Pickleball Injuries

Pickleball is the fastest-growing sport in the United States, with 19.8 million Americans playing and the number increasing every year. Multiple studies across the U.S. confirm that injuries from pickleball have risen alongside the popularity of the sport.

“Pickleball has a reputation as a casual recreational sport, so players assume injuries are rare,” says Elizabeth Matzkin, MD. “But any athlete in any sport can be injured without the proper strength, balance, and prevention tactics to reduce the risk of injury.”

Dr. Matzkin is the co-leader of Mass General Brigham Women’s Sports Medicine Program and a women’s sports medicine surgeon at Brigham and Women’s Hospital and Brigham and Women’s Faulkner Hospital.

She shares tips to help players reduce their risk of pickleball injuries and provides guidance on when to seek medical care if you do get injured on the court.

Common pickleball injuries

Athletes often mistake pickleball as less dangerous than tennis. Players use lighter balls, play on a smaller court, and wield smaller rackets. Injuries in both sports, however, regularly occur from overuse and quick pivots.

Many players with pickleball injuries that see their primary care provider (PCP) or the sports medicine team have either an overuse injury or they can have an acute traumatic injury Overuse injuries are often tendinopathy, or degeneration of a tendon, which can be seen in tendons at the elbow or in the Achilles tendon. Acute or traumatic injuries from a fall or from sudden quick-cutting motions can result in meniscal or ACL injuries.

How do pickleball injuries typically occur?

The most common cause of pickleball-related emergency room visits varies by age group. Adult players were most often injured in falls, while adolescent players were more frequently hit by a paddle.

Non-emergency injuries typically occur when players overestimate what their body can handle, given pickleball’s reputation as a sport that’s easy to pick up. People with a more sedentary lifestyle or pre-existing injuries can get caught up in the excitement and fun of a new hobby and not realize how hard their body is working.

Even for athletic or active players, repetitive motions—underhand serves, wrist flicks, and side shuffles—can overwork muscles and joints, resulting in overuse injuries. Even if they appear shorter and less straining than shooting a basketball or hitting a baseball, the toll of these movements adds up.

The ankle, Achilles, elbow, and wrist carry the heaviest burden from pickleball. They are smaller joints and muscles typically reserved for less daunting tasks, such as standing or writing. If these joints or muscles take on too high of a workload, they can easily strain or tear.

Who is most prone to injuries?

Athletes with chronic injuries such as arthritis or tendinopathy, or degeneration of the tendons, can aggravate their injuries playing pickleball.

Older individuals, particularly women with osteoporosis or low bone density, can risk bone fractures. In studies of emergency room visits, older women were more likely to break a wrist than other age groups.

Women players can have a greater risk for certain injuries—like ACL tears—than men, due to muscle imbalances, dietary alterations, hormonal changes and other biological factors. “Building strength, balance, and awareness can help all athletes, but particularly women, prevent injuries,” says Dr. Matzkin.

Accidents can happen, even to the most well-conditioned sports players. Falls, collisions, being hit with a paddle or a ball, or pushing your body too hard can occur at any time, to any player regardless of age, gender, or athletic ability. The most important thing is to know your own limits, practice prevention tactics, and use safety gear like eye protection, wrist guards, or compression sleeves as recommended by your health care provider.

Pickleball injury treatment

Players might self-diagnose an injury from pain or discomfort in a specific location of the body. The body, however, is interconnected; each part affects another. For instance, tight gluteal muscles and hamstrings may pull on the calves, which can make someone more prone to an Achilles injury.

Treating pain in the Achilles tendon alone may not prevent further injury if the tightness in the gluteal muscles, hamstrings, and calves is not addressed.

Players should:

Seek emergency care for bone fractures, severe bleeding, or suspected concussion.

Signs and symptoms of a fracture in the arms and legs include:

• Swelling
• Bruising
• Inability to bear weight

Bleeding injuries can be an emergency if the bleeding:

• Is severe
• Is spurting
• Is from the neck, chest, or abdomen
• Doesn't stop after 10 minutes of direct pressure

Call 9-1-1 to get medical attention as soon as possible. Follow tips to stop bleeding as you wait for emergency help.

