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What You Need To Know About Pickleball Injuries

Pickleball is widely considered the fastest growing sport in America. Pickleball participation grew by 21.3% between 2019 and 2020, prompting that accomplished title! 4.2 million Americans now play at least once a year and that number is on the rise going into 2022. It’s the ultimate combination of ping-pong, tennis, and badminton.

Here within my own area of Greenville, South Carolina and the Upstate; it has exploded on the scene. In Greenville alone, there over 4 outdoor courts and 3 indoor courts, with more expected to pop up each year.

If you have not played pickelball yet, theres a good chance you can find a local court and jump in at anytime with people showing up to play. Given its ease of play and low impact nature, it can be an enjoyable way for people of all ages to stay active and fit and help to promote a healthy lifestyle. Core’ participants tend to be older, with 75% participants being age 55 or older, and 42% of all participants being over 65.

Looking at the dimensions of the court we can see the playing area is roughly only 440 square feet. That’s enough space to START and STOP movement with large amounts of ground reaction force going through our body. We can see how lower extremity injuries at the hip, knee, and ankle could occur with lots of change of direction based movements with acceleration and deceleration.

We can classify these injuries many different ways but let’s lay down the ground work first. There are two types of injuries:

Individual characteristics such as age, fitness level, experience, body composition, and injury history will have an impact on your injury profile.

1) Acute Injury: Sudden, occur from a very specific mechanism of injury. Examples:

-Ankle Sprains

-Shoulder Dislocations

-Knee Sprains/Tears

2) Overuse Injuries. We wrote about these prior and you can learn all about them HERE.

Examples Include:



-Stress Fractures

-Muscular Strains (can also be acute in nature)

Overuse injuries are the MOST COMMON types of injuries to have and these are more preventable with the right methods. Research is limited on current injury profiles and data surrounding pickleball given the newness of the sport. We can use tennis injury epidemiology to correlate with pickleball but the sport is still different given the smaller surface area of the court and size of the racket/paddle. Here are the MOST COMMON injury diagnosis in pickleball. Another post will discuss these in further detail as well as on social media so be sure to stay connected:


1) Ankle Sprains

2) Elbow Tendonopathy

3) Shoulder Impingement

4) Hamstring Strains

5) Patellar Tendonoapthy

6) Low Back Pain

Can you relate to any of the above mentioned issues? The 5 considerations below is what you came here for. Helpful advice to help reduce the liklihood of the above mentioned pathologies.




-Fatigue is a major contributor to injury risk. Fatigue is essentially the outcome of your ability to meet the demands of the activity through aerobic means. If the demands exceed your ability then you will be in a fatigued state. In a fatigues state we compromise muscle strength, mental acuity, alertness, coordination and awareness. The fatigue will change how you accomplish the movement needed for your sport. It’s important to understand that fatigue is normal physiological response but we can combat that with a higher level of fitness gained through proper training intensities. If your heart rate and respiratory rate stays at 75 and 15 all week and then you go perform an activity that gets those numbers up to 150 and 30; you can see how we aren’t ready.


-You can’t live like a non-athlete and expect to have movement success on that one day a week. If you have a body you’re an athlete. Unlocking your athletic freedom starts with consistency. Developing and preserving your athletic capabilities is arguably one of the most important things you can do as you age. Being an athlete means we prepare for the demands of our activity each day. We consider the movement qualities needed to perform. We need to be strong, agile, conditioned, and capable. Training is how you become like an athlete. Do you engage in a regular training routine?


A proper warm-up should accomplish several things.

-Increase your heart rate

-Warm the tissue with blood flow

-Prepare you for the demands of the movement. So for pickleball we likely want to address full body since we move with our lower body and swing with the upper body.

-Prepare the central nervous system

-Improve mobility

It’s easy to get confused with an abundance of techniques, tools, and phrases. It’s not that any one type of warm-up strategy is inherently good or bad, but rather the sequencing, technique, and understanding of each method that matters most. Knowing WHY the warm-up and HOW the warm-up will translate to and maximize your performance may help provide some clarity before you head out to your next match.


Balance is an umbrella term for awareness and coordination. When we consider movement we respect the hardware: muscles, joints, tendons, ligaments, bones. We tend to under-appreciate the software, how those structures work together to accomplish a movement task in a coordinated and efficient manner. Balance is integral in being able to solve those complex pickleball movement problems. And balance is the first component to be neglected in our movement health practices.


I have been widely outspoken against the footwear wave in powerlifting and strength training. But pickleball is much different. We have more reactive moments in a complex environment that is always changing. Reacting to a serve down the line and being able to position your body to hit it back over the net is far different than putting a bar on your back and squatting down and up. The principles and mechanics are different. The foot is now moving in all three planes of motion with consideration of what your trunk, hips, and knee are doing. Having footwear that cushions as well as provides room for movement front and back as well as side to side is critical. We want a good balance of rigidity and flexibility in the shoe.



Dr. Bryan Keith

Myomuv PT

We help active adults and athletes return to the activities they love without pain, without taking time off, and feeling more confident and capable than ever before.