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  • Hugh Clarke

Medical Time Outs with Skin in the Game

Updated: Jul 9

In Nassim Taleb's famous book, Skin in the Game, the Lebanese trader and polymath outlines the important function of the aphorism in all walks of life. In a nutshell, skin in the game means that there needs to be symmetry and shared risk in order to maintain some sort of honesty. This isn't some revolutionary idea. King Hammurabi of Babylon laid out the first recorded set of laws nearly 4000 years ago, known as Hammurabi's Code, and it makes clear exactly what skin in the game meant way back then. Here is law 229:

If a builder builds a house for a man and does not make its construction firm, and the house which he has built collapses and causes the death of the owner of the house, that builder shall be put to death.

Pretty simple. Pretty brutal. But you knew you were getting honest workmanship—that's what skin in the game means. Your literal skin (or life, or in our case, friendly tennis match) is on the line with every decision you make. This is instinctively what we do as humans; your local entrepreneur who has invested his own money and time into a business venture is going to be working a lot harder than the 9-5 city employee, that's for sure. Modern life is devoid of skin in the game everywhere; politicians go to war, but it's the young and naive troops that go to war, often not coming back; banks take on risk for their customers knowing the government will bail them out with the same customers taxes; and tennis players take medical time outs knowing there's a chance they will halt their opponent's momentum, all without penalty.


Momentum is a huge thing in sports. We've all seen the inevitable comeback where a player that was seemingly dead and buried looks unstoppable 30 minutes later. It's one of those intangible phenomenons that we can all sense and feel, but can never really define with statistics or an operative definition. In tennis there's no teammates to sub you out, there's no coach to tell you what to change, and there's no half-time locker room to help you regather. But, there is the scoring system; a player can't simply 'run out the clock' in tennis, even if they are up a set and 5-0, and this is where a tennis player can find a crutch on the court. The only point in tennis you must win is the last point, and this gives a competitive player the motivation to stay out there as long as possible to look for solutions.




This isn't a new discussion. Tennis has long required an update to the current MTO rules which provide a 'convex' option to a player who wishes to use it when they aren't really injured. Convexity is just a fancy word that means a decision or action costs you very little, but has the potential for huge upside; you're punting pennies for the chance to win big bucks.


So, what needs to change?


The official Grand Slam rule book can be found here, but I've pulled out a few key excerpts:


  • 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 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 all of these rules is that they are vague. There's no way to really tell if a player has a treatable medical condition a lot of the time. Often you see a player grab at a knee or a hip, and I'm sure every player carries the little aches and pains that come with being a world-class athlete, but it's hard to really know how bad these kinds of injuries are compared to something like a blister, or a badly rolled ankle. However, I think there is a way to change that.


Make MTO's Expensive


Picture this. You're up 7-6 4-1 and cruising. Sure you're confident, but closing that match out is the hardest part, and it's still only one break before your opponent is right back in it. You've been pulling away in the second set, building on the momentum and freedom of having a lead, but now your opponent has requested an MTO for 'leg soreness' and you're sitting in your chair getting cold, looking around, thinking. A big momentum killer. When you start again, your opponent plays with renewed vigour. Your feet aren't moving as well as before and you feel a little sluggish now. You double fault the first point at 4-2 and now you're suddenly wondering if your opponent even has sore legs, 'do I just try to move them around? Do I keep attacking? Then at 0-30, other, more destructive thoughts creep in. The dreaded 'choke' word starts turning over in your head. Your opponent wins the second set 6-4 and you lose the third 6-0 in a heap.


This happens more often than you think. And even if it doesn't always work, it's a play that is worth taking for a player that doesn't mind gamesmanship, given the current rules essentially make it a free bet.


The solution is simple. Make MTO's expensive. I propose one new rule that can replace that whole set of jargon from above:

Rule 1: A MTO can be taken on a change of ends, with a point docked for every minute the MTO exceeds the regulation change of ends (90 seconds during sets, 120 seconds between sets).

Pretty simple. Pretty brutal. But you know the injury is real in this instance. No one is taking an MTO for 'leg soreness' if it's going to cost them a few games, and if a player is really that injured, they will be willing to throw a few extra points to give themselves a chance to play on. Umpire discretion is no longer needed.


The upsides to this are threefold:


1) Speeds up matches. The attention economy is more competitive than ever. Tennis is competing with YouTube, Instagram, Netflix, E-sports, and every other traditional sport out there. Innovation and speed is key to attracting new fans and holding on to old ones. Keeping viewers engaged requires an understanding that things need to move fast enough for a viewer who has an endless amount of options in their pocket. The trend in tennis has always been about getting faster matches. In the last 15 to 20 years we have seen the introduction of: super-tiebreakers in deciding sets, short-deuce in doubles, and a shot clock of 25 seconds. Tennis, especially men's Grand Slam tennis, is a long-form sport. Matches can run for 5 or 6 hours sometimes, and your typical match would run for around 2 hours, but in that time only a fraction involves live point play. The rest of the time is soaked up with between-point towel wiping, change of end breaks, set breaks, and sometimes MTO's. The goal of tennis' future is to bring that ratio down so that there is less dead time where commentators riff on whatever the camera focuses on.


2) Ensures less gamesmanship. You can't take that MTO at 7-6 4-1 for leg soreness now, because you're going to be down match point if you take too long. If the injury is that bad and you can't play on, retire.


3) Related to the above point. Players use MTO's to sneak through with a little injury, only to pull out before their next round or retire early in the match. It kills the tournament buzz when someone makes it through to the fourth round only to withdraw and allow the next opponent a spot in the quarterfinals. Ticket holders are robbed of a match they paid good money for.


Tennis made a good decision when it introduced the shot clock several years ago. The next step is finding other areas to keep the play fast, and the fans entertained. The MTO rule is being abused and fans and honest players are being hurt for it.


What do you think? Does tennis need to continue adapting, or will too many players retire and be put at risk with this proposed change?









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