Pickleball: How to Prevent Injuries and Play Safely

Almost one in five adult Americans—roughly 48.3 million in total—have played pickleball in the last year according to the Association of Pickleball Professionals (APP). This represents a 35% increase over the year before.

While pickleball is a fun sport and a good way to get physical activity, research also indicates that pickleball injuries are on the rise. This makes it important to find ways to prevent injuries and play the game safely.

What’s Behind the Rise in Pickleball Injuries?

“There are a couple of factors that may contribute to the number of injuries in pickleball,” explains Michael Braccio, DC, DACRB, an American Chiropractic Association (ACA) member who practices in Seattle, Wash., and plays the sport himself.

“The first is that the general physical activity level over the previous three years has been reduced because of COVID,” Dr. Braccio says. “So, for some, starting to play pickleball has resulted in a rather sudden increase in physical activity, which is one of the risk factors we see for injuries in many other sports.”

Even if you were physically active before, the pandemic may have impacted your ability to get back into regular exercise. Studies show that many recreational and elite athletes now face detraining as a result of community lockdowns during the COVID-19 pandemic. And if you contracted the virus, you may face additional challenges when starting or returning to pickleball, such as those related to fatigue, cognitive issues, and virus-related cardiopulmonary effects.

Dr. Braccio adds that another factor that is likely contributing to an increase in pickleball injuries is that “not everyone has a racquet sports background.” In other words, you may not be used to or familiar with the typical upper extremity (upper body) movements executed when playing, such as those affecting your shoulders, elbows and wrists. You might also not be familiar with lower extremity (lower body) movements used during pickleball, like moving side-to-side on the court.

If your body isn’t used to moving around in this way, it may not be prepared, opening the door for injury during the game.

Common Injuries in Pickleball Players

What areas of your body are most at risk for an injury when playing pickleball? “For the upper extremity, elbow and shoulder injuries are the most common,” says Dr. Braccio, “with lateral epicondylopathy (tennis elbow) and rotator cuff strains being the specific diagnoses. There are a lot of wrist and elbow movements in racquet sports like pickleball, which can overload the muscles leading to an injury.”

In this way, pickleball injuries are similar to those experienced when playing tennis. “They share similar biomechanics with paddle swings and moving on the court,” explains Dr. Braccio, “although the magnitude of load is higher with tennis.”

For some players, it is their lower body that becomes injured. “For the lower extremity, patellar tendinopathy and ankle sprains are common injuries,” says Dr. Braccio. “The quick movements forward and backward, plus the squats and lunges at ‘the kitchen’ (the non-volley zone on either side of a pickleball net) can lead to overloading of the patellar tendon. And with the quick movements, ankle sprains can occur as well when reacting to the game.”

The low back is another area where it is common to develop a pickleball injury. “There are a lot of squats and lateral lunges during dink rallies (soft, low shots),” Dr. Braccio says, “which can overload the muscles around the low back, leading to flexion-intolerant low back pain. Additionally, overhead smashes (hard, overhand shots) can lead to irritation of the facet joints leading to extension-intolerant low back pain.”

Injury Prevention Tips

What can you do to prevent common pickleball injuries and practice the sport safely? Here are some tips to consider.

• Do warm up. While you may be tempted to just step on the court and play, not allowing your body to properly warm up could increase your injury risk. Aim for a 5 to 10-minute warm-up and include some light cardio movements along with shoulder exercises such as arm circles.

“For pickleball-specific movements, don’t just warm up with dinks at the kitchen,” says Dr. Braccio. “Hit some drop shots and some drives as well to warm up the shoulder range of motion and velocity. Not only will this help with your game, but it will help to reduce the risk of injury too!”

• Don’t overdo it. “It’s not uncommon to start playing pickleball multiple days in a row for several hours,” says Dr. Braccio, “which can result in a sudden increase in load, increasing the risk of injuries. So, gradually increasing the amount of load can be a useful strategy, making sure that there are recovery days so that the body can adapt.”

If you play pickleball one day, take the next day off. Give your body time to recover from the activity.

• Do strength training exercises. Another way to prevent pickleball injuries is to condition your body so it can better tolerate the increased load. “Strengthening exercises for the rotator cuff, core and knees are all areas that people playing pickleball would benefit from focusing on,” Dr. Braccio says, “initially working on building up general strength in those areas and then working into performing quicker movements similar to the movements in pickleball.”

Exercises good for building muscles around the rotator cuff include holding dumbbells while holding your arms to make the letters “I,” “Y,” and “T,” as well as performing internal and external shoulder rotations while standing. Core-strengthening exercises include planks, side planks, and Pallof presses. Knee extensions, lateral band walks (crab walks), lateral lunges, lunges, and calf raises all help build the muscles around your knees.

• Don’t forget to protect your eyes. Pickleball Magazine reports that the average pickleball travels baseline to baseline in just one second—half the time it takes a tennis ball to cross the same distance. What happens if the ball is coming directly toward your eyes?

“Eye protection is something that you may want to consider,” says Dr. Braccio. “Because there are quick battles at the kitchen line, there is a chance that the ball can hit your face.”

Taking these steps can help you continue to play the sport you love without injury, while also satisfying you socially. “For myself, not only is pickleball a lot of fun, but the community surrounding it is awesome,” shares Dr. Braccio. “There’s a great social aspect of playing with friends and meeting new people.”

 

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This article was written by Christina DeBusk, a freelance contributor to the American Chiropractic Association’s “Hands Down Better” blog series.  It was reviewed by the ACA Editorial Advisory Board and published to their website August 25, 2023.  It is being shared as part of TCA’s “Realign Your Thinking” public-awareness campaign – helping Tennesseans understand what chiropractic care offers and the positive role it plays in the overall health care system.

The information in this post is for educational purposes. It is not a replacement for treatment or consultation with a healthcare professional. If you have specific questions, contact your doctor of chiropractic. You can find a TCA Member doctor at tnchiro.com.