If a fall causes a head injury, or you get hit in the head or face by a paddle get emergency medical attention to rule out a concussion or other severe head injury. Concussions are a neurological condition and can cause:

• Loss of consciousness
• Loss of memory
• Headaches
• Sensitivity to light or noise
• Dizziness
• Depression

Any loss of consciousness or severe headache after a bump to the head is a cause for concern.

Use the R.I.C.E method: Rest, ice, compression, and elevation for suspected sprains or strains.

How to prevent pickleball injuries

Improving mobility and conditioning muscles and tendons from overuse can help prevent injury. Dr. Matzkin and the team at Mass General Brigham Women’s Sports Medicine Program recommend a multi-faceted approach to injury prevention, including:

Stretching

Using the right equipment and wearing the right gear

Equipment matters in every sport. Pickleball is no exception.

Muscles and joints overcompensate when players use the wrong equipment. Those who use paddles too large or small strain muscles in their hand, wrist, and elbow. Those who wear footwear too loose or tight can similarly strain muscles in the ankles, heel, and feet.

Loose footwear can also jeopardize a player’s balance. Slipping and falling can roll ankles, break bones, and tear ligaments. Pickleball courts exist on grass, clay, or concrete surfaces. Players should wear footwear with a grip compatible to the surface they choose to play on.

While grass and turf have raised questions about the safety of playing on different surfaces in sports like football or soccer, an injury can happen on any surface without proper conditioning and footwear.

If you play with any level of regularity, invest in a pair of sports protective eyewear to prevent pickleball eye injuries. Mass General Brigham ophthalmologist Nimesh A. Patel, MD, notes that your standard glasses or sunglasses are not protective for sports, as they’re more likely to break when hit. Eye protection doesn’t have to be expensive or fancy–any standard sports eyewear from your local sporting goods store will work.

Cross-training and strengthening exercises

Different sports rely on different muscle groups. The more varied an athlete’s activities, the less likely they are to overuse those same groups. Varied activities can also help condition and build muscles used to support the wrist, elbow, ankles, and calves.

Badminton, tennis, and ping pong resemble pickleball most. While these sports help players learn and improve the technical skills needed for pickleball, they might not allow players to properly rest muscle groups overused by the sport.

Biking and yoga can help stretch and condition muscles typically not used as much in pickleball, such as the quadriceps, shoulders, and biceps.

Strength training exercises—particularly core strengthening activities—help players build muscle to support their body and maintain proper form. Dr. Matzkin recommends exercises like planks, side planks, and abdominal crunches for core strength, and squats, lunges, and deadlifts for resistance training. “Players need to have proper strength, balance, landing form, and techniques specific to their sport in order to reduce the risk of injury,” says Dr. Matzkin.

Focus on your form.

Whether you’re a serious player and have a pickleball coach or you play for fun with friends, improving your form while playing in any sport can help protect you from injury. Proper technique, foot placement, and posture are ways to hold your body that are less stressful on the muscles, tendons, and ligaments.

Dr. Matzkin notes that it’s not just during competitive play that players get injured. “In general, the risk of injury is higher during competition, but we also see many injuries during casual games, including overuse injuries from repetitive movements or poor form.”

Consider filming yourself playing a game–it's easier to critique your form by watching yourself after the fact rather than during gameplay.

When can someone return from a pickleball injury?

Take time away from the court to rest and recover and follow your health care provider’s instructions for your specific injury. Rest is critical to the body’s recovery process. Common sports recovery techniques like stretching—or more advanced recovery techniques like cryotherapy or saltwater floats—can help get players back to full fitness and ready to play again.

Work your way back to the court slowly, beginning with small, short bouts of play. If you feel okay and experience little-to-no pain, only then should you increase the intensity, frequency, and length of their play.

“There’s a psychological aspect of sports, especially the loss of identity when a player is injured and can’t play. They may also have a fear of re-injury, or a risk of overcompensating and injuring something else,” says Dr. Matzkin. “Having a background in sports, I understand how much players want to get back to the game. But it’s important to take time to recover, consulting a sports medicine physician to help with strengthening, balance, and form to prevent re-injury and improve your game.”