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Pickleball Injuries

Did you know that Pickleball, a sport greatly enjoyed by people from all age groups, has risen by 51.8% between 2022 and 2023, and an astounding 223.5% in just three years? This makes it the fastest-growing sport in America for the third consecutive year, according to The 2024 State of Pickleball: Participation & Infrastructure Report by SIFA. However, despite its fun nature and exciting rallies, the game also comes with its fair share of injuries. With its growing popularity, this low-impact sport presents unique challenges in injury prevention and rehabilitation.

Pickleball has emerged as a popular form of exercise for seniors. It can be played indoors, outdoors, or even in wheelchairs. The sport blends elements from several activities you may already be familiar with, such as tennis, table tennis/ping-pong, and badminton. The court used for Pickleball is the same size as a doubles badminton court, and the net is designed similarly to a tennis net but mounted two inches lower.

The average Pickleball player is 35 years old, and according to SIFA’s 2024 report, the age group with the highest participation is 25 to 37 years. Pickleball is a common cause of musculoskeletal injuries, particularly in individuals who may have pre-existing conditions or are less physically fit. Additionally, people tend to play for long hours, which fatigues the muscles and makes them more susceptible to injury. According to a 2024 report by the American Academy of Orthopedic Surgeons, over the past five years, Pickleball players in their 60s have experienced a 90-fold increase in fractures. In this article, we’ll discuss common Pickleball injuries from a physiotherapist’s perspective, as well as prevention strategies, treatment options, and recovery tips to help you stay active in the game.

Pickleball
Pickleball Injuries

Common Pickleball Injuries

Before diving into the treatment and prevention of Pickleball injuries, it’s crucial to familiarize ourselves with the common upper and lower extremity injuries players may encounter on the court. While the sport itself is low impact and widely celebrated for its accessibility, it still places significant stress on the body due to the demands of its quick, forceful lateral movements, and abrupt pivots. It’s these quick, directional changes that can lead to both acute injuries and overuse syndromes, even in experienced athletes. This is especially true in areas of the body that are subjected to repetitive pressure and sudden impact.

Rotator cuff strain

The most frequent injuries in Pickleball are shoulder injuries, often caused by abrupt rotations or excessive overhead motions that place significant strain on the shoulder muscles and joints. Similar to tennis and volleyball, Pickleball requires quick movements, sudden changes in direction, and many arm swings, all of which can lead to shoulder strain. Most rotator cuff injuries are degenerative, meaning they occur with aging and tend to affect senior Pickleball players. These injuries can include degenerative rotator cuff tears, biceps tendinitis, and tendonitis. This is why shoulder injuries are so common among older Pickleball players.

Tennis elbow or Pickle Elbow

Another very common condition, also known as lateral epicondylitis, is characterized by pain on the outer part of the elbow. This is caused by repetitive arm movements that stress the forearm muscles and tendons, which extend the wrist and fingers. The repetitive rotational and pronation movements on the forearm cause tears and microtrauma, leading to tendon inflammation, along with symptoms of pain and limited mobility.

Knee Injuries

Sudden lateral movements, blocking, and twisting, especially at the knee joint, are common movement patterns in Pickleball. These high-velocity movements can cause injuries, as discussed in a study published in Current Sports Medicine Reports (2020). Typical overuse injuries in the knee, such as meniscal injuries, patellar tendinopathy, medial collateral ligament strains, and osteoarthritis flare-ups, are the most frequent Pickleball injuries observed in local and regional tournaments, as well as open play in Southern California. Physiotherapy treatment often involves a combination of proprioceptive training, exercise, and manual therapy to enhance balance and coordination. Strengthening the quadriceps and hamstrings can help reduce knee pain and prevent further injuries.

