Common Pickleball Injuries and How to Prevent Them

These days, pickleball is everywhere!

What seemed like a passing trend at first is now the fastest-growing sport in the United States across all age groups, with the sport particularly popular among older adults.

Pickleball, which was introduced in 1965 by a Washington state senator, is a relatively low-impact exercise and can be a great way to help older adults stay physically and socially active.

Pickleball has been shown to improve wellbeing, reduce stress and depression, and enhance quality of life.

However, an increase in pickleball players has an unwanted side effect: an increase in pickleball injuries!

As a certified hand therapist, I often see patients who are recovering from injuries like wrist fractures and ligament tears.

Over the past few years, I’ve noticed a significant increase in the number of my patients who report pickleball as the source of their injuries.

The data backs my anecdotal evidence: recent research found that pickleball injuries have increased by nine times over the past decade, with those injuries driving more than $250 million in American medical costs in 2023 alone.

What are the most common pickleball-related injuries?

The upper extremity (hand, wrist, and arm) is the most common site of pickleball injuries, with the most common mechanism of injury being what we refer to as a FOOSH: fall on outstretched hand.

Falls can occur in a variety of ways in a pickleball match: some patients report tripping while going for a ball, while others occasionally fall due to a collision with a teammate.

However, in my experience, the most common reason for a pickleball fall is a player backpedaling in an attempt to track down a ball.

When we fall, our instinct is to stick out our hands to brace ourselves – meaning our hands and wrists absorb the brunt of the impact.

A FOOSH can lead to a number of injuries, including wrist fractures, lacerations, and hand or wrist sprains.

We also frequently see pickleball-related overuse injuries, including tennis elbow and shoulder strains, as well as ligament tears.

Why are pickleball injuries so common?

As participation in a sport or recreational activity increases, we logically expect to see an increase in the number of injuries related to that activity – if more people are playing, more people are going to end up injured.

However, a few things make pickleball particularly susceptible to causing injuries:

Age of pickleball players

While younger people are into pickleball as well, the sport remains particularly popular with older Americans – and with age comes a greater risk of injury.

As we age, we lose bone density, flexibility, and muscle mass. Our tendons and ligaments lose collagen composition.

In addition, our reaction time decreases with age, which makes it more difficult to avoid a collision or catch yourself before a fall.

Gender plays a role as well: women aged 60-69 are nine times more likely than men to sustain a fracture due to post-menopausal bone loss, while men are more likely to sustain sprains and strains.

Inadequate preparation

While many consider pickleball a recreational activity, it’s important to remember that pickleball is a sport, and one that requires a good amount of physical exertion.

Too many players hit the pickleball court expecting some fun, lighthearted exercise, only to quickly catch the competitive spirit and overexert themselves.

Failing to properly stretch and warm up prior to playing pickleball increases your risk of sprains, strains, ligament tears, and similar injuries.

Additionally, players often hit the pickleball court in normal athletic clothing, wearing running sneakers or whatever shoes they’d wear to the gym.

To reduce risk of injury, players should wear sport-specific shoes.

Pickleball shoes, court shoes, or tennis shoes have the grip, cushioning, and support required to help prevent slips, trips, and related injuries.

The sport of pickleball itself

Because it’s a relatively fast-paced sport that requires quick reactions and decision-making, pickleball will inevitably lead to injuries.

However, there are a few aspects of pickleball that make injuries particularly common:

• Pickleball courts are small, increasing the chances of player-to-player or player-to-net collisions.
• Many courts are outdoors, increasing the likelihood of uneven or slippery surfaces.

How can I avoid pickleball injuries?

If you’re participating in a sport, there’s always going to be a risk of injury – and pickleball is no different.

However, there are steps you can take to ensure you’re as prepared as possible to play, decreasing your overall risk of injury:

• Always stretch and warm up before you play.
• Make sure you wear the appropriate footwear, with good support and traction.
• Listen to your body – if something feels off, stop playing. You’re most likely to get injured when you’re tired.
• Keep both your safety and the safety of others in mind when competing! Don’t be that overly aggressive player who knocks over a teammate.
• Consider adopting an exercise program outside of pickleball to keep you ready to play. Flexibility exercises, including yoga, can maintain and improve range of motion, while strength and resistance training can improve muscle and bone mass. Additionally, low-impact aerobic exercises can improve or maintain general fitness levels.

If you suspect you’ve suffered an injury during a pickleball match, don’t try to play through it! Addressing the issue with a medical professional will help keep the injury from getting worse.

If you sustain an injury to your hand, wrist, or elbow, you may be referred to a certified hand therapist, a type of therapist who specializes in injuries to the upper extremity.

Options to boost your activity level

South Shore Health’s Center for Physical Wellness offers a number of options for individuals looking to get more active.

Our Community Exercise Programs feature land, pool, virtual, and hybrid classes designed for all ages and abilities.

With classes offered at all hours of the day, there’s something for every schedule.

Browse our current classes >>

Peggy Leung, OTR/L, CHT is an occupational therapist and certified hand therapist at South Shore Health.

Learn more about Hand Therapy on the South Shore.

References

Bohannon, M., (2023). Pickleball injuries cost Americans nearly $400 million this year – and seniors are hit the hardest. 

Firouzbakht, T., Bagdady, K., Gupta, R et al. (2024).  Quite a pickle: a 10 year increase in pickleball-related hand injuries.  DOI 10.1177.15589447241238371

Frederick, A., Lamplot, J., Bernholt, D. et al (2024). Pickleball: a standard review of injury prevalence and prevention in a rapidly growing sport.  Journal of the American Academy of Orthopaedic Surgeons, 32(22): p e1130-e1141.

Kasper, A., Gibbons, J., Abboudi, J et al. (2023) Pickleball and paddleball related injuries to the upper extremity.  Cureus 15(6): e39831.  DOI 10.7759/cureus.39831.

Pergolizzi, J., Matera, J., LeQuang J.  Treating geriatric sports injury among pickleball players: a narrative review of an exercise craze among seniors. Cureus 15(12): e49909.  DOI 10.7759/cureus.49909.

Touhey, D., Bozorgmehr, C., Tartibi, D., & Smith, M. (2024) Pickleball injuries in the aging athlete: a critical analysis review.  Cureus 16(9): e69950.  DOI 10.7759/cureus.69959.