Pickleball combines elements of tennis, badminton and table tennis. It is played indoors or outdoors on a badminton-sized court with a slightly modified tennis net and lightweight rackets and balls. Some 4.8 million Americans played pickleball in 2021, according to USA Pickleball, and more than half of those considered “core” — or regular — players were 55 or older.
Experts stress that pickleball is a safe, all-ages sport — but it is a sport, so warming up, building up to longer play and using the right equipment are keys to heading off Achilles’ tendon injuries and more.
One analysis, using data from the National Electronic Injury Surveillance System (NEISS), used a sample of 300 emergency room visits for pickleball injuries to extrapolate that there were some 19,000 ER visits for pickleball injuries from 2001 to 2017, and that the pace of injuries rose as pickleball’s popularity grew. People 50 and older accounted for nearly 91 percent of the patients, according to the study.
For older players, muscle sprains and strains from on-court slips and falls are common hazards.
Most play is underhand, but strains or tears in the shoulder rotator cuff can also result from overhand volleys or repetitive stretching for the ball, although such injuries occur more often in tennis where the force of the ball is greater and much more of the game involves overhead shots.
Bumps and bruises from falls, sprained ankles, wrist fractures and strained muscles and tendinitis from overdoing things are also part of the game.
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A recent study compared annual tennis injuries with pickleball injuries between 2010 and 2019, tracking the most common injuries in both sports for people over 60. For pickleball, the study said, older women were at higher risk than men for trips and falls leading to the wrist broken bones; men were at higher risk for lower-leg injuries, including to their Achilles’ tendon. (The study also linked on NEISS data.)
“Almost no one was playing pickleball at the start of the study, but as the sport exploded over the time period, pickleball play and corresponding injuries went from almost nothing to increasing rapidly over that decade, especially over the last few years,” says Harold Weiss, an adjunct associate professor of population health sciences at the University of Wisconsin at Madison School of Medicine and Public Health, who co-wrote the study. Weiss, a pickleball enthusiast, stresses that it’s not possible to calculate the rate of injuries per pickleball players because there aren’t enough data yet.
A former squash and racquetball player, Weiss, 71, took up pickleball when he found other sports were too hard on his body — although he, too, has suffered his share of twisted ankles and occasional pulled muscles in his back and leg.
“I switched overnight,” he says. “There’s not as much speed, you don’t have as much area to cover, no overhead smashes, a lighter racket and ball — and it’s fun, which is why I think people do it. It’s also an excellent workout.”
Pickleball fans extol its social appeal. “We have made many new friends, and laughter is a huge part of the game,” says Robin Dobler, 66, of Westerville, Ohio, who took up the game in 2021. “Our Friday group plays from 9 to 11:30 in the morning, then we all go to lunch after.”
“I am absolutely hooked,” Dobler, a retired physical therapist assistant, adds.
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One thing to watch out for, however, is not to do too much too soon. Warm up first, and take it easy out there.
“People go from doing nothing to playing pickleball five days a week, and they will get overuse injuries as a result,” says Nicholas Greiner, an osteopath who practices sports medicine in St. Louis. Greiner conducted a 2019 review of common injuries associated with pickleball. “The one thing I tell people is to go into it gradually.”
And while stressing the safety of pickleball overall, Greiner and others recommend that older participants take extra precautions against falls, which can be especially dangerous in this age group. One way to reduce the risk is to wear “court” shoes designed for pickleball and tennis, they say.
“There is a lot of side-to-side lateral movement” in pickleball, Greiner says. “We tend to be straight with our movements in our daily activities. We walk straight. We bike straight. We run straight. Sometimes we lose our mastery of balance with lateral movements, so falls can be a risk.”
While playing one day last fall, Dobler ran wide to return a ball, planted her right foot and turned toward her opponents—and felt instant pain inside her right knee. She tried to keep playing, but it hurt. Later, she iced the knee, did strengthening exercises and got an injection to lubricate the joint. She improved quickly and wasted no time returning to the court.
“I would play every day if my body would let me,” she says.
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DC podiatrist Sheldon Laps says he commonly sees inversion ankle sprains from pickleball, injuries that occur when the foot twists upward and the ankle rolls inward, often the result of inappropriate shoes.
Many runners who take up pickleball assume they can play in running shoes: Don’t. Instead, wear short shoes. They are designed for pickleball, tennis and other sports that involve lateral movement.
“Many running shoes today have a ‘rocker’ sole, that is, viewing the shoe from the side, the forefoot of the shoe is curved up,” Laps says. “This aids push-off during running and walking. But rocker type soled shoes should not be used to play a court sport. The side-to-side motion on a pickleball court increases the likelihood that the player will twist the foot at the ankle and thus, sprain the ankle.”
As with all sports, experts recommend warming up first — easy jogging or walking, or pedaling on a stationary bicycle to work up a light sweat — and stretching, “so you don’t shock the muscles when you start doing game play,” Greiner says.
Other things to remember: If a body part hurts after the game, put ice on it for 20 minutes. Bring a water bottle, and drink frequently to avoid dehydration. If playing outdoors, wear a hat with a brim, or a visor, and use sunscreen liberally. And use eye protection — there have been reports of eye injuries from being hit in the eye with a ball or paddle.
“Injuries are part of all sports,” says Greiner, who also plays. “But if you take the proper steps, pickleball is a great sport — even at a high level of play, there is less risk of injury than from many of our other traditional sports. And it’s a fun game.”