Achilles Tendonitis

As Pickleball becomes increasingly popular among seniors, Achilles tendinitis has become a significant concern. Research indicates that Achilles tendon injuries in Pickleball are rising, particularly in people aged 58 and older. This highlights the importance of raising awareness and taking preventative action within this group. Overuse activities—such as sudden starts, stops, ankle blocking, and dorsiflexion and inversion movements—can lead to Achilles tendonitis, which manifests as sharp, tearing pain in the ankle region due to the fast-paced nature of the game. A study in Sage Journal (2024) found 43 instances of Achilles tendon ruptures linked to Pickleball between 2013 and 2023, with a noticeable rise in injuries since 2016. These results indicate an increasing incidence of Achilles tendon injuries as more people play Pickleball.

Wrist Sprains

Pickleball requires quick reactions, powerful paddle strokes, and frequent wrist adjustments. This action involves sudden wrist movements, along with slight rotations. Over time, these repetitive motions, along with improper techniques, can lead to overuse injuries in the wrist, such as sprains. Wrist sprains are often caused by poor technique, excessive use, or an unexpected fall during play. These injuries occur when the wrist ligaments are stretched beyond their limit or torn. Although a wrist sprain may seem minor at first, ignoring it 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, bruising, or decreased mobility.

Adductor Magnus Tear (Mini Hamstring)

The Adductor Magnus, a strong thigh adductor, is also referred to as the “mini hamstring” due to its similar innervation, blood supply, and action in hip extension. While Adductor Magnus tears are relatively uncommon and typically occur in high-impact sports with strong eccentric loading and adducting forces, this pattern is now being seen more in Pickleball. The major load is sustained by the adductor longus, primarily referred to as a pulled groin. Unlike the hamstrings, the mini hamstring does not typically sustain a complete tear or rupture.

Slip, Trip and Falls

Pickleball combines elements of tennis, badminton, and volleyball. While the rules are easy to understand, there’s one area called “the kitchen” where the rules differ, and players must stop abruptly in certain situations. This requires both mental alertness and physical capability to stop and start quickly. The sudden eccentric loading while slowing momentum puts the lower extremities at increased risk of injury, resulting in slips, trips, and falls. Contributing factors include improper footwear, naive techniques, and poorly maintained courts, which negatively affect balance and lead to excessive biomechanical stress, causing the musculoskeletal system to overcompensate.

Physiotherapy Management of Pickleball Injuries

The management of chronic Pickleball injuries differs significantly from acute injuries, not only because of prolonged and aggravated symptoms but also due to significant tissue damage, muscle stiffness, and mobility restrictions. Chronic injuries often develop due to repetitive stress, improper mechanics, or delayed treatment of acute injuries. Unlike acute injuries, chronic conditions involve significant tissue degeneration (e.g., tendinosis), restricted mobility, and muscle guarding, which complicate the recovery process. Physiotherapy treatment protocols are based on the patient’s presenting complaints, type of injury, activity level, and recovery goals.

Pickleball Rehabilitation
  • Strength Training
      • Training the upper and lower limbs before engaging in the game is essential to reduce the occurrence of sudden injuries. Dynamic and sports-specific strength training are particularly important. Wrist strengthening using dumbbells or cuff weights improves grip strength, while ankle strengthening aids in quick multidirectional movements.

  • Flexibility Training
      • Stretching the essential muscle groups, especially synergists and antagonists in targeted movements, is key. Focus on muscle groups like the gluteus, hip extensors, quadriceps, and gastrocnemius.

  • Balance Exercises
      • Balance training improves dynamic and static balance. Exercises such as tandem walking, Romberg standing, and wobble board training improve proprioception in the ankles and help players control quick starts and stops.

  • Plyometric and Agility Training
      • Pickleball requires agility, quick sprints, and directional changes. Plyometric training improves agility and strengthens the muscles in the upper and lower limbs.

  • Rotator Cuff Strengthening and Shoulder Stability
      • Strengthening the rotator cuff muscles improves shoulder mobility, flexibility, and stability. Programs like the “Throwers Ten” have proven beneficial for Pickleball players.

  • Core Stability Exercises
      • Core activation exercises improve posture and transfer power among muscles during direction changes. Strengthening the hip abductors, squatting, lunging, and weight-bearing dorsiflexion improve pelvic stability and core training.

How to Prevent Pickleball Injuries?

