How to Prevent Pickleball Injuries

The explosion in pickleball’s popularity in recent years has also generated a surge in injuries related to the sport, which is a hybrid of tennis, badminton, and ping-pong.

From 2002 to 2022, there was a 90-fold increase in fractures related to pickleball, with most occurring in players between ages 60 and 69, according to a recent study.

“From pickleball, we most often see strains and sprains of the muscles and tendons, including injuries to the ligaments around the knee, tennis elbow, ankle sprains, Achilles tendonitis, and rotator cuff inflammation,” says Andrew Jimenez, MD, a Yale Medicine orthopaedic surgeon and sports medicine specialist.

As interest in pickleball continues to grow, the sport is attracting players of all ages. In fact, the average age of a pickleball player is about 35, according to the Association of Pickleball Professionals.

And injuries, particularly those caused by overuse, can happen at any age or skill level, says Jim Hsu, MD, a Yale Medicine orthopaedic surgeon and sports medicine specialist.

“The sport is deceivingly perceived as casual and easygoing, because you don’t need any preparation to play, and you can play all weekend long,” Dr. Hsu says. “That notion lures people in, but the sport can be rigorous, and the strains on the body are not casual. Players should ease themselves into it and not play too much, too fast, too soon.”

For the uninitiated, pickleball is a paddle sport in which two or four players hit a perforated, hollow plastic ball over a net until one side is unable to return the ball or commits a rule infraction. Many say the small court and lightweight ball make the sport easier and more enjoyable than other paddle sports.

"The good news is that there are many things people can do to limit injuries,” says Dr. Jimenez.

Below, we talk more with Drs. Hsu and Jimenez about how to avoid pickleball injuries, no matter your age and experience level.

A solid warmup, which should take between five and 10 minutes, is an important first step before playing pickleball, Dr. Jimenez says. The idea is to raise your body temperature and increase blood flow to your muscles, which loosens your joints so that you are ready to play.

Instead of traditional “static” stretching, where you hold one position, Dr. Jimenez recommends "dynamic" stretches and movements, including lunges, moving your arms in wide circles, and knee lifts. You could also do a short, easy jog or 30 seconds of jumping jacks, he says.

After playing—and as part of a cool down—he suggests light static stretching and a slow walk.

For any athletic activity, especially if you are new to it, remember to listen to your body and rest when needed, Dr. Jimenez says.

“If you become fatigued while playing, especially when you are new to the sport or just starting a game, take a break before continuing and don’t play to the point of full exhaustion and exertion, because that is when you are more likely to sustain an injury or fall,” he says. “It’s better to start off doing less and then increase the number of games or the amount of time you play as you become more fit.”

The main thing, Dr. Hsu says, is to monitor your enthusiasm for the sport, rather than curb it. “You want to respect the demands on the body and know that the game can be rigorous,” he says. “I think sometimes it’s promoted as being so easy and fun—more akin to playing ping-pong at a party—but it’s a lot more than that.”

What’s more, doing too much too soon can lead to an overuse injury, Dr. Hsu explains. “That occurs when the body doesn’t have a chance to adapt to the activity,” he says.

For example, Dr. Hsu says he often sees “pickle elbow,” which is pickleball’s equivalent to tennis elbow. It presents as pain on the outside of the elbow caused by repetitive wrist and arm movements that inflame the tendons in the forearm.

“Usually, you feel tennis or pickle elbow pain only when you are playing, but sometimes, it can affect how you carry things in your arms, how you type, or even how you hold a cup of coffee,” Dr. Hsu says. “You can avoid any injury like this by easing into the sport and letting your body adjust to the increasing demands you put on it with something new.”

Supportive sneakers are key, Dr. Jimenez says. Pickleball can be played on a variety of courts, including at indoor facilities, on concrete or asphalt tennis courts, and even on grass.

“Depending on the type of court you play on, typically, a tennis-type shoe is a good idea,” Dr. Jimenez says. “You want something comfortable, secure, and with a good grip to help you avoid slips and falls.”

Because pickleball has a reputation as a sport anyone can play and enjoy, people who don’t have any experience with tennis or racquetball often take it up, Dr. Hsu says. “They might wear a casual shoe that doesn’t have a lot of support or running shoes, which are designed for moving forward and not the multidirectional nature of pickleball, with lots of side-to-side movement,” he says.

Pickleball is played with a paddle that has a leather-like wrap, or grip, on its handle. “It’s important for players to know that there are different grip sizes; you should find one that is the most comfortable for you,” Dr. Hsu says. “If the grip size is too large, it can strain your muscles. If you go to a sporting goods store, they can measure your hand size and help you pick the best paddle.”

Doing activities other than pickleball is a good way to build up your cardiovascular reserve and support your pickleball play, Dr. Jimenez says. This can include running, swimming, or riding a stationary bike.

Strength training can also help with avoiding injuries. “General shoulder and arm strength exercises, as well as core exercises, are great to do,” Dr. Hsu says. “Plus, it’s good to work on your balance and reflexes.”

For nagging pain or minor injuries caused by pickleball, rest, ice, and using nonsteroidal anti-inflammatory (NSAID) medications, such as ibuprofen, should help, Dr. Jimenez says.

If the injury is sudden and acute, such as a possibly broken wrist or ankle, or If the pain doesn’t go away, Dr. Hsu recommends seeing your primary care doctor, a sports medicine doctor, or a physical therapist.

“Pickleball is a great sport, and I encourage people to try it or keep at it,” Dr. Jimenez says. “Anything that encourages people to be active and exercise is a wonderful thing. They just need to be prepared.”