Pickleball Injuries

Pickleball Injuries: How to Play Safe and Avoid Common Setbacks

Pickleball injuries can sidetrack even the most enthusiastic players, turning a source of joy into a cause for concern. But there's no need to let these setbacks keep you off the court. With insights from seasoned experts, this article delves into the common injuries associated with pickleball, offering clear, actionable advice for prevention and management.

Whether you're just starting out or have been enjoying the game for years, we provide friendly, expert guidance that resonates with players of all skill levels. Join us in a journey towards safer play, where your passion for pickleball is met with understanding and support for your well-being.

The Nature of Pickleball Injuries

nature of Pickleball injuries

Pickleball is essentially a combination of racket sports like tennis, badminton, and table tennis, mostly involving the same lateral movements. According to the Association of Pickleball Professionals, about 36.5 million people play pickleball in the United States, making it the country’s fastest-growing sport in 2023. It's a racket sport that can also be played indoors.

Given that these sports involve many sudden, pivoting dynamic movements, some players, especially those new to the game, may suffer certain injuries. According to one study, older adults aged 50 and above were more prone to pickleball-related accidents — with them constituting about 90% of the pickleball injury cases.  At the same time, studies showed that many players tend to be older, with 75% of core participants being aged 55 (or older), and those over 65 composed 42% of players. 

Additional data also showed that the most common injuries sustained in pickleball are:

  • the wrists (13.2%)
  • the lower legs (12.9%)
  • head (11.9%)
  • lower trunk (11.6%)
  • ankles (6.1%).

These have contributed to the spike in treatments that cost Americans up to $500 million worth of treatments in 2023. 

There are two types of pickleball injuries – acute and chronic. Acute ones result from falls secondary to sudden turning or pivoting movements, while chronic ones typically result from overuse or repetitive pounding on the hard playing surface and develop over longer periods.

Common Pickleball Injuries

Acute Injuries

Ankle sprains

Pickleball Ankle Sprain

Ankle sprains occur when the ankle is rolled, twisted, or turned suddenly and awkwardly. This can overstretch or tear the ligaments that hold the ankle bones together, causing intense pain, tenderness, and limited mobility. 

Given its intense shifting and turning movements, ankle sprains are common among pickleball players.

Knee ligament injuries

Pickleball knee ligament injury

Injuries that involve the knee ligaments like ACL (anterior cruciate ligament), PCL (posterior cruciate ligament), MCL (medial collateral ligament), and LCL (lateral collateral ligament) are often the result of overstretching or straining the ligaments beyond their normal capacity, causing instability and pain in the knees.

The rapid starting/stopping and sudden pivoting movements in pickleball often result in knee ligament injuries among its players, especially those who are either new to the sport or play too roughly. 

Wrist pain

Pickleball wrist injury

An overuse injury is a continuous repetitive motion that often causes stress on the joints. It can be caused by one’s nature of work or the sports one plays that involve strenuous repetitive actions.

Wrist pain is one of the most common overuse injuries suffered in pickleball, stemming from the sport’s repetitive motions or holding the pickleball paddle too tightly, which results in overuse motions. This pain is characterized by a consistent aching or sharp pain and tenderness when pressing the wrist, especially when moving the wrist. 

Concussions

A concussion is a brain injury that causes the head and brain to go back and forth. It’s caused by a strong or sudden bump, blow, or jolt to the head. 

People new to pickleball may find themselves overwhelmed by the sudden pivotal moments and risk falling and hitting their heads on the ground. However, even experienced players can also suffer concussions if they don’t learn proper techniques and form. 

Chronic Injuries

Tendonitis

This condition is the inflammation of the tendons in the elbows, shoulders, hips, and knees. Elbow and patellar tendonitis are some of the more frequent cases of tendonitis caused by repetitive motions that put excessive stress and tension on the calf muscle and achilles tendon, which connects the patella and shin, leading to achilles tendon rupture.

Pickleball elbow (lateral epicondylitis) is a type of tendonitis that causes elbow and arm pain and limits your ability to use your wrist and fingers. Similar to tennis elbow, this type results from gripping a pickleball paddle tightly for long periods or repeatedly twisting and turning the wrists as one hits the ball – the overall stress creates tears in the tendons connected to the elbow.

Plantar fasciitis

Plantar fasciitis is an inflammation of the plantar fascia tissue in the foot. It is a common cause of heel pain in adults and can cause great pain and hardened mobility, especially upon waking up in the morning.

It’s fairly common for those who play pickleball to experience heel pain after a rough game. Plantar fasciitis is usually attributed to collagen degeneration caused by repetitive microtears of the plantar fascia. This degeneration starts at the origin of the plantar fascia at the medial tubercle of the calcaneus.

Rotator cuff injuries

Rotator cuff injuries are shoulder injuries that involve wear and tear on the joints responsible for lifting and rotating the arm. This wear and tear can cause the joints to become weaker, making them more vulnerable to problems like soft tissue damage and immobility.

