backhands to drop serve and trail 2-5.
With Van de Zandschulp serving for the set, Rune struck two groundstroke errors while Van de Zandschulp hit an inside out crosscourt forehand winner to reach double match point at 40-15.
However improved play from Rune combined with several unforced errors from Van de Zandschulp led to a break of serve followed by a hold of serve from Rune as he pulled to 4-5.
With Van de Zandschulp serving for the match for a second time, Rune reached breakpoint again following a Van de Zandschulp doublefault as well as a netted down the line forehand.
Dramatically Rune twisted his right ankle in the point to reach 30-40.
The trainer arrived oncourt to treat Rune's injury right before the chair umpire tells Rune that he cannot take an injury time out at that point in the match.
Rune; unhappy which what he was told says it's "ridiculous" and asks "do you want to be responsible for my injury?"
The game goes to three deuces before Rune hits two consecutive overhead winners to break serve and level the set at five games all.
After Rune strikes several unforced groundstroke errors, Van de Zandschulp breaks serve to serve for the match again at 6-5.
The 27 year old 29th ranked Van de Zandschulp holds two additional match points at 40-15.
However Rune hits a down the line backhand volley winner before Van de Zandschulp doublefaults to drop serve and level the set at six games all to enter a decisive tiebreaker.
In the tiebreaker Rune takes a 3-1 lead after striking a down the line forehand passing shot winner while on the run.
Serving ahead 4-3, Rune struck a powerful down the tee serve.
Van de Zandschulp nets his down the middle forehand return to trail 3-5 before also netting a crosscourt backhand to trail 3-6 and face match point.
Rune struck a down the line backhand passing shot winner to end the match in a remarkable comeback; winning five of the last six games.
The 19 year old 7th ranked Rune fought for two hours and 51 minutes before winning.
Tomorrow at the Mutua Madrid Open, in Madrid, Spain, Rune plays his first match of the week versus the 55th ranked Alexander Bublik of Kazakstan in what could be a very difficult match for Rune.
The 6 feet 5 inches tall Bublik possesses one of the most powerful serves on the tour and won the duo's only prior meeting 6-3, 5-7, 6-4 last year in Metz on an indoor hardcourt.
Rune could possibly meet the top seeded Carlos Alcaraz of Spain in the semifinals.