As Jack Draper stepped up to serve in the third set of his US Open first round match against Federico Agustín Gómez on Monday, the British star threw up on court.

It was a moment that brought back unwanted memories of his US Open run last year, when the 23-year-old reached the first semifinal of his fledgling career.

During that defeat to eventual champion Jannik Sinner, Draper battled yet more sickness on court, vomiting three times in the biggest match of his life to date.

It followed a trend of Draper struggling with nausea in big moments on court and it’s one he’s vowed to better understand.

Speaking to reporters after his win on Monday, Draper put his latest bout of sickness down to a combination of different things.

“I felt physically fine,” he told reporters. “I’ve always had some problems with my gut, so, you know, it could be a little bit of just getting out there again, a bit of nervous tension.

“But, yeah, it wasn’t kind of affecting me at all. I wasn’t physically struggling or anything. It was just that I have had problems with my gut over time, so it’s probably that.”

Unfortunately for Draper, he won’t get the opportunity to keep working out those problems in Queens at the US Open. The tournament announced Wednesday that Draper dropped out of the tournament with an injury and Zizou Bergs will be advancing to the third round by walkover. Draper had been managing an arm injury that had forced him to hold back on hitting his serves as fast as he can.

“Hi guys, I’m sorry to say I’ll be withdrawing from the US open. I tried my very best to be here and give myself the every chance to play but the discomfort in my arm has become to much and I have to do what is right and look after myself,” he said in a post on X. “Thank you for all the support.”

In recent years, Draper has established himself as a true contender at these major tournaments. He’s one of the players battling it out below Sinner and Carlos Alcaraz, bidding to close the gap on his two rivals – the clear best-of-the-best in men’s tennis.

In order to do so, Draper has undergone a physical transformation this year, an area of his game perhaps lacking in previous seasons.

There was a thought that his previous sickness bouts were partly due to his body struggling to keep up with the demands on the sport, further exacerbated by the high temperatures that players often compete in at the grand slams.

But now, as the result of hours spent training in the gym, Draper boasts an imposing frame with biceps visibly bulging from underneath his t-shirt.

Understanding his ‘anxiety’

His fitness, one would imagine, is no longer the issue, and yet the sickness is still there. The reason, then, is perhaps something Draper identified himself at last year’s US Open.

“I’m definitely someone who is, I think, quite an anxious human being,” he told reporters after his semifinal defeat last year.

“I think when you add all that together, sometimes I do feel a bit nauseous on court, and I do feel a little bit sick when it gets tough.”

After his sickness against Sinner in last year’s semifinal, Draper said he would “really look into” the mental side of his game.

Jannik Sinner and Draper (in purple) at the end of their semifinal at the 2024 US Open.
Dubreuil Corinne/Abaca/Sipa

Feeling nausea and sickness is one of the many symptoms that come with anxiety.

Dr. Phil Hopley, a psychiatrist who specialises in elite sport, told CNN Sports’ Don Riddell that he isn’t surprised that Draper is having such a physical response to his mental state.

It’s something he has seen in many other athletes from a variety of sports.

“People sometimes talk about the gut brain and very often when people get nervous or anxious, they talk about feeling it in their guts or elsewhere,” he said. “It’s well proven as a strong link.

“What is happening is that under pressure, under stress, [Draper’s] brain is responding in a certain way and it’s releasing cortisol, it’s releasing a hormone called adrenaline, which gets him ready to perform and play.

“Unfortunately for him, his stress profile seems to connect very strongly with his stomach.”

Draper has long been aware that it’s something that’s been present in his life both on and off the court.

“I’m an athlete, I’m a tennis player, and there are so many athletes out there, we’ve all got things we’re working through all the time,” he told reporters last year.

“Tennis especially, or just any sport, is hugely mental and physical. I try my best all the time to keep on evolving, to keep on learning, and it’s definitely something I’ve had to just work through my whole entire life.

“I think I’ve got quite a strong mentality and I use up a lot of mental energy a lot of the time because I want it so badly.

“But, obviously, that doesn’t necessarily help a lot of the times, especially in these five-set matches and that sort of anxiety and those feelings can build up. So it’s definitely just something that is a real strength of mine but also a weakness, and I have to continue to work on it.”

Hopley credited Draper for speaking about the problem and praised the tennis star for his resilience.

He said working with a psychologist would definitely help redefine those big matches in a more healthy way, putting less pressure on his mind and body.

“Everything that [Draper] can do to reduce that level of perceived pressure and make it something that’s more routine for him is gonna help him,” Hopley said, adding that such a process may force Draper to look deep into his own mental state.

“I think by his own admission, it’s really only in these very top exposure or top flight competitions that it manifests.”

Ahead of this year’s tournament, the British star said he was leaving no stone unturned in his pursuit to getting better, but it seems like there is still a way to go before he resolves the sickness issue.