Rotator cuff strain

The most frequent injuries in pickleball are shoulder injuries, which are sometimes brought on by abrupt rotations or excessive overhead motions that put a lot of strain on the shoulder muscles and joints. Similar to tennis and volleyball, pickleball necessitates quick movements, sudden direction changes, and a lot of arm swings, all of which can lead to shoulder strain. The majority of rotator cuff injuries are degenerative, meaning they occur with aging and affect the capacity of senior pickleball players to play the game. It may include degenerative rotator cuff tears, biceps tendinitis, and tendinitis. This reveals why these kinds of injuries are rather prevalent among senior citizens who play pickleball.

Tennis elbow or Pickle Elbow

It’s another very common condition also known as lateral epicondylitis characterized by pain on the outer part of the elbow, resulting from repetitive arm movements on the forearm muscles and tendons that extend the wrist and fingers. The reason for this is again continuous repetitive rotational and pronation movement on the forearm causing tear and micro trauma leading to tendon inflammation along with symptoms of pain and limited mobility.

Knee Injuries

Sudden abrupt lateral movement along with blocking and twisting specifically at knee joint are a common pattern of movement in pickleball sports, these sudden movements when performed at high velocities can cause injuries as discussed in  the study journal, Current Sports Medicine Reports (2020), the typical overuse injuries in knee such as (meniscal injury, patellar tendinopathy, medial collateral ligament strains, and osteoarthritis flares), are the most frequent pickleball injuries observed in the (Southern California) local and regional tournaments and open-play. Physiotherapy treatment involves combination of proprioceptive training, exercise treatment, and manual therapy to treat these injuries and to enhancing balance and coordination. Strengthening the quadriceps and hamstrings can help reduce knee pain and avoid further injuries.

Achilles Tendonitis

Because pickleball is becoming more and more popular among senior citizens, Achilles tendinitis has become a significant concern. According to research, pickleball-related Achilles tendon injuries are significantly on the rise, particularly in people 58 years of age and older. This pattern emphasizes how important it is to raise awareness and take preventative action within this group.

Overuse activities such as those in Pickleball sports, that involve sudden rapid starts, sudden stops and ankle blocking along with sudden dorsiflexion and inversion movements can cause Achilles tendonitis, which manifests as a severe, tearing pain in the ankle region owing to the fast-paced nature of the game.

Pickleball players frequently sustain this injury as a result of their repetitive motions and abrupt stops. A study in 2024 in Sage Journal found 43 instances of Achilles tendon ruptures linked to pickle ball between 2013 and 2023, with a noticeable rise in injuries since 2016. These results indicate an increasing incidence of Achilles tendon injuries as more and more people tend to play Pickleball sports.

Wrist Sprains

Pickleball sports are all about quick reactions, powerful paddle strokes, and frequent wrist adjustments. This action involves sudden forceful wrist movement along with slight rotation, over time these repetitive movement and improper techniques can lead to overuse injuries of the wrist leading to problems like wrist sprains. Often brought on by poor technique, excessive use, or an unanticipated fall during play. These injuries happen when the wrist ligaments are stretched beyond their limit or torn. Even if it may seem minor at first, ignoring a wrist sprain can result in long-term instability or persistent discomfort. It’s critical for pickleball players to recognize the early symptoms of a wrist injury, such as swelling, numbness, bruises, or a decreased mobility.

Adductor Magnus Tear (Mini Hamstring)

The Adductor Magnus being a strong thigh adductor is also referred as mini hamstring because of their similar innervation, blood supply and action in hip extension. Although the adductor magnus tears are fairly uncommon and can only occur in high impact sports with strong eccentric load and adducting force that pulls away in abduction. This type of pattern is now widely seen in pickleball. The major load is sustained by adductor longus primarily referred as pulled groin. Unlike hamstrings the mini hamstrings does not sustain complete tear or rupture of the muscle.

Slip, Trip and Falls

The pickleball rules are amalgam of tennis, badminton and volley ball. Although it is easy to comprehend, there is this area in pickleball called “the kitchen” where the rules slightly vary and the player has to suddenly stop in certain situations, keeping the strategy in mind. It requires mental alertness as well as physical capability to stop and start in abrupt motion. This sudden eccentric load while slowing the momentum puts lower extremity in increased risk of injury as a result of slip, trip and falls. A subsequent contribution comes from wearing improper foot wear, naive techniques and poorly maintained pickle ball court. It impacts players balance and excessive biomechanical stress leading to overcompensation by musculoskeletal system.

