Tennis’s injury discussion has sharpened in 2026, with the ATP Tour losing several leading names and major events feeling the effect. Carlos Alcaraz’s five-month absence has already underscored the strain on the sport, and now Jannik Sinner’s withdrawal from the US Open because of a knee injury has added another major setback.

Holger Rune, Arthur Fils and Jack Draper have also dealt with significant injuries over the past year, reinforcing the sense that the problem has spread through the tour. While the packed calendar is often cited as the main culprit, Patrick Mouratoglou says the issue runs deeper than scheduling alone.

Speaking on Instagram, the former coach of Serena Williams said: “You know the reason, the calendar? I don’t think so. I have a completely different explanation. Since the early 2000s, the governing bodies have decided to slow down the surfaces and homogenise them.

“Some surfaces that used to be very fast are not fast anymore. “Now, most of the players play fully from the baseline, hitting the ball extremely hard with a very high intensity. Look at the injuries that are listed. It’s only upper body injuries.

“We’re not talking about the movement. One of the explanations is the fact that, you know, all the players have to hit the ball way harder than before. The second explanation is the balls. First, from one tournament to the other, it’s a different ball.

“Some are lighter. Some are heavier. It’s constant adaptation for your upper body, and constant different stress on the joints of the upper body. A lot of players have complained that the balls are reacting differently. They get old extremely fast.

“So I think that it’s important that the governing bodies at this point, knowing now that there is a huge increase in injuries from the upper body, work to find the explanation of this phenomenon and then find solutions so we go back to a percentage of injury that is acceptable.”

Mouratoglou is not alone in raising the issue. Earlier this year, Emma Raducanu said: “I do think the balls are a big challenge for all of us. The way that they deteriorate is really challenging.

“I think it gets very fluffy. You see a lot of wrist, elbow, shoulder injuries happening now. And it is hard because the dynamic of the points can be different from when they’re new to when they’re old.”

Daniil Medvedev has also been a persistent critic. “I’m crying because it disadvantages me,” he said earlier this year at the Rotterdam Open. “But if you take six balls out of the new balls out of the can, if you look closely and you bounce them, there are going to be six different balls. I don’t think that’s how it’s supposed to be.”

With top players repeatedly voicing concern, pressure is building for tennis to address one of the sport’s most persistent complaints.

Arthur Fils has made the biggest move in the Race to the ATP Finals after winning the Cincinnati Open, while Novak Djokovic has fallen out of the top 10.

The Frenchman is now up to a career-best ATP ranking of No 11 after beating Frances Tiafoe in the Cincinnati final to secure the most significant title of his career. That victory has lifted him to fifth in the Race to Turin, underlining the impact of his run in Ohio.

With the back-to-back ATP Masters 1000 events in Montreal and Cincinnati now complete, the North American hard-court swing will finish at the 2026 US Open.

The Race to Turin is the seasonal points table that determines which eight players qualify for the ATP Finals, scheduled this year in Turin from 15 to 22 November. The event, first staged in 1970, will be played indoors on hard courts at the Inalpi Arena.

The two players ranked ninth and 10th in the Race can still travel to Turin as alternates, ready to replace any withdrawals. If a Grand Slam champion from the current season finishes between ninth and 20th, he takes the final qualifying place.

At the top of the standings, Jannik Sinner has not played since winning the Wimbledon final last month, yet he remains first with 7,950 points. Alexander Zverev was unable to make full use of Sinner’s absence in Canada and Cincinnati, collecting only 110 points and staying 1,300 points behind.

Carlos Alcaraz, who has not played since April, is still third on 3,650 points ahead of his US Open return. Flavio Cobolli sits just 220 points behind him in fourth, with Fils 290 points further back in fifth after his Cincinnati title.

Ben Shelton is sixth, Daniil Medvedev seventh, and Tiafoe has moved into eighth after reaching the Cincinnati final.

Rafael Jodar is ninth on 2,499 points, just 31 behind Tiafoe, with Taylor Fritz 10th. Djokovic’s loss in his opening Cincinnati match has pushed him down to 11th.

Jannik Sinner’s late decision to pull out of the US Open has shifted attention from New York to the nature of the injury behind it. The world No 1 had been linked with fitness concerns in the days leading up to the event, but there had been no firm confirmation that the issue would prevent him from competing.

That picture has now become clearer. According to Gazzetta, Sinner is not dealing with a knee lesion, which would have raised the prospect of a far longer absence. Instead, the issue is inflammation in the knee, and he has been instructed to stay off tennis courts for at least eight days while he works toward a return.

The report also says he will not resume practice until September 6 at the earliest. That timeline makes his US Open withdrawal easier to understand, and there is a possibility the layoff could stretch a little longer.

Even so, Sinner is still looking ahead to a specific comeback point. Reports indicate that he is targeting the China Open as his next tournament, with the ATP 500 event starting on September 30. That schedule would give him more than a month to recover properly and aim to be back at full strength.

The Italian won the tournament last year, meaning he will be defending 500 points when he returns. He beat Alex de Minaur, Learner Tien, Fabian Maroszan, and Marin Cilic on the way to the title then, and he will again be expected to contend strongly if he is fit enough to play.

Should he return in Beijing, he would avoid Carlos Alcaraz, who is set for the Japan Open in the same week. After that, Sinner is likely to continue with the Shanghai Masters before the indoor European swing. That section of the season should suit him, provided he is ready in time for Paris, Vienna, and the ATP Finals, all events he won in 2025.