Pickleball can cause rotator cuff injuries due to the sport’s repetitive sweeping and slicing motions.

Lower back pain

Lower back pain is more frequent among older adults. The pain in the lower back results from natural wear and tear, excessive sitting, or carrying heavy weights. 

For pickleball players, it’s the constant rotation of the trunk and forward bending the wrong way can trigger this condition. They are also at risk of injuring other areas of the back, including the lower back, upper back, and even the neck.

Other injuries

Hamstring strains

Otherwise called a pulled hamstring, this injury happens when one or more of the hamstring muscles gets stretched too far and starts to tear. It’s also common among pickleball players,  who tend to overextend or reach to return a ball, straining the hamstrings in the process. 

A hamstring strain may be acute or chronic. While it’s usually acute, it can become chronic when a damaged tendon doesn’t heal properly, so it’s important to have the injury evaluated by a sports medicine physician immediately. 

Causes of Injuries in Pickleball

The following factors contribute to the incidence of pickleball accidents:

  • Inadequate warm-up and stretching - Not doing warm-up or stretching exercises before playing pickleball can drastically increase the likelihood of sustaining muscle damage and more injuries in joints that bear weight. However, this factor applies to all sports and workouts. 

  • Overexertion and lack of rest -  Overexertion can cause tearing or overstretching in the muscles, tendons, and ligaments. Not having sufficient rest in between or after games/sets can aggravate injuries sustained. 

  • Improper technique - Poor technique leads to repetitive motions, which can cause excessive pressure and stress on particular joints or muscles like wrists and elbows, leading to acute injuries.

  • Court hazards - External factors like wet surfaces and uneven flooring can lead to missteps, slipping, and or severe injury. 

These factors can also apply to other racket sports like ping-pong, tennis, and badminton.

Injury Prevention Strategies

Doing proper stretching and recovery routines

All workouts and games should start with stretching exercises. Doing low-impact exercise reduces the risk of common injuries, improves physical performance, enhances flexibility and range of motion, and increases blood flow.

Cooling down, on the other hand, is similar to warming up. After a game or a workout, you can do light, low-impact upper and lower-body stretching exercises like walking lunges, which strengthen the calf muscles and prevent calf strains, and brisk walking, which lessens the risk of achilles tendonitis.

Equipment considerations: correct court shoes, paddles, and protective gear

Always ensure you are using proper, safe equipment and are wearing the correct clothing and footwear for the activity – opt for lightweight and breathable clothes to prevent discomfort.

Wear proper footwear. Shoes specifically designed for intense physical activity, like tennis shoes or running shoes, tend to last longer and are suitable for indoor and outdoor courts. Knee braces prevent injury, lessen the stress on knee joint pain, and the impact and stress of sudden movements. 

Technique improvement tips

When you’re new to pickleball, it’s best to arrange a few training sessions with a qualified instructor, professional coach, or trainer (if your budget permits); this will ensure you are taught the correct technique from the beginning and evade the risk of common pickleball injuries. 

Regular rest and understanding the body’s limits

The body needs rest just as much as it needs to stay active. As it rests, its muscles start to heal and recover stronger, meaning you'll be able to do the same workout with less effort in the future. 

Warm-Up and Cool-Down Routines

Give these preparatory and cool-down exercises a try to prevent injuries in pickleball. You won’t need any equipment for any of these routines.

Stretching Exercises

These exercises target the principal joints and muscles involved in pickleball and play an important role in injury prevention.

Elbow Extensions

Elbow exercises help stretch the ligaments to promote wrist mobility and increase flexibility. This helps avoid the risk of tennis elbow.

  • Lie on a bench and let the right forearm and hand hang off relaxed, palm up. Only your upper arm should be on the bed.

  • Gently straighten the arm until you feel a stretch in the elbow. 

  • Hold for 30 seconds to a minute before relaxing the arm. 

  • Do up to 12 reps and two more sets or as instructed.

Wrist Curls

Wrist curls are an isolation exercise that targets the forearm muscles. They help improve grip strength and encourage stronger wrists.

  • Holding some weights or dumbbells, Curl your wrists upward as you exhale. (Doing this exercise slowly to  prevent the joints from straining.) 

  • Extend your wrists downward as far as you can as you inhale.

  • Return to the first position slowly. Repeat up to 12 times and three sets.

Modified Squats

Squats are multi-joint movements that work the quads, hamstrings, glutes, and lower back muscles.

  • Stand straight with feet hip-width apart. Tighten your stomach muscles.

  • Bend your knees as if you were lowering yourself onto an invisible chair. Keep your upper body as straight as possible.

  • Straighten your legs to lift you back up. Be careful not to lock your knees when you stand.

Knee Extensions

Knee extensions benefit the quadriceps and the joints, enabling better mobility. 

  • Sit in a chair or on a platform so that your hips and knees are at 90°. Roll up a towel and place it under a knee to increase your range of motion.

  • Straighten out the leg with the towel underneath it. 

