MELBOURNE, Australia — When the world's top-ranked female tennis player was examined on the court and then granted a medical timeout Thursday during her semifinal match at the Australian Open, the howling commenced immediately. Skeptical fans at Rod Laver Arena and those watching on television worldwide were convinced that the player, Victoria Azarenka of Belarus, was suffering from nothing more than an attack of nerves and perhaps faked an injury to collect herself after losing several crucial points.
After her 10-minute reprieve — six minutes of it off the court — Azarenka closed out a 6-1, 6-4 victory. A sport that in recent years has dealt with loudly grunting players and accusations of match fixing is now facing another vexation: determining what constitutes a real injury.
Azarenka's opponent, Sloane Stephens of the United States, called injury timeouts — legitimate or not — "the in thing," noting that Azarenka was one of many recent opponents to use a medical timeout. "It's trendy," Stephens said.
Others were more critical. "I thought it was a little unfair play," said David Nainkin, Stephens's coach. "I thought she bent the rules. I don't think she broke the rules, but she bent them, and I think those rules need to be looked at because I think there's a gray area there."
The TV analyst Patrick McEnroe called the timeout an "absolute travesty" in a post on his Twitter page. (McEnroe also heads the United States Tennis Association's player development program, which has supported Stephens.) "I mean, everybody's appalled by it," said Pam Shriver, an analyst and a former player.
The controversy arose when Azarenka, serving for the match against the 29th-seeded Stephens at 5-3 in the second set, failed to convert on five match points and was eventually broken. When she took her seat during the changeover, she wrapped a towel stuffed with ice around her neck and was examined by the primary health care provider for the women's tour, Victoria Simpson, and by a tournament doctor, Tim Wood. She then left the court for further treatment, leaving Stephens, in her first Grand Slam semifinal, waiting nearly 10 minutes for the next game.
Stephens, who had upset the tournament favorite, Serena Williams, in the quarterfinals, proceeded to lose her serve and the match. She did not blame Azarenka's timeout for her loss.
Azarenka did not mention an injury during her on-court interview after the match, but she did refer to a feeling of crisis at the 5-4 changeover. "I almost did the choke of the year," she said. "I just felt a little bit overwhelmed. I realized I'm one step away from the final, and nerves got into me, for sure." Azarenka added: "I love to play here and I just couldn't lose. That's why I was so upset."
Later, in a news conference, she said that she left the court for treatment of a rib injury and that she had not mentioned the injury in her on-court interview because she had misunderstood the question.
Shriver, who noted that Azarenka had also not mentioned the injury in an ESPN interview while coming off the court, was skeptical. "I think her response at the time was very honest and truthful, that she was stretching the rules," Shriver said. "That was my reaction coming off the interview, and so that's why I think all of us, many of us, jumped on it. Because we've seen the rule abused for years. I abused the rule when I played."
If Azarenka was not legitimately injured, was calling a medical timeout cheating? Playing at the edge of the rules? Good old win-at-any-cost strategy?
To Michael F. Bergeron, executive director of the National Youth Sports Health & Safety Institute, it is part of a disturbing trend extending to youth sports: emphasizing winning over sportsmanship and developing character.
"I'm not saying everyone does that, and I'd like to think there are still players who would never do it," Bergeron said. "It shows a lack of character, a lack of respect for her opponent and the game. You'd like to think sports would be developing those traits. But in the bigger picture, this emphasis on winning and losing over everything else is doing athletes a disservice. It's not making them better people. It's not making them better athletes."
Bergeron, a clinical and scientific consultant to the Women's Tennis Association, acknowledged that tennis was harder on athletes' bodies than ever before. But he suspected that Azarenka had used the timeout as a strategy to stop Stephens's momentum.
Other sports have had similar issues. In football, there have been debates over timeouts taken just before field goals. During a college game between Cincinnati and Duke this season, Cincinnati took a too-many-men-on-the-field penalty to negate a 53-yard field goal, leaving Duke Coach David Cutcliffe irate. And after an N.F.L. game last season in which the Giants appeared to fake injuries to slow the Rams' offense, Seahawks Coach Pete Carroll said the phenomenon was nothing new or alarming.
In tennis, though, the injury timeout is tricky because medical personnel have to treat all calls for treatment seriously, no matter when they happen. The Grand Slam rule book does include some restrictions: all medical timeouts must take place during a changeover or a set break except in the case of an "acute medical condition."
The Grand Slam supervisor Donna Kelso confirmed that Azarenka had been given two consecutive medical timeouts of three minutes each to be treated for two separate injuries: one to a rib and one to her left knee. Azarenka explained that she was having trouble breathing on court because of a rib problem that was causing her back to seize up.
"I had to unlock my rib, which was causing my back problem," she said. "The trainer said, 'We have to go off court to treat that.' I just didn't really want to take off my dress on the court."
Nainkin, Stephens's coach, said he had "never heard of two medical timeouts back to back."
"In all my years, that's a first," he said. "Two different injuries? I think it's unprofessional. Saying that, she did win the match and played a great game at 5-4, but tennis is a game of momentum and Sloane had the momentum, and obviously the little break definitely changed things."
Azarenka agreed that the timing of her timeout was unfortunate. "The timing, yeah, it was my bad," she said. "The game before that, when I lost my service game, it kept getting worse. I thought I would have to play through it and keep calm. But it just got worse. You know, I had to do it."
Several coaches and analysts expressed hope that the incident Thursday would lead to a re-examination of the medical timeout rule at Grand Slam events and on the WTA Tour. "I think if you can continue to play in any way, it's bad luck but you've got to wait until the person is finished serving," Shriver said.
But ultimately, the decision lies with the medical personnel on court. According to the Grand Slam rule book, if they determine that a player needs a medical timeout, their word is final.