How to Prevent Pickleball Injuries

Pickleball is the latest sports sensation. A Keck Medicine of USC orthopedic surgeon and sports medicine specialist shares her advice for avoiding injuries and staying in the game.

Move over, standup paddleboard and tennis: Pickleball is the new game in town.

Having clinched the title of fastest-growing sport in the nation for four years running, pickleball is bringing millions onto the courts for fun, fitness and friendship.

So what’s not to love?

A rise in pickleball-related sports injuries, that’s what. And that is why Jamie E. Confino, MD, an orthopedic surgeon and sports medicine specialist with the USC Epstein Family Center for Sports Medicine, counsels caution before making that first serve. The USC Epstein Family Center for Sports Medicine is part of USC Orthopaedic Surgery and Keck Medicine of USC.

Are pickleball injuries rising?

It is not that Dr. Confino wants pickleball fans to keep their paddles out of the queue. “I think pickleball is a great sport,” she says. “It is accessible, beginner-friendly and welcoming to all different skill levels and ages. But people can underestimate its physical demands. It is still a sport that carries real injury risk.”

And she should know.

“I see multiple cases every day of patients with pickleball-related complaints ranging from overuse conditions like tendonitis and strains to fractures and full Achilles-tendon tears that can need surgery,” she says. Wrists, feet, hips and more: “The injuries I see run the gamut, which surprised me at first.”

Why so many pickleball injuries?

In fact, a new study found an 88% increase in pickleball injury rates since 2020, she notes, “which definitely mimics what I encounter in clinic.”

And she has a few ideas as to why.

For one, pickleball attracts older players, with the previously mentioned study finding that 91% of injuries occur in players aged 50 and older — “definitely a key demographic here,” Dr. Confino says.

She also notes that pickleball appeals to “weekend warriors” who might jump into the sport without the conditioning or strength it requires. “All those quick lateral movements take neuromuscular control,” she says. Not only that, but the small playing courts create considerable need for back-and-forth, stop-and-start movements that she says tax the body. Players without good balance may also find themselves falling more, she adds.

Finally, Dr. Confino wagers that pickleball aficionados might be so excited to play that they neglect the details important to any sport, like warming up beforehand and wearing appropriate shoes.

How to prevent pickleball injuries

With this in mind, Dr. Confino says, “While we are improving in treating pickleball injuries, we need to get better at preventing them.”

Here are her tips for doing just that:

• “Before playing, make sure you warm up well for at least five to 10 minutes with dynamic movements like light jogging, hip mobility, shoulder activation, practice strokes and other motions you will be making once the game begins.”
• “Do some cross-training to increase conditioning, and strengthen key muscle groups like the rotator cuff, core, hip muscles, calves and lower body. Do not just jump in without any conditioning.”
• “The biggest prevention strategy I would recommend is progressing gradually. Start playing for limited amounts of time; do not compete in a tournament every other day, or play 10 games in a row. That is when overuse injuries occur. Start slowly, focus on form and play in small doses at first.”

What to do if you suspect an injury

Despite prevention, injuries can still happen. If you suspect you night be injured, do not ignore it.

“Respecting pain signals is important,” Dr. Confino says. “It is not normal to have repetitive pain every time you play. Do not play through pain, because that is how a lot of chronic overuse injuries occur.”

Do not hesitate to take your concern to a health care professional. “At Keck Medicine, we have lots of sports medicine experts, whether they are orthopedic surgeons like me or primary care sports medicine specialists,” Dr. Confino notes. “They are a great place to start.”

She is also a fan of physical therapy to help avoid developing a chronic problem. “Having a physical therapist evaluate and address muscle imbalances and proper form can be really helpful,” she says. She adds that Keck Medicine’s physical therapy and sports rehabilitation program has multiple locations throughout Los Angeles to make seeking care convenient.

“Our goal as sports medicine doctors is to help people stay healthy, active and on the court as much as possible,” Dr. Confino says. “A lot of that is seeing people before injuries take them away from the sport. The key is to enjoy pickleball — but prepare for it like the sport that it is.”

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