Rafael Nadal needed all his famed will to win and competitive fire to win his fourth US Open title on Sunday night, holding off a brave, brilliant fightback from Daniil Medvedev to finally get over the line after four hours, 49 minutes of brutal, exhausting tennis.

For the 19th time in his career, Nadal came out on top, with his 7-5, 6-3, 5-7, 4-6, 6-4 victory sealing a second Grand Slam win of 2019 and he is now just one behind Roger Federer in the all-time list of men's Grand Slam champions.

As Medvedev’s final forehand return landed long, an exhausted Nadal fell to the ground in celebration, arms and legs apart. After the match, as he and Medvedev watched a montage of his 19 Grand Alam wins on the big screen, the 33-year-old let his emotions flow, the tears running down his cheeks.

“Just very happy,” Nadal said. “This trophy means everything to me today. Personal satisfaction the way that I resisted all these tough moments is very high. I normally try to hold the emotions, but at the end for all these facts have been impossible today.

“The emotions have been there watching all the success, all the moments that came to my mind in that moment. Yeah, I tried to hold the emotion, but some moments was impossible.”

At 33 and having overcome so many injuries in his career, Nadal knows time is not on his side but he remains a warrior on the court, a man many would choose to play for their life.

He needed every ounce of his mental strength, though, as the 23-year-old Medvedev fought back from two sets and a break down to force a fifth set. And then, having trailed 5-2, the Russian got back to 5-4 before Nadal finally closed him out.

“The last three hours of the match (was) very, very intense,” Nadal said. “Very tough mentally and physically, too. At the end with the video, the crowd that have been as always amazing, all these facts that make the moment super special. Unforgettable moment.

“At the same time Daniil created this moment, too. The way that he (fought), the way that he played, is a champion way. Just well done for him. I really believe that he will have many more chances. The way that the match became very dramatic at the end, that makes this day unforgettable, part of my history of this sport.”

It had looked as if it would be a relatively straightforward path to another Grand Slam title when Nadal took a tight first set and then pulled away in the second.

At 3-2 in the third, with a break, the match looked over but Medvedev, in his first Grand Slam final after a stunning summer, in which he reached four straight finals and won his first Masters 1000 title, would not give up.

“It was true, I was thinking, OK, in 20 minutes I have to give a speech,” Medvedev said. “What do I say? Something like this. I was like, OK, OK, just fight for every point, don't think about these things. It worked out not bad.”

Even in the fifth set, when Nadal led 5-2, Medvedev was not done, breaking back to 5-4 and the crowd, which had been on his back earlier in the tournament, was roaring his name.

But Nadal would just not be denied and a big serve, on his third match point, finally saw him clinch a victory that will go down as one of the most satisfying of his career.

The two men embraced warmly at the end, with Nadal telling Medvedev how well he had fought and the Russian wishing him luck as he tries to chase down Federer and stay ahead of Novak Djokovic in the all-time list.

“I would love to be the one who have more (slams), yes,” Nadal said. “But I really believe that I will not be happier or less happy if that happens or not happen.

“What gives you the happiness is the personal satisfaction that you (gave) your best. In that way I am very, very calm, very pleased with myself.”

The final was carried live on Russia’s main TV station and Medvedev, who now sits at No.4 in the world rankings, said he had no regrets about the result.

“Was I close to winning? Yes, one set away,” he said. “I mean, had breakpoints at 5-4. I will remember everything of it. I will be disappointed with the result, but I will be happy with the way I played, as I say, the whole summer, the whole US Open.

“I have to give myself credit for these two weeks. It's been amazing.

“Before the tournament, my best result was fourth round of a Grand Slam. I had some physical problems. Sometimes I didn't play as good as I wanted. But I managed to be in the final. I managed to give huge fight to one of the best players in the history of our sport. Have to give myself credit. I hope I grew a lot doing these things. But I need to continue and I need to be better.”

Both men will now have a rest before beginning the final couple of months of the season, a year that could well end with Nadal back at No.1 in the world rankings. In addition to his 12 Roland-Garros titles, he now has four US Open crowns to go with his two Wimbledon wins and one Australian Open title.

Not bad for a man they said was a clay court specialist.