A concerned Novak Djokovic says he will undergo extra medical tests in relation to being struck by a water bottle after crashing out in the third round of the Italian Open.

The Serb had been signing autographs on Friday after his second-round win over Corentin Moutet when a metal bottle fell out of a fan’s backpack and directly on his head. After the initial blood and nausea, Djokovic said he had felt fine on Saturday as he returned to training, even entering the practice court jokingly wearing a helmet. On Sunday, though, he felt like a “different player” as he was defeated 6-2, 6-3 by Chile’s Alejandro Tabilo, the 29th seed.

“It was unexpected obviously,” said Djokovic. “I wasn’t even looking up. Then I felt a very strong hit in the head. That has really impacted me a lot. After that I got the medical care. Been through half an hour, an hour of nausea, dizziness, blood, a lot of different things. I managed to sleep OK. I had headaches.

“The next day or yesterday was pretty fine, so I thought it’s OK. Maybe it is OK. Maybe it’s not. I mean, the way I felt on the court today was just completely like a different player entered into my shoes. Just no rhythm, no tempo, no balance whatsoever on any shot. It’s a bit concerning.”

Tabilo arrived in Rome full of confidence after winning an ATP Challenger event in Aix-en Provence, rising to a career-high ranking of No 32. Still, Sunday marked by far the biggest win of his life. Despite his own issues, Djokovic was complimentary about the 26-year-old’s game. “I was trying not to think about it, trying to keep it point by point. And no, I can’t believe it, it’s crazy,” said Tabilo.

An athletic left-hander with a sweet serve and forehand, Tabilo stepped up to the world No 1 determined to take the first strike with his forehand, to control as many exchanges as possible and keep Djokovic on the move. It soon became clear that there was minimal resistance across the net. Djokovic gave away his opening service game with two double faults, including one on break point, and as Tabilo became increasingly comfortable on the front foot, the Serb struggled badly.

Alongside his passive play and unforced errors, Djokovic was extremely flat emotionally and he rushed between points, seemingly determined to get off the court as quickly as possible and his tournament ended with a miserable double fault off a 115mph second serve. Afterwards, Djokovic said that he did not undertake any medical checkups on his day off but, with two weeks until Roland Garros, he will now.

“I have to check that,” said Djokovic. “Training was different. I was going for kind of easy training yesterday. I didn’t feel anything, but I also didn’t feel the same. Today under high stress, it was quite bad – not in terms of pain, but in terms of this balance. Just no coordination. Completely different player from what it was two nights ago. Could be. I don’t know. I have to do medical checkups and see what’s going on.”

Djokovic produced one of the best seasons of his career in 2023, winning the Australian Open, French Open, US Open and ATP Finals, but this has been a curious year so far. The defeat means that Djokovic, who turns 37 this month, will head to the French Open yet to win a title in the season for the first time since 2018 and just the second time since he won his first title in 2006.

Meanwhile, Aryna Sabalenka continued to rebuild her momentum as she reached the fourth round with a 6-4, 6-2 win over Dayana Yastremska. It is the Australian Open champion’s first victory over the Ukrainian.

“I’m a better player right now,” said Sabalenka. “I got more stuff in my pocket to get this win against her. Yeah, our last matches were a long time ago when I was kind of on and off.

“I was just trying to find my way. I was going quite confident into this match knowing that I have everything to get the win. I’m super-happy to finally get the win against her.”