• Strength Training
  • • Training the upper and lower limb prior to engaging in game is essential to reduce the occurrence of sudden injury. Dynamic strength training, including sports specific strength training is particularly important. Wrist strengthening in extension using dumbbells or cuff weights improves grip strength and ankle strengthening improves quick multidirectional movement changes. The strength training focuses on all major groups to develop control in movement while acceleration and deceleration phases.
• Flexibility Training
  • • The flexibility training involves stretching the essential group of muscles, particularly synergist and antagonist in targeted movement. The stretching/flexibility training includes muscle groups i-e gluteus, hip extensors, quadriceps, gastrocnemius in lower extremity.
• Balance Exercises
  • • The balance exercises improve dynamic balance, reactive balance and static balance, some of these include, Tandem walking, Romberg standing, training on balance board/wobble board, and training on force plate. Balance exercises improve proprioceptive neuromuscular signaling in ankles to develop control to compensate for quick start and stop agile action while playing sports.
• Plyometric and Agility Training
  • • Playing pickleball requires strong foundation in tactical, technical, and psychological skills. Playing pickleball improves hand eye coordination, but it also involves quick sprints, directional changes in order to hit the ball. Plyometric training involves the eccentric and concentric movement components, it not only significantly improves agility performance, but it also improves strength in upper limb and lower limb muscles.
• Rotator Cuff Strengthening and Shoulder Stability
  • • The rotator cuff has direct correlation in injury prevalence. Dynamic Strengthening of rotator cuff muscles improve mobility, flexibility and stability of shoulder. Rotator cuff activation program such as throwers ten program have proven beneficial in pickler’s shoulder injuries. Although it is designed for volleyball players it does improve overhead movements in pickleball players as well.
• Core Stability Exercises
  • • The core activation exercises, improve posture and adequately transfer power among muscles while changing directions. Circuit training of lower extremity has proven to improve core stability. Strengthening of hip abductors, squatting, lunging and weight bearing dorsiflexion indirectly provides beneficial results in pelvic stability, core stability and core training.

How to Prevent Pickleball Injuries?

Warm Up Properly

Take 10 to 15 minutes to warm up before playing the game. Include dynamic stretches, adequate range of motion, lunges, move arm in circular motions to prepare muscles and joints for quick movements. According USA Pickleball Association, the athletes should consider warm up regimen to avoid pain in shoulder with volleys and quadriceps activation to avoid knee pain with short stops. Remember! Cooling down after warm up is important to relax muscles and regulate blood flow. It is a deceleration phase of warm up regimen where you continue to do the activity at a much slower pace.

Use Proper Technique

While playing pickleball avoid abrupt pivoting movements. It is suggested to cross train muscles for sport specific training to build strength, it minimizes the incidence of sudden injury, trips and falls. Respect the demands of your body! Do not get overenthusiastic to play it to the point of complete exhaustion. Keep yourself hydrated. Take frequent breaks and rest periods to avoid physiologic muscle fatigue.

Wear Supportive Gear

Although people might think it is an easy to play sports activity that can also be played indoors. Pickleball involves quick multidirectional movements. You will be requiring court shoes to have good tread and lessen the incidence of ankle sprain. Use neutral grip to handle the racquet to avoid elbow/wrist injuries. In addition, wearing protective ankle braces, wrist guards and tapping can aid in minimizing the instability in chronic patients.

Prevent Ocular injuries

With the rising popularity of pickleball, ophthalmic injuries have risen to the top in the recent years. Retinal tear, corneal abrasions and traumatic lens subluxation are among the top presented conditions in the ER. To prevent ocular trauma, wearing protective eye wear is mandatory. It not only protects eye from foreign object coming directly in contact with eye but also improves visibility and reduces glare with polarized lenses

Manage Load

Pickleball injuries are inherently preventable. You should gradually increase playtime and intensity to avoid overuse. It is important to understand for novice players that different tennis racquet have different types of grip. Choose the racquet that has more firm grip in your hand and has light weight when moved in air. A racquet with heavy head increases the chances of epicondylitis.

Prehabilitation

The goal of prehabilitation is to increase function and fitness before participating in a high-risk sport or for individuals who have been deconditioned in an effort to prevent injuries. It is particularly recommended for older individuals to train for the game under the supervision of physiotherapist keeping account of various orthopedic and systemic conditions.

Final Word:

Pickleball is a recreational fun sports activity with fast paced surge in its players post Covid. It encompasses a low impact aerobic exercise, but just like any other contact sport pickle ball also comes with injury risks. However if managed with proper care, prevention and rehabilitation strategies, players of all ages can safely play the game.