy]

If a player is cramping, or says he has an injury that is not visible to the chair umpire, and asks for the trainer, we make them wait until the changeover. If they insist that they have to see the trainer now, we need to call for the trainer because umpires are not doctors or trainers and can't be responsible for making a medical decision that the player can continue.

I'm sure I've seen matches where the player 'insists' he has to see the trainer & is still told to wait till the changeover.

Are you saying the umpire would be wrong to do that iin that situation?

It seems like most umpires just stick with 'wait until the changeover' rule, no matter how strongly a player argues.

 

[woodrow1029]

I'm sure I've seen matches where the player 'insists' he has to see the trainer & is still told to wait till the changeover.

Are you saying the umpire would be wrong to do that iin that situation?

It seems like most umpires just stick with 'wait until the changeover' rule, no matter how strongly a player argues.

No we don't. We try to get them to wait till the changeover if possible. If they insist that they need the trainer right away, we get the trainer and let the trainer make the decision whether to treat then or at the changeover. Like I said, the umpire would be taking a risk by completely denying the trainer flat out. We are not doctors or trainers and don't make medical decisions.

 

[woodrow1029]

It was well within the rules(and it wasn't anything to do with cramps)







http://sports.espn.go.com/sports/tennis/usopen05/columns/story?id=2156997



did you see the Bagdhatis-Agassi USO match? I'm almost positive he got 2 injury timeouts for cramping(one for his arm & then one later for his leg - he actually fell to the ground & was allowed to be treated then & there - not having to wait until the changeover)

I will take a look at the tape. I actually think the commentaors mentioned this & a reporter claimed that Bagdhatis tried to pretend it was a 'new' injury.

I believe when he fell, it was decided by the trainer that it was not cramping. It was either a sprained ankle or knee. If the trainer had determined that the second injury was cramping again, Baghdatis would have had to continue playing until the changeover. Then he could receive changeover time treatment only.

This was also before the term "acute medical condition" was put in the rule book. So we would call the trainer any time the player asked for it.

 

[Moose Malloy]

No we don't. We try to get them to wait till the changeover if possible. If they insist that they need the trainer right away, we get the trainer and let the trainer make the decision whether to treat then or at the changeover

If that's the case, then this isn't much of a 'new way to cut down on injury timeout abuse' to begin with.

Is there a number of times one has to ask before the umpire says 'yes'?

like in the middle of a game - "I want the trainer"

"You have to wait until the changeover."

"No, I really want the trainer."

"Okey-dokey, coming right up"

If that's the case, any player on tour that doesn't 'insist' on a trainer if they want a break is a fool.

But I'll keep a note the next time I see an umpire deny an insistent player. I have visions of an annoyed Safin being told he has to wait by Fergus Murphy.
And it seems like the commentators(including coaches cahill & gilbert) think the waiting for the changeover thing is a strict rule, unless one is clearly injured.

 

[mtommer]

First of all, as it's been mentioned already, there is no definitive cause for cramping at this time. So, whether or not one thinks is has to do with fitness or not is beside the point. You don't know, I don't know, experts don't know.

As such, it very well could be a medical condition. Until it is known one way or another it is better to err on the side of caution and treat it like it is. As far as I'm concerned, this is the only thing that matters. More importantly, it keeps a match going which I happen to think is for the best. It forces one player to have to beat the other player with their actual game play. For me, as a player, that is a more satisfying way to win anyway. You can come away from the match knowing that no matter what the other player did, no matter how much they were able to trouble you, no matter how good they are or perceived to be, you won. You. On your own merits. If another player is engaged in gamesmanship, well, it's a chance for you to work on your own mental game and get stronger.

 

[woodrow1029]

Well, as is demonstrated during every tournament, the broadcasters do not know the rules.

When I am in the chair and a player is down on the ground rolling in pain and obviously needs the trainer, then I will call the trainer right away.

If they come up and ask me to see the trainer, and I can't see what the problem is, I will ask what the injury is. If they say it's cramping, or a blister or something like that, I will let them know that they need to see the trainer. If they insist that they need to see the trainer right now, the next step is to call the supervisor and the trainer. I will let the player know that the trainer is on the way and if the trainer decides that its not an acute injury, then he will need to continue playing and can get the treatment on the changeover. MOST of the time, this sentence gets them to go back and play. Sometimes, they still insist, and the trainer comes out. Sometimes he will make the player wait till the changeover, sometimes will treat right then. Which is why if the players insist, we need to call him. We don't know how serious it is in the chair. But, the amount of mid-game medical time outs has reduced a HUGE amount over the last 2 years.