Have you heard of “pickleball elbow”?
That’s a new diagnostic term that’s emerging, thanks to one of the nation’s fastest-growing sports: pickleball.
Pickleball is a cross of tennis, ping pong and badminton played with a paddle and a perforated plastic ball on a pickleball court — much like a tennis court, but smaller. The game has developed a passionate following, thanks to its social nature and multi-generational appeal.1 Invented in Washington state in 1965, pickleball particularly appeals to those 50 and older because it’s a low-impact sport.
Nearly 14 million Americans tried their hand at this hot new racquet sport last year, according to a report from the Sports and Fitness Industry Association.2
“As a physician, I’m happy to see how the growing popularity of pickleball is encouraging people of all ages to become more active,” said Dr. James Walter, an orthopedic surgeon on the medical staff at Texas Health Center for Diagnostics and Surgery (THCDS.) “However, the growth of the sport has also sparked a surge in pickleball-related injuries. Even though it’s a low-impact activity, pickleball can be deceptively demanding.”
The game often involves quick stops and starts, and frequent lunging and twisting. Overhead shots can stress the shoulder joints. And even though the court is small, players may reach or bend to make a play.3
As a result, people get injured. An estimated 19,000 pickleball injuries occurred in 2017, according to a report in the Journal of Emergency Medicine. Some 90 percent of those affected people aged 50 or older.4
Most Common Pickleball Injuries
The most common pickleball injuries involved strains and sprains, fractures and contusions (bruises).
Gender seems to play a role in the types of injuries people are likely to sustain. One study found that older adult men are three-and-a-half times more likely than women to suffer a pickleball-related strain or sprain, whereas women are over three-and-a-half times more likely to suffer a fracture compared to men and nine times more likely to suffer a wrist fracture.5 
Strains and sprains may affect almost any muscle, ligament or tendon. In the lower body, that includes the ankle, calf, knee, quadriceps and hamstrings. Here are a few common pickleball injuries that doctors are seeing these days:
• “Pickleball elbow” – otherwise known as lateral epicondylitis, or tennis elbow.6 It’s an overuse injury that involves the degeneration (wearing down) or, in some cases, micro-tearing of the tendons that join the forearm muscles on the outside of the elbow.
• Plantar fasciitis – inflammation of the band of tissue connecting the heel bone to the toes. Typically, it causes stabbing pain with the person’s first steps in the morning and then decreases.
• Achilles tendon tears or ruptures – Often these affect players who are trying the sport for the first time. The player takes a quick step on the court and feels pain in the back of their ankle. Sometimes the player hears a pop and has difficulty walking.
• Hip injuries – These may include muscle strains of the gluteal, hip flexor or hamstring muscles. Another possibility is a labral tear, which affects the labrum — a ring of cartilage on the socket part of the hip joint.
• Sprains or fractures of the wrist, elbow or shoulder – These typically occur when a player trips or reaches with an outstretched hand to break a fall.
• Injuries to the fingers and hand – These may range from sprains and strains to fractures.
Treatment Options for Pickleball Injuries
Many minor sprains and strains can be treated at home. Remember the acronym RICE: Rest (avoiding use of the injured area), Ice (applying ice packs or bags of frozen peas, without them touching the skin directly), Compression (wrapping the injured area with an elastic bandage to provide support and limit swelling) and Elevation (keeping the area raised above the level of the heart, to help avoid swelling.) Nonsteroidal anti-inflammatory (NSAID) medications, such as ibuprofen, may also help reduce pain and inflammation.
For fractures, however, it’s important to seek medical attention from an orthopedic specialist. The physician may prescribe a split, cast, and/or crutches, depending on the location and extent of the injury. The specialist may recommend a boot or brace. Planter’s fasciitis, for example, can usually be treated with a boot that keeps the foot flexed during sleep or long periods of sitting.
Your orthopedic physician may also recommend physical therapy, to help regain function and build strength. Steroid injections to the affected area may help reduce pain.
If non-surgical methods don’t provide relief, surgery might be an option. Persistently painful meniscal tears or ruptured Achilles tendons, for example, may require repair with minimally invasive (arthroscopic) surgery. In some cases, a surgeon may recommend joint replacement surgery for a hip or knee injury, particularly if the injury is exacerbated by underlying arthritis.
