Physical Therapy for Pickleball Injuries

By Barbara Kutch, PT

Pickleball, a paddle sport that combines elements of tennis, badminton and ping-pong, has seen a surge in popularity in recent years.

In fact, according to the Sports & Fitness Industry Association (SIFA), pickleball is the fastest growing sport in America.

However, like any sport, pickleball comes with the risk of injuries.

At Penn Medicine Princeton Medical Center (PMC) Princeton Rehabilitation physical therapists offer sports specific rehabilitation programs, including for pickleball and tennis, to treat injuries, improve game performance and reduce the risk of re-injury.

Overuse Main Cause of Injury

More than 13.6 million people in the United States played pickleball in 2023, according to SIFA.

That’s up 51.8% from 2022 to 2023.

And while a growing number of people are enjoying the physical and mental health benefits of pickleball, injuries are also on the rise.

Though pickleball may be less intense than tennis — it’s played on a significantly smaller court for one — the types of injuries players suffer are largely similar and often attributed to overuse.  

Common injuries include:

• Pickleball elbow. Just like tennis elbow, pickleball elbow occurs with repeated use of the arm, particularly the forearm muscles. Over time this can lead to pain and inflammation around the elbow.

• Rotator cuff injuries. Rotator cuff injuries are typically a result of gradual wear and tear from doing the same arm movements repeatedly, especially reaching overhead. Unlike in tennis, pickleball serves are performed underhand, taking some of the burden off the rotator cuff. However, too many overhead shots or playing too long can injure the rotator cuff as can one single overhead smash.

• Ankle sprains. According to USA Pickleball, ankle sprains in pickleball most commonly occur on uneven terrains or by stepping on a stray ball or another player’s foot.

• Knee injuries. The abrupt stops, starts and pivots during a pickleball or tennis match can put a lot of stress on the knees, leading to strains and sprains and in some cases meniscus and ACL (anterior cruciate ligament) tears. Knee pain can also be related to overuse.

• Achilles tendonitis. The stress on the Achilles tendon from repetitive stop-and-go action or a sudden change of direction can cause inflammation and pain. Injuries to the Achilles tendon are common in people over age 40, according to USA Pickleball.

• Hamstring strain. Hamstring strain or a pulled hamstring is usually caused by overextending or stretching to return a ball.

• Lower back pain. Bending, twisting and reaching for the ball can strain the lower back and cause pain.

• Fractures. Bone fractures, including wrist fractures, related to pickleball have increased 200% over the past 20 years, according to the American Academy of Orthopaedic Surgeons. Wrist fractures most often occur when a player goes backward for a ball, falls and lands on an extended arm.

Physical Therapy for the Win

If you suffer an injury on the court or experience any pain or discomfort while playing or at rest, physical therapy can help get you back in the game.

At Princeton Rehabilitation, rehabilitation programs specifically for pickleball and tennis injuries are designed to improve and optimize physical performance by addressing flexibility, stability, endurance, and conditioning.

Specially trained physical therapists also focus on correcting faulty mechanics during play and provide a thorough evaluation of your swing.

Customized treatment plans address all areas that may impact your game and aim to:

• Optimize motion and decrease stress on the body during play.

• Encourage proper technique and focus on injury prevention.

• Reduce pain during or after playing.

Physical therapy at Princeton Rehabilitation is available for people of all ages and skill levels.

Injury Prevention Tips

To help reduce the risk of injury on the pickleball court and play pickleball safely, USA Pickleball offers the following tips:

• Warm up and stretch before you play.  Warm up with a fast walk, a bike ride or other total body activity and then stretch. Start with an ankle stretch and then work up toward your shoulders and arms.

• Wear proper court shoes. Regular sneakers and running shoes do not supply the right kind of support for pickleball. Pickleball (and tennis) players need a shoe that supports quick side-to-side movements or shifts in weight and provides stability on the inside and outside of the foot.

• Be aware of any obstacles in the area that you might run into or trip over, such as benches or gym equipment.

• Never play on a wet court.

• Never backpedal. Never back up on your heels to return a lob. Instead turn around and go back to get the ball. Fractures and serious head injuries can occur if you fall backward.

• Know your limits. Avoid overexertion, especially if you are new to the game or have been inactive for a while. Listen to your body and take breaks as needed.

• Work with a professional to improve your fundamentals.

• Don’t play through pain. Work with a qualified physical therapist to help decrease your pain and improve your game.  

To find a physical therapist with Penn Medicine Princeton Health, call (609) 853-7840 or visit www.princetonhcs.org.

Barbara Kutch, PT, is physical therapist and certified strength and conditioning specialist with Penn Medicine Princeton Medical Center Princeton Rehabilitation.