Common Pickleball Injuries and How to Prevent Them
Pickleball is one of the fastest-growing sports in the United States, with more than 13 million players as of 2024. Its appeal spans across generations, especially adults over 50 who enjoy the social, competitive, and cardiovascular benefits of the game.
But as pickleball participation skyrockets, so do injuries. According to a 2023 report in the Journal of Emergency Medicine, pickleball-related injuries among older adults have more than doubled over the past decade, with the majority involving strains, sprains, and overuse conditions. At Metro Wellness, we’re seeing this firsthand—patients who love the game but are limited by pain or injury.
The good news? Most pickleball injuries are preventable with proper preparation, strengthening, and recovery strategies. Below, we’ll break down the most common injuries and what the evidence says about prevention.
The Most Common Pickleball Injuries
1. Tennis Elbow (Lateral Epicondylitis)
What it is: Overuse of the wrist extensors leads to microtears at the lateral elbow tendon.
Why it happens in pickleball: Repeated paddle swings, especially with poor grip mechanics.
Evidence: Eccentric strengthening of the wrist extensors significantly reduces symptoms and recurrence (Cullinane et al., 2014).
2. Rotator Cuff Tendinopathy & Shoulder Strain
What it is: Irritation or tearing of the rotator cuff tendons.
Why it happens: Frequent overhead serves and reaching for lobs.
Evidence: Weakness in scapular stabilizers and poor shoulder mobility are major contributors to rotator cuff injury (Kibler et al., 2019).
3. Low Back Pain
What it is: Strain of the lumbar muscles or irritation of discs/facets from rotation and flexion.
Why it happens: Quick twisting movements and limited hip mobility force the spine to compensate.
Evidence: Core stabilization and hip mobility training reduce recurrence of sport-related low back pain (Standaert & Herring, 2008).
4. Knee Pain and Meniscus Strain
What it is: Overuse or acute pivoting injuries affecting cartilage and ligaments.
Why it happens: Lateral cutting, lunges, and sudden stops.
Evidence: Neuromuscular training and quadriceps/hamstring balance reduce knee injuries significantly (Sugimoto et al., 2016).
5. Ankle Sprains & Achilles Tendinopathy
What it is: Sprain of lateral ankle ligaments or overload of the Achilles tendon.
Why it happens: Rapid directional changes and explosive push-offs without proper warm-up.
Evidence: Proprioceptive training (like balance exercises) reduces recurrence of ankle sprains (Doherty et al., 2017).
How to Prevent Pickleball Injuries (Evidence-Based Strategies)
✅ Warm-Up and Mobility (5–10 minutes)
Dynamic warm-ups improve blood flow and prepare tissues for quick movements.
Arm circles, leg swings, torso rotations, side shuffles.
Evidence: Dynamic warm-ups reduce sports injury risk by up to 30% (Fradkin et al., 2006).
✅ Strength and Stability Training
Target weak links that pickleball stresses most.
Shoulder/Rotator Cuff: Resistance band external rotations, rows, YTWs.
Core & Hips: Planks, dead bugs, glute bridges, Pallof presses.
Legs: Step-ups, single-leg squats, balance work.
Evidence: Neuromuscular training programs like FIFA 11+ reduced lower extremity injuries by 30–50% (Soligard et al., 2008).
✅ Footwear Matters
Wear court shoes (not running shoes) for lateral stability and grip.
Evidence: Shoes with lateral support decrease ankle sprain risk during side-to-side movements (Queen et al., 2021).
✅ Recovery and Load Management
Stretch and foam roll after games.
Hydrate and avoid sudden spikes in play frequency.
Evidence: Progressive training loads strongly reduce overuse injuries (Gabbett, 2016).
✅ Seek Early Intervention
Don’t ignore persistent soreness. Physical therapy can correct movement imbalances before they lead to serious injury.
Takeaway
Pickleball is a fun, social, and healthy way to stay active—but like any sport, it comes with risks. The most common injuries affect the elbow, shoulder, back, knees, and ankles, and they often stem from poor preparation or overuse.
The best prevention is evidence-based:
Warm up dynamically
Build strength and stability
Wear proper footwear
Recover smart
Get professional help when needed
At Metro Wellness, our team specializes in helping athletes stay pain-free and performing at their best. Whether you’re recovering from an injury or want a personalized program to prevent one, we’re here to keep you moving—so you can enjoy the game for years to come.
References
Cullinane FL, Boocock MG, Trevelyan FC. (2014). Is eccentric exercise an effective treatment for lateral epicondylitis? BMJ Open Sport & Exercise Medicine.
Kibler WB, Sciascia A, Thomas SJ. (2019). Glenohumeral internal rotation deficit: pathogenesis and response to acute throwing. Am J Sports Med.
Standaert CJ, Herring SA. (2008). Expert opinion and controversies in sports and musculoskeletal medicine: low back pain. Spine J.
Sugimoto D, Myer GD, Bush HM, Klugman MF, McKeon JM, Hewett TE. (2016). Compliance with neuromuscular training and anterior cruciate ligament injury risk reduction in female athletes. Br J Sports Med.
Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. (2017). The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis. Sports Med.
Fradkin AJ, Zazryn TR, Smoliga JM. (2006). Effects of warming-up on physical performance: a systematic review. Br J Sports Med.
Soligard T, Myklebust G, Steffen K, et al. (2008). Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ.
Queen RM, Gross MT, Liu HY. (2021). The effect of shoe design on ankle injuries in cutting sports. J Foot Ankle Res.
Gabbett TJ. (2016). The training-injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med.
