Playing Pickleball? Here Are 5 Tips for Avoiding Injuries
By: Houston Methodist The Woodlands Hospital | Published 11/21/2022
In case you've somehow missed it, pickleball has gone mainstream.
The recreation — a cross between tennis and ping pong that features paddles, a Wiffle ball and an outdoor court — has been dubbed "the fastest growing sport in America" by The Economist. Schools are adding it to P.E. classes. Leonardo DiCaprio told Vanity Fair he plays every single day.
Little wonder: Pickleball is not just good exercise, it's a social sport that's fairly easy for anyone to pick up.
"It's a sport with a relatively small learning curve," says Dr. Bobby Song, a sports medicine physician at Houston Methodist and frequent pickleball player. "You don't have to practice for hours and hours to be able to hit a decent shot. There is also a big pick-up culture which brings people together."
Dr. Song adds that "the scoring system is not especially complicated; the ball is a Wiffle ball, which doesn't pick up as much spin — making the bounce more predictable; and the paddle is more forgiving, so new players inexperienced in racket sports can quickly learn how to make good contact with the ball."
That said, the increasing popularity has come with a correspondingly higher number of doctors' visits. Injuries are possible in any sport. Pickleball is no exception.
"I think the No. 1 reason there are so many injuries in pickleball stems from its broad appeal," says Dr. Song. "The average person — regardless of age or athletic ability — can just pick up a paddle and play, not considering that they may not be conditioned or ready for that kind of rigor on the body."
Despite this, Dr. Song still encourages anyone interested in pickleball to join in on this social sports phenomenon, so long as players understand the injuries that can occur and how to prevent them.
Common pickleball injuries and why they happen
"Because the sport appears easy to pick up, it is common for players to overexert themselves," says Dr. Song.
He adds that the ease of playing can lead to other bad habits as well, such as a lesser emphasis on proper technique and footwork. Both can predispose a person to both acute and overuse injuries.
"In my experience, the most common pickleball injuries involve the knees and lower back," says Dr. Song. "These areas of the body are particularly prone to injury for a few reasons, including the quick start-stop nature of the game, frequent bending due to the low bounce height of the ball and a smaller court size that means more sudden changes in direction."
The potential injuries that can occur in the legs or lower back include:
- Calf strains and tears
- Flares of knee arthritis
- Herniated disks in the lower back
- Meniscus tears
- MCL and LCL strains
- Plantar fasciitis
- Hamstring strains
- Achilles injuries
- Ankle sprains
Because pickleball players swing paddles, the upper extremities — shoulder, wrist, elbow — are also prone to injuries. Those include:
- Tennis and golfer's elbow (tendinitis involving the forearm muscles)
- Wrist tendinitis
- Rotator cuff tendinitis and tears
- Labral tears
While the shoulder is vulnerable, one advantage of pickleball — at least compared to tennis or other racket sports — is that the serve is underhand, rather than overhand.
"This results in an inherent reduction in amount of overhead movement, which may make the sport more tolerable for people with pre-existing shoulder issues," explains Dr. Song. "These players should exercise caution to prevent overcompensating with other parts of the body, however."
Lastly, as with almost any sport, traumatic injuries are possible.
"Ocular (eye) injuries from direct impact from the paddle or ball are possible and should be evaluated immediately," warns Dr. Song. "Falls resulting in fractures or head trauma are also common, either from changing directions too quickly or from backpedaling on the heels to return a lob, causing a loss in balance."
5 tips for minimizing pickleball injuries
Pickleball can be a great benefit to your physical and social well-being, so long as you're taking the following steps to prevent injury:
1. Recognize physical limitations
Pickleball attracts a wide audience, but the most prevalent is what Dr. Song considers the weekend warrior population — players in their 40s to 60s who participate in the activity once or twice per week.
"Because the average age of a pickleball player is a little bit older, it is not uncommon to see overuse and even traumatic injuries stemming from wear and tear of the joints and natural, age-related decline in coordination," says Dr. Song.
Avoid overdoing it by starting slow and listening to your body, especially if you have pre-existing injuries or you're prone to flares of arthritis. The use of wrist, knee or ankle braces may also be beneficial.
2. Make time for warm-up
For anyone interested in pickleball, Dr. Song emphasizes the importance of developing a consistent, safe and comprehensive warm-up routine.
"I recommend at least 5 to 10 minutes of warm-up prior to playing," Dr. Song says. "This should consist of some light jogging and stretching of all the major muscle groups, including the calves, quads, hamstrings, inner thighs, lower back, shoulders, elbows and wrists."
And when getting on the court, don't just dive into competition immediately.
"I also recommend doing sport-specific warm-ups, such as short court volleys and skinny singles, followed by serves, lobs and smashes," Dr. Song adds.
3. Use the right equipment
"Investing in a pair of shoes specifically designed for tennis or pickleball can significantly decrease the risk of injury," explains Dr. Song. "In contrast to running shoes, tennis shoes provide better side-to-side support and are also designed to provide optimal court traction, decreasing the risk of ankle sprains and Achilles injuries."
Using a paddle with a properly sized handle can also decrease the risk of wrist and elbow injuries and tendinitis.
4. Don't ignore your form
It may be easy to just pick up a paddle and play, but taking the time to adopt correct form matters.
"A lot of people end up relying heavily on their arms instead of translating momentum from the rest of their body," warns Dr. Song. "Sports fundamentals teach us that incorporating energy from the legs, specifically from the hips, is essential for generating power. A lack of this may increase strain on other body parts."
Dr. Song recommends taking a few pickleball lessons if you can. This will help encourage the proper technique and footwork that can help prevent injury.
5. Know the role of exercise recovery
After a game, don't forget to cool down, incorporating several minutes of walking and stretching.
"There is some degree of muscle soreness that's going to happen if you're not conditioned," says Dr. Song. "This is natural. There's not much you can do to prevent it, but stretching and warm-up can help minimize it."
And exercise recovery doesn't stop there. Optimizing your nutrition and hydration is crucial for preventing overuse injuries. So is taking frequent breaks to help give your body the time it needs to fully recover before your next match or workout.
(Related: 6 Ways to Keep Overuse Injuries From Disrupting Your Workouts)
What to do if you experience a pickleball injury
In the event of an injury, don't return to action too soon.
"Consider following the well-documented RICE technique — Rest, Ice, Compression, Elevation — in the short term," says Dr. Song. "If symptoms persist or are serious, seek attention from a trained medical professional since accurate diagnosis and treatment are crucial."
Nowadays, there are a variety of newer treatments for overuse injuries — like platelet-rich plasma (PRP), a therapy in which Dr. Song is well-versed.
"It's not for everyone, but it has been shown to be helpful in tennis/golfer's elbow and mild-moderate knee arthritis," explains Dr. Song.
Other potential treatments for overuse injuries include steroid injections, viscosupplemention (gel injections) and physical therapy.
By: Katie McCallum