If you’re looking for treatment options for pickleball injuries, consider THCDS in Plano, Texas. THCDS has many experienced orthopedic surgeons on the medical staff, including surgeons who specialize in hip, knee and shoulder replacement surgery as well as arthroscopic surgical procedures. If you’re considering arthroscopic surgery or joint replacement surgery, know that it's important to find a surgeon with experience in the specific procedure you require.
How to Prevent Pickleball Injuries
Prevention is the best medicine, and that’s true with pickleball.
“The most effective approach to prevent pickleball injuries begins before the player sets foot on the court,” said Dr. Walter. “If you’re a new player, don’t assume you can jump in and play all weekend. This sport can be rigorous. Ease yourself into the game. Don’t play too much, too fast or too soon.”
Some key steps to prevent pickleball injuries:
• Warm up before and after. Spend 5-10 minutes warming up before the game. A good warmup raises your body temperature and increases blood flow to your muscles, which loosens the joints. Try dynamic stretches such as lunges, moving the arms in wide circles, and knee lifts. A short easy jog or 30 seconds of jumping jacks might help, too. After playing, cool down gradually with some light static stretching and a slow walk.
• Start slowly. Too much too soon can lead to an overuse injury. Start off doing a little and then increase the number of games or the amount of time you play as you become more fit. Also, avoid pushing yourself through fatigue. If you get tired, take a break. Injuries are more likely to occur when you’re fatigued.
• Get the right gear. Wear comfortable sneakers, with good support and a good grip to help avoid slips and falls. Choose a paddle with a grip size that’s comfortable for you. A sporting goods store can measure the size of your hand and help you choose the right paddle.
• Cross-train off the court. Cardio exercises like running, swimming or riding a stationary bike will build your stamina and support your pickleball play. Strength training can also help with avoiding injuries. These can include exercises to strengthen the shoulder and arms as well as the core. Strengthening thigh muscles – including quadriceps and hamstrings – can also help protect your joints. Also, consider exercises like tai chi or yoga, which will improve your balance and reflexes.7
“Pickleball is a great way to stay active and socially engaged – but like any sport, it can lead to injury,” said Dr. Walter. “If you know how to prevent pickleball injuries and play safely, you’ll be able to enjoy this fun new fitness trend for years to come.”
[1]2023 USA Pickleball Facts and Highlights (as of 1.4.24). https://usapickleball.org/about-us/organizational-docs/pickleball-annual-growth-report/
[2] Sportico, PICKLEBALL GROWS 52% AS AMERICANS INCREASE ACTIVITY IN 2023: DATA VIZ https://www.sportico.com/business/sports/2024/most-popular-sports-2023-pickleball-players-1234768327/
[3] https://www.nytimes.com/2022/08/20/health/pickleball-sports-injury.html
[4] Pickleball-Related Injuries Treated in Emergency Departments, Journal of Emergency Medicine, November 30, 2019DOI:https://doi.org/10.1016/j.jemermed.2019.09.016. https://www.jem-journal.com/article/S0736-4679(19)30799-1/abstract
[5] Pergolizzi J Jr, Matera J, LeQuang JAK. Treating Geriatric Sports Injury Among Pickleball Players: A Narrative Review of an Exercise Craze Among Seniors. Cureus. 2023 Dec 4;15(12):e49909. doi: 10.7759/cureus.49909. PMID: 38174176; PMCID: PMC10763694. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10763694/#:~:text=Senior%20men%20were%20more%20likely,%E2%80%8B1)%20%5B5%5D.
[6] https://www.nytimes.com/2022/08/20/health/pickleball-sports-injury.html
[7] All info for the prevention section from this source: Yale Medicine, How to Prevent Pickleball Injuries. https://www.yalemedicine.org/news/how-to-prevent-pickleball-injuries#:~:text=Cross%2Dtrain%20when%20you're%20not%20on%20the%20pickleball%20court&text=This%20can%20include%20running%2C%20swimming,Hsu%20says.