Novak Djokovic has acknowledged that he is struggling to make sense of the health problems that have shadowed him in recent weeks, while also suggesting he does not know how much longer he can continue in this condition after his US Open exit.

The 39-year-old’s first-round loss to Mariano Navone in New York came only weeks after a second-round exit in Cincinnati that was already affected by vomiting and other issues requiring treatment on court. Against Navone, the same pattern returned. Djokovic threw up multiple times during the match and also needed medical attention for his lower back and shoulder.

After more than four hours on court, his resistance faded. He won only one of the final 12 games as Navone completed a notable 7-6 (7-5), 5-7, 4-6, 6-2, 6-1 victory. The result marked the first time Djokovic has lost his opening match at the US Open, and it also stood as his first round-of-128 defeat at a Grand Slam since the 2006 Australian Open.

Djokovic, a 24-time Grand Slam champion, had already declined to go into detail about his condition after the Cincinnati event, and he again kept his comments measured in New York. “I think it was obvious that it was an awful feeling for me on the court,” the former world No 1 said. “It’s something that I’ve been carrying, unfortunately, pretty much every match this year: vomiting, throwing up, a serious issue there.

“Then my whole body starts to collapse, cramping and pain. The back just gave up in the end, and shoulder, and I couldn’t close it out.

“I don’t want to take anything away from his victory. Congratulations to him. He’s a good guy and a fighter. But I didn’t have fun out there.”

Asked whether the past few months had taught him anything about the problem, he answered: “I don’t know [how I can solve the problem]. I don’t want to go into too much detail right now. I’m just trying to understand what’s going on and how much longer I can keep going like this.”

He also admitted that retirement crossed his mind during the match, but after winning a set and then another, he chose to continue. By the fifth set, though, the contest was slipping away. As he trailed 1-3, he began to cry while the crowd inside Arthur Ashe Stadium tried to lift him by chanting his name.

Even in defeat, Djokovic said the support meant a great deal. “The love and appreciation they gave me in the end really touched my heart,” he said. He added: “They were super nice. So grateful to experience this. When it comes to the match itself and overall feeling of how I felt with my body and playing, it was really not enjoyable. I pretty much despised every moment that I spent on the court for that.

“But from the perspective of the crowd and support, it was incredible, honestly from the beginning. They were trying to lift me up in important moments, and I’m very sorry that I didn’t perform as well as I should have or could have or wanted for them.”

Novak Djokovic’s 2026 US Open began in the worst possible way, as he was beaten in the first round in New York for the first time in his career. The result also triggers a significant slide in the ATP Rankings.

With Jannik Sinner sidelined at Flushing Meadows because of a knee problem and Carlos Alcaraz still recovering from a wrist injury, Djokovic had been viewed by some as a leading contender for the season-ending major. Seeded fourth, he also appeared to have a workable section of the draw, with 16th seed Brandon Nakashima the highest-ranked player in his part of the bracket and a possible quarter-final meeting with seventh seed Daniil Medvedev or 11th seed Frances Tiafoe.

Few expected Mariano Navone to create serious trouble in the opening round. The Argentine was only making his third US Open appearance and had won just once at the event before this match.

Yet Navone pushed Djokovic early, taking the first set before the former world No 1 responded by winning the next two. Djokovic then seemed positioned to close it out after moving 2-1 ahead in the fourth set and earning an early break. But the world No 49 seized control from there, aided by Djokovic’s illness and lower back problem, and finished strongly by taking 11 of the last 12 games to complete a 7-6 (7-5), 5-7, 4-6, 6-2, 6-1 victory.

Navone will next face either Matteo Berrettini or Stan Wawrinka, while Djokovic heads home.

The defeat carries a major ranking cost. Djokovic reached the semi-final at Flushing Meadows 12 months ago, losing to Carlos Alcaraz in a 6-4, 7-6 (7-4), 6-2 match that earned him 800 points. This year, a first-round exit is worth only 10 points, leaving him to drop 790 points overall.

He began the tournament at No 5 in the official rankings with 3,770 points, but has fallen six places to No 11 in the Live ATP Rankings, his lowest position in eight years, having last gone as low as No 21 in July 2018.

Prize money is unlikely to be a concern in the immediate aftermath, though Djokovic will still collect $140,000 for his first-round exit. His career earnings stand at $194,691,590, including $3,017,725 already earned in 2026.

Arthur Ashe Stadium witnessed an emotional night as Novak Djokovic was overcome with tears in the middle of his first-round loss to Mariano Navone.

The 24-time Grand Slam champion appeared in control early. After losing the opening set, he responded by taking the next two and even moved ahead with an early break in the fourth. From there, however, the match swung sharply in Navone’s favour. Djokovic won only one more game the rest of the way as Navone claimed the fourth set 6-2 and the fifth 6-1 to complete a 7-6 (7-5), 5-7, 4-6, 6-2, 6-1 victory after four hours and 36 minutes.

The result leaves Djokovic still searching for a 25th major title. It was his first defeat in the opening round of a Grand Slam since the 2006 Australian Open, and his first-ever exit in the round of 128 at the US Open.

Physical problems clearly shaped the contest. Djokovic had already spoken after his Cincinnati Open defeat about the “health issues” that have troubled him for the past couple of years, especially in humid and hot conditions. Those same issues were again visible on Arthur Ashe.

He vomited several times during the match and later needed treatment on a lower-back problem. At points during the fourth and fifth sets, he could barely move as cramping set in. The strain became impossible to hide when he began crying while trailing Navone 1-3 in the fifth set. Three games later, his 2026 US Open ended.

There was still respect from the crowd as he left Arthur Ashe Stadium to a standing ovation. He also paused to sign autographs on his way out.

The defeat carried one more striking note: for the first time since 2003, none of the Big Three, Djokovic, Roger Federer and Rafael Nadal, will appear in the second round of a Grand Slam.

23 years.