Despite his obvious disappointment at not being able to complete the match, Sinner can take some comfort that it was illness, not injury, that held him back.
He was on a 26-match winning streak on hard courts going into the final and had not dropped a set in Cincinnati.
Sinner will stay world number one regardless of the loss, but Alcaraz is closing in on the top ranking – and remains Sinner’s biggest rival for the US Open title.
The pair can only meet in the final in New York, and Sinner is defending more ranking points than Alcaraz, who lost in the second round last year.
This was the fourth time the pair have met in a final this year, with Alcaraz winning twice on clay and Sinner triumphing in their last meeting at Wimbledon.
However, this was barely a contest, with Sinner’s lack of movement and early attempts to hit his way out of trouble hinting something was amiss.
Alcaraz won 21 of the 29 points on offer and committed just one unforced error to Sinner’s nine.
The pair have split the past seven Grand Slams between them – and it is difficult to see who will stop them adding an eighth to that tally.
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