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Sports2026-03-05•7 min read

Pickleball Injuries: Prevention, Treatment, and Getting Back on the Court

The Pickleball Phenomenon

Pickleball is the fastest-growing sport in America. It's social, accessible, and addictive. It's also sending a lot of people to physical therapy.

Here's what you need to know about pickleball injuries—and how to avoid them.

Why Pickleball Causes Injuries

The Perfect Storm

1. Older demographic: Many players are 50+ with less tissue resilience

2. Quick adoption: People play 3-4x/week before their bodies adapt

3. Deceptive intensity: Feels easier than tennis, but involves similar movements

4. Stop-start demands: Sudden direction changes stress joints

5. Smaller court: Less time to react, more explosive movements

The Most Common Injuries

Research and clinical experience show:

1. Ankle sprains (lateral court movement)

2. Achilles tendon injuries (push-off and pivoting)

3. Knee injuries (sudden stops, pivots)

4. Shoulder problems (overhead shots, serving)

5. Elbow tendinopathy (pickleball elbow—yes, it's a thing)

6. Wrist and hand injuries (paddle impact)

7. Falls (moving backward, court obstacles)

Ankle Sprains

How They Happen

Side-to-side movement, pivoting, stepping on a ball, or awkward landings.

Prevention

  • **Court shoes with lateral support** (not running shoes!)
  • Ankle strengthening exercises
  • Balance training
  • Don't play on wet surfaces
  • Proper warm-up before playing

    • Treatment

    Mild sprain: RICE (rest, ice, compression, elevation) + early movement within pain limits.

    Moderate/severe: May need immobilization, physical therapy, or evaluation for fracture.

    Key exercises:

  • Alphabet ankle circles
  • Single-leg balance progressions
  • Lateral band walks
  • Controlled lateral movements

    • Achilles Tendon Problems

    The Danger Zone

    The Achilles takes enormous force during the explosive movements pickleball demands. For older adults, this can mean:

  • Achilles tendinopathy (gradual overuse)
  • Partial tears
  • Complete rupture (often with a "pop")

    • Warning Signs

  • Stiffness in the morning or after sitting
  • Pain at the back of the ankle during or after play
  • Thickening of the tendon
  • Pain going up on toes

    • Prevention

  • **Gradual increase in playing volume**
  • Calf strengthening (especially eccentric)
  • Proper warm-up including dynamic calf stretches
  • Avoid playing when fatigued
  • Good court shoes with heel drop

    • Treatment

    Tendinopathy: Eccentric loading exercises (Alfredson protocol), load management, gradual return.

    Rupture: Immediate medical attention—surgical or non-surgical treatment depending on various factors.

    Knee Injuries

    Common Problems

  • **Meniscus tears:** Twisting on a planted foot
  • **Ligament sprains:** Sudden stops, pivots
  • **Patellofemoral pain:** Overuse, quad/hip weakness
  • **Arthritis flares:** Increased activity on compromised joints

    • Prevention

  • Strengthen quads, glutes, and hamstrings
  • Work on single-leg stability
  • Avoid pivoting on a planted foot—lift and turn
  • Maintain healthy body weight
  • Consider a knee sleeve if history of problems

    • Treatment

    Acute injury: Rest, ice, compression. Seek evaluation if swelling is significant, you can't bear weight, or the knee gives way.

    Overuse injuries: Activity modification, strengthening, gradual return.

    Shoulder Injuries

    Overhead Stress

    Serving, overhead smashes, and reaching for balls overhead stress the rotator cuff.

    Common Problems

  • Rotator cuff tendinopathy
  • Shoulder impingement
  • Biceps tendinitis
  • Labral irritation

    • Prevention

  • **Strengthen the rotator cuff** (external rotation exercises)
  • Work on scapular stability
  • Maintain thoracic mobility
  • Proper technique (don't muscle the ball)
  • Avoid excessive overhead shots when fatigued

    • Treatment

  • Rest from aggravating activities
  • Rotator cuff and scapular strengthening
  • Address thoracic mobility
  • Technique modification if needed

    • Pickleball Elbow

    Medial vs. Lateral

  • **Lateral epicondylitis (tennis elbow):** Outside of elbow, backhand strokes
  • **Medial epicondylitis (golfer's elbow):** Inside of elbow, forehand and grip

    • Why It Happens

    Repetitive wrist and forearm motion, grip strength demands, and vibration from paddle impact.

    Prevention

  • **Grip size matters:** Too small = more force needed
  • Paddle with vibration dampening
  • Strengthen forearm muscles (wrist curls, reverse curls)
  • Avoid gripping the paddle too tightly
  • Take breaks during play

    • Treatment

  • Relative rest (may not need complete stop)
  • Eccentric wrist exercises
  • Counterforce brace below the elbow
  • Ice after playing
  • Gradual return to full volume

    • Falls and Traumatic Injuries

    The Risk

    Backpedaling, tripping on lines or balls, wet surfaces, and collisions all cause falls.

    Serious Consequences

    In older adults, falls can mean:

  • Wrist fractures (FOOSH injuries)
  • Hip fractures
  • Head injuries
  • Knee contusions

    • Prevention

  • **Never backpedal**—turn and run to the ball
  • Call "yours" or "mine" to avoid partner collisions
  • Keep court clear of loose balls
  • Wear non-marking court shoes
  • Know your limits

    • The Warm-Up Protocol

    10-Minute Pre-Play Routine

    Dynamic movement (3 min):

  • Walking lunges × 10 each leg
  • Lateral shuffles × 30 seconds
  • High knees × 30 seconds
  • Arm circles × 10 each direction

    • Leg prep (3 min):

  • Calf raises × 15
  • Bodyweight squats × 15
  • Single-leg balance × 30 seconds each

    • Upper body (2 min):

  • Shoulder rotations
  • Paddle swings (easy)
  • Wrist circles

    • Court warm-up (2 min):

  • Dinking rally at the net
  • Gradual intensity increase

    • Don't Skip This

    Cold muscles and tendons don't handle sudden loading well. The warm-up is your insurance policy.

    Playing Smart

    Load Management

  • **Build up gradually:** Don't go from zero to 4 days/week
  • **Take rest days:** Tissue needs time to adapt
  • **Listen to your body:** Pain is a signal
  • **Mix intensity:** Every session doesn't need to be competitive

    • Technique Matters

  • **Bend your knees,** don't reach down with your back
  • **Move your feet** instead of lunging
  • **Let balls go** that are too far—your body isn't worth the point
  • **Stay balanced** before and after shots

    • Equipment Considerations

  • **Court shoes:** Lateral support is essential
  • **Paddle weight:** Lighter reduces arm stress but may require more swing force
  • **Grip size:** Match to your hand
  • **Eye protection:** Those balls are fast

    • When to Sit Out

    Stop Playing If:

  • Sharp pain during play
  • Swelling
  • Inability to move normally
  • Previous injury flaring up
  • Significant fatigue (increases injury risk)

    • When to See a Professional:

  • Pain lasting more than a week
  • Joint swelling
  • Giving way or instability
  • Loss of motion
  • Any "pop" followed by pain and swelling

    • The Bottom Line

    Pickleball is fantastic for health—social, active, and fun. But respect what your body is being asked to do.

    Build up gradually, warm up properly, strengthen consistently, and listen to pain signals. With smart preparation, you can enjoy pickleball for decades.

    Don't let an injury end your pickleball career before it really gets started.

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