  • Squeeze the quad as much as you can. Hold for 2 to 3 seconds before returning to resting position.

  • Repeat for 3 sets of 10 reps on each side.

Recovery Exercises

Do these exercises to let the muscles heal and recover and to avoid muscle soreness.

Downward-Facing Dog

  • Do the plank position and move your hips up and back while maintaining your spine straight. 

  • Push your hands flat on the ground and press your weight evenly between each hand. 

  • Pedal out your legs by pressing one heel into the floor at a time. Hold this position for 1 minute.

Corpse Pose

  • Lie on your back with your arms at your sides, feet slightly wider than hips, and toes splayed out to the sides.

  • Relax and breathe deeply to release any tightness or tension.

  • Stay in this position as long as needed.

Tips to Prevent Pickleball Injuries

Common Mistakes To Avoid

  • Improper Form & Balance - Poor form and balance while swinging the paddle to serve the ball can lead to injuries. Great form allows you to perform better in the game.

  • Incorrect Footwork -  Focus on doing shuffle and split steps and avoid doing long strides.

  • Overexertion - Don’t use too much power on each serve. Overexertion while serving can cause upper extremity injuries, such as shoulder pain and tennis elbow.

Tips To Improve Your Game

  • Develop a positioning strategy - Start balancing your serves strategically to score more. That way, you can position yourself to attack and defend effectively, allowing you to anticipate your opponent's next move.

  • Improve your communication - Like in tennis, learn to observe each other’s bodily movements and signals to allow you to play in sync. Like a musical duet – both players need to jive well and know when to deliver properly to create a good performance. 

Treatment and Rehabilitation

The RICE Method

RICE stands for Rest, Ice, Compression, and Elevation. This method is a common first-aid self-care technique for minor injuries in sports like pickleball.

  • Rest - Stop the game immediately and rest. Refrain from doing heavy physical activity as well.

  • Ice - Apply an ice pack on the affected area for up to 20 minutes. Repeat as needed.

  • Compression - Firmly wrap the injury with a bandage or compression sleeve to release tension and stress to speed recovery.

  • Elevation - Elevate the affected area above the level of the heart to decrease pain and swelling.

However, if the symptoms persist, consult a healthcare provider or a physical therapist immediately. 

Physical Therapy and Alternative Treatments

  • Physical therapy - Physical therapy employs a structured exercise program for the injured muscles to allow them to absorb the impact on the knee during movement.

  • Radial nerve flossing – Nerve flossing exercises help the peripheral nerves move free and allow for joint flexibility and mobility, especially in the elbows and wrists.

  • Voodoo flossing - Voodoo flossing helps relieve post-exercise musculoskeletal pain, improve recovery from injuries, and achieve greater mobility. It can also serve as a pre-game routine.

  • Knee replacement surgery - If the injured joints continue to manifest problems like more severe pain, an orthopedic surgeon can perform either a partial or complete knee replacement surgery, depending on the extent of the damage.

FAQ: Answering Your Pickleball Injury Concerns

1. What is the most common injury in pickleball, and how can I avoid it?

Wrist injuries are considered the most common in pickleball due to the sport’s repetitive motions or holding the paddle too tightly. The best way to avoid them is to learn the proper form and balance your power in each serve.

2. How can I tell if my pickleball injury is serious?

For the most part, pickleball injuries are acute and can be treated with rest and self-care techniques. However, if the pain and other symptoms persist more than usual, it’s best to seek immediate medical attention. 

3. Can older players reduce their risk of injury while playing pickleball?

Pickleball is a low-impact sport suitable for older adults. However, they need to learn the proper technique and sufficient warm-up and post-exercise cool-down routines to minimize muscle injury or trauma. 

4. Are there any specific stretches or exercises recommended for pickleball players?

Exercises that target the main muscle groups and joints involved in pickleball, such as wrist curls, elbow extensions, squats, and knee extensions, are excellent examples of pre-game exercises. Regular physical therapy sessions can enhance your flexibility, allowing comfortable movement on the court.

5. How does the playing surface affect the risk of injuries?

The playing surface of a pickleball court, much like a tennis court, can define the quality of the game and its comfortability. Conditions like plantar fasciitis stem from overuse or repetitive foot pounding on hard playing surfaces, so it’s important to opt for a surface that’s not too hard but durable enough for foot grip. 

6. What are the long-term effects of repeated pickleball play on the body?

Given the nature of the sport, pickleball can result in overuse injuries in the elbows, wrists, and knees, especially when done without proper stretching. It’s important to allow the body to prepare and cool down after each game to release stress and tension.

Conclusion

The pickleball craze is going strong, and it’s a definite must-try for those who want to stay active or achieve a sporty lifestyle. But before hitting the court, it’s important to learn proper techniques to improve your performance and prevent pickleball injuries. 

If you’re still new to playing pickleball, you can learn and study from pickleball pros and trainers to not miss out on secrets to make each game a real blast. 

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