Warm Up Properly

Take 10 to 15 minutes to warm up before playing. Include dynamic stretches, adequate range of motion, and arm circles to prepare your muscles and joints for quick movements.

Use Proper Technique

Avoid abrupt pivoting movements and cross-train muscles for sport-specific strength. Don’t push your body to exhaustion; stay hydrated and take breaks to avoid muscle fatigue.

Wear Supportive Gear

Pickleball involves quick multidirectional movements, so wearing court shoes with good tread is essential to prevent ankle sprains. Use a neutral grip on your racquet to avoid elbow or wrist injuries, and consider protective gear like ankle braces, wrist guards, and taping for chronic patients.

Prevent Ocular injuries

With the rise in Pickleball’s popularity, ocular injuries have also increased. Protective eyewear is essential to prevent trauma from foreign objects and improve visibility.

Manage Load

Gradually increase playtime and intensity to avoid overuse. Choose a racquet with a firm grip and lightweight design to reduce the risk of epicondylitis.

Prehabilitation

Prehabilitation is especially important for older individuals to prevent injuries. Working with a physiotherapist to build strength and mobility before starting Pickleball can help prevent injuries.

Final Word:

Pickleball is a fun and fast-paced sport that has surged in popularity since the COVID-19 pandemic. While it offers a low-impact aerobic exercise, like any sport, it comes with injury risks. However, with proper care, prevention, and rehabilitation strategies, players of all ages can continue to enjoy the game safely.

< Recommendation by Our Experts>

  • Warm Up & Cool Down – Always spend 10–15 minutes warming up before playing to prepare your muscles and joints for quick movements. Include dynamic stretches, arm circles, and lunges. After playing, cool down with light stretching to prevent stiffness and injuries.
  • Use Proper Footwear & Gear – Wear court shoes with good tread to prevent ankle sprains and use a paddle with a comfortable grip to reduce wrist and elbow strain. If you play often, consider protective eyewear to avoid eye injuries from fast shots.
  • Play Smart & Listen to Your Body – Avoid overplaying to the point of exhaustion. Take breaks, stay hydrated, and pace yourself to prevent muscle fatigue. Gradually build your strength and agility through training to reduce the risk of common injuries.

< Reference >

  • Forrester MB. Pickleball-Related Injuries Treated in Emergency Departments. The Journal of Emergency Medicine. 2020;58(2):275-279. doi:1016/j.jemermed.2019.09.016
  • Casals M, Jimenez S, Caparros T, Martínez-Gallego R, Baiget E. Scoping review and quality of studies on the epidemiology of pickleball injuries. Apunts Sports Medicine. 2023;58(217):100403. doi:1016/j.apunsm.2023.100403
  • Fong DT, Chan YY, Mok KM, Yung PS, Chan KM. Understanding acute ankle ligamentous sprain injury in sports. BMC Sports Sci Med Rehabil. 2009;1(1):14. doi:1186/1758-2555-1-14
  • Gribble PA, Robinson RH. An Examination of Ankle, Knee, and Hip Torque Production in Individuals With Chronic Ankle Instability. Journal of Strength and Conditioning Research. 2009;23(2):395-400. doi:1519/JSC.0b013e31818efbb2
  • Tooth C, Gofflot A, Schwartz C, et al. Risk Factors of Overuse Shoulder Injuries in Overhead Athletes: A Systematic Review. Sports Health: A Multidisciplinary Approach. 2020;12(5):478-487. doi:1177/1941738120931764
  • Meenakshi Sharma, Charu Eapen, Jaganaath Kamath. Effect of Adding Rotator Cuff Strengthening To Therapeutic Ultrasound and Wrist Extensor Eccentric Exercise for Lateral Epicondylalgia – A Randomized Clinical Trial. International Journal of Health Sciences and Research. 2015;5(7):250-257
  • Moreno Catalá M, Schroll A, Laube G, Arampatzis A. Muscle Strength and Neuromuscular Control in Low-Back Pain: Elite Athletes Versus General Population. Front Neurosci. 2018;12:436. doi:3389/fnins.2018.00436

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