Pickleball Mania: Important Tips on Injury Prevention in America’s Fastest Growing Sport

Pickleball mania is sweeping across the Lehigh Valley and surrounding regions. Pickleball’s growing popularity has attracted athletes of all ages, and athletes of varied body types and underlying physical conditions. This variability makes injury prevention crucial to keeping players of all age groups on the court and in the game.

Pickleball mania is sweeping across the Lehigh Valley and surrounding regions. Pickleball’s growing popularity has attracted athletes of all ages, and athletes of varied body types and underlying physical conditions. This variability makes injury prevention crucial to keeping players of all age groups on the court and in the game.

It’s estimated there will be 67,000 emergency room visits and 9,000 outpatient surgeries related to pickleball injuries in the U.S. this year. If pickleball is your new sport, you will appreciate the injury-prevention insights from orthopedic surgeon Wayne Luchetti, MD, Associate Chief, Division of Orthopedic Surgery at Lehigh Valley Orthopedic Institute, and physical therapist Michael Price, with Rehabilitation Services–Highland Avenue. Together, Dr. Luchetti and Price have more than 40 years combined experience treating elite athletes, including teams at the region's only Division I schools, Lehigh University and Lafayette College.

“Pickleball is the fastest-growing sport in America, but it is certainly not injury-free,” Dr. Luchetti says. “Many players are trying the sport after taking a decade-long hiatus from athletic endeavors, and this amplifies the risk for injuries.” Dr. Luchetti adds that “the most common injuries are those to the lower extremities, including the hips, knees and ankles, as a result of the intense cutting and back-and-forth motions of pickleball.” Given its similarities to tennis, Dr. Luchetti also reports an increase of shoulder and elbow injuries in his office as a direct result of pickleball.

Here’s a breakout of the types of pickleball-related injuries being seen at the Orthopedic Institute:

Knee injuries

As a knee specialist, Dr. Luchetti says that the most common pickleball complaints he sees are those of an inflamed knee. “Many older patients playing pickleball for the first time come to the office with inflammation of a previously arthritic knee,” he says. “Many forget that they’ve had a prior issue with their knee.” He also points to an increase in meniscal tears given the cutting and twisting nature of the sport, as well as ligament sprains and occasional tendon tears of the quadriceps or patellar tendon.

Lower extremity soft tissue injuries

Soft tissue injuries in pickleball are nonsurgical issues but very common. These include calf strains, hamstring and quad strains, and hip flexor strains. They commonly occur because pickleball athletes are firing tight muscles they haven’t used in years. One soft tissue injury that needs surgical intervention is that of an Achilles tendon rupture.

Foot and ankle injuries

The most common injury seen in this area is that of a “high” or “low” ankle sprain as a result of an inversion injury (ankle rolls inward) or eversion injury (ankle rolls outward). These injuries involve tearing or partial tearing of important ligaments surrounding the ankle and are caused by the extreme cutting nature and side-to-side movement required in pickleball. They are typically treated without surgery but can cause lingering pain for weeks.

Shoulder and elbow injuries

As in tennis, the repetitive nature of the swing in pickleball can lead to shoulder pain in the form of rotator cuff injuries and elbow pain in the form of lateral epicondylitis, or “tennis elbow.” These two injuries can cause debilitating pain that can be very persistent if a player does not seek the proper care.

Low back injuries

Given the extensive twisting and turning required for pickleball play, as well as the requirement to “get low,” low back injuries are quite common in the form of simple lumbar strains, or even a significant flare-up of sciatica.

About half of pickleball-related injuries occur in the first year of play. Older players coming off a long time of inactivity have a higher susceptibility due to injuries from their past, limited range of motion and flexibility, and a deterioration of strength and balance. “People often like to jump into a new activity and forget that their bodies don’t move the same and that their muscles have undergone changes that impact their ability to react and change direction with the same speed and stability,” Price says. They also tend to partake in the new activity without considering what their body may need to recover, which also increases injury risk.

Here are seven tips from Dr. Luchetti and Price to help reduce your risk for pickleball-related injuries:

1. Warm up – Pickleball is a fast-paced game, and the movement starts right away, so it’s important to warm up before taking the court. Take a 5-minute light jog or brisk walk before you play or do high knees and some side shuffles at a controlled speed for a few minutes.
2. Stretch or self-release – Your shoulders, wrists, calves, quads, hamstrings, piriformis (a muscle in your buttocks) and neck all need optimal movement before being asked to perform no matter the sport. Follow a stretching routine before and after play.
3. Build strength – You want to improve power and endurance to reduce injury risk. Strengthening muscles that are called upon to play pickleball can help reduce your risk for injury. Those muscles include:
   • Rotator cuff – Muscles that support the function of the shoulder joint
   • Scapular stabilizers – Muscles that stabilize the shoulder blade in the upper back
   • Wrist
   • Core – Major muscles of your torso and back, including your abdominal muscles
   • Hips
   • Quadriceps (quads) – Muscles that cover the front and sides of your thigh
   • Calves
4. Improved technique – If you’re a novice or haven’t played a sport in a long time, it’s important to have your movements analyzed. LVHN Sports Performance offers performance assessments to analyze agility and movement patterns to help prevent injury. You can then be guided on performing the required movements of pickleball more safely to decrease strain on muscles and joints. Learning to pivot to get your hips and shoulders in the best position to hit is an example of how improved technique can lessen strain on the knees and spine.
5. Proper footwear – Pickleball requires side-to-side and forward and backwards movement at a quick pace. Prevent rolling your ankles or putting too much stress on lower extremity joints or your spine by wearing supportive athletic shoe wear. Running shoes should be avoided. A properly fitting court shoe that provides traction is essential.
6. Load management – Many overuse activities are due to a person doing too much too soon after doing too little for too long. It’s smart to monitor your activity and only increase it by 10-15 percent a week to not overload the musculoskeletal system. When you first start playing it is also important to allow a day to recover. This helps to avoid cumulative microtraumas leading to something bigger. The most important injury tip is, if you are injured, stop playing, and get assessed to ensure you don’t put yourself out of the game any longer than you must be.
7. Bracing – A simple elastic brace for joints that have had problems in the past is highly recommended. For example, a lace-up ankle brace should be worn by any athlete who has had problems “turning their ankle” in the past.

If an injury occurs, Dr. Luchetti notes that RICE – rest, ice, compression and elevation – are keys to early management, but the importance of getting an early and accurate assessment by a qualified musculoskeletal expert is vital to getting back safely on the court and preventing further injury. Lehigh Valley Orthopedic Institute strives for ultimate access with same-day appointments and walk-in care at Lehigh Valley Health Network Injury Centers. Most pickleball injuries can be effectively treated without surgery through conservative measures with guidance from an experienced physical therapist.