Jannik Sinner has advanced to the Italian Open final, but it wasn’t easy. The world No. 1 beat Daniil Medvedev in a match that stretched across two days, winning 6-2, 5-7, 6-4 after rain forced the suspension of play with Sinner leading 4-2 in the third set. What happened between those sets defined the night.

Sinner was cruising through the first set against Medvedev before trouble began to set in the second. He was seen throwing up by the side of the court, leaning on his racquet between points, and grimacing visibly at changeovers. After his serve was broken, he called for a medical timeout, during which a physio worked on both his quadriceps while he sipped pickle juice, a well-known remedy for cramps. The optics were not lost on Medvedev, who questioned chair umpire Aurelie Tourte and suggested Sinner was receiving special treatment.  

Jamie Murray, on commentary for Sky Sports, was blunt about what he was watching. “He is getting treated for cramp essentially, he’s getting his quads massaged. He’s getting his other quad massaged now, so it’s a tough one to explain that you have got two injured quads and it’s not cramp while you’re sipping on your pickle juice. Players exploit that every week, it’s not a unique situation. Medvedev knows what is up.”

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Sinner held on to take a 4-2 lead in the third before rain arrived and suspended proceedings. The next day, when he came back to close out the game, 6-4, in the decider, the physical action of the previous evening added a new set of difficulties. 

“During the night, usually I never struggle to sleep. This night was not easy. When you’re in the third set, nearly done, but you still have to show up again, you never know what’s happening. It’s basically a new start of a match. There are nerves again,” Sinner said after the match.

He now faces two-time French Open finalist Casper Ruud in the final, a player he acknowledged is in significantly better form than their previous meeting. “I think he’s playing much, much better tennis right now. It’s gonna be very tough. Every match every week even if you play with the same player week after week is completely different. I’m just happy to stand again here in the final,” Sinner said. The prize is more than just this title. The Italian Open is the last of the nine ATP Masters 1000 events that Sinner has yet to win.

Victory on Sunday would make him only the second player in history to complete the Golden Masters, after Novak Djokovic. Sinner has picked up the last five Masters 1000 tournaments and will come into Roland Garros with a great deal of momentum – with Carlos Alcaraz sidelined with an injury, he poses a chance to sweep up the whole clay swing. Whether his body holds up through one more match in Rome is the question that follows everything else.

Sinner vs Ruud: A final with history on the line

The series between the finalists is truly lop-sided. Sinner has taken all eight sets he and Ruud have faced on the road. Last year at this tournament, the world No. 1 put Ruud away with a 6-0, 6-1 quarterfinal victory, one of the most one-sided matches between two top players in a Masters event over the past few years. Ruud has never beaten Sinner on tour, and he knows it.  “Last year I was kind of blown out of the court by him. We will both remember it, of course. I hope that’s not the case,” Ruud said after his semifinal win over Darderi. He added, with the kind of pragmatism that has defined his clay court career: “At the end of the day he’s human. I have to try to think that way as much as I can.”

Sinner was careful not to treat the final as a foregone conclusion, framing it simply in terms of what the occasion means. “Special tournament for me. Special tournament for Italians. I just try to do my best. If it goes well, I’m very happy. If not, final of a Masters is an amazing result,” he stated. 

For Ruud, reaching the Rome final completes a remarkable set. He has now reached the finals of all four of the clay season’s biggest events, Roland Garros, Madrid, Monte Carlo, and Rome, a consistency on the surface that puts him in elite company. The trip to the final in Rome also puts him in the top-16 of Roland Garros, where he will not face the top players until at least the quarterfinals in Paris. Either way, the Norwegian will walk away from Rome with some big gain already in hand. 

What adds an unexpected dimension to the final is Sinner’s physical state. If a player vomits on court, has to take a medical timeout due to what seemed to be extreme cramping, and confesses to not sleeping well the night before, he’s not walking into a final at full capacity. In the semifinal against Darderi, however, Ruud had time to rest and will walk out on Sunday fresh and ready. Ruud will have a true physical edge on Sinner for the first time in their head-to-head record of 4-0 for Ruud.

The Norwegian has a busy schedule, as he plays in Geneva the next day on the R32 schedule against Jenson Brooksby, meaning he is at his seasonal peak and doesn’t want to waste that form. If there is ever a moment for Ruud to end his winless record against Sinner, a home final on a sun-baked Foro Italico clay court with the world No. 1 running on empty might be the closest thing to it.