Pain in the pickleball: Ways to reduce injuries as sport’s popularity rises

Nearly four years ago, Spokane resident Aurora Benton discovered pickleball.

Benton liked the sport so much that she started playing several times a week – until her elbow complained.

“It was overuse,” said Benton, 50. “There for a while, I was playing pickleball three or four and sometimes five times a week. I started to get tendinitis in my elbow. It was really inflamed to the point where I was having a hard time even bending my elbow and there was pain when I played, so I had to rest.

“I took some time off, and I went to physical therapy.”

Benton did exercises to strengthen her back and shoulder muscles, along with her body’s core. She worked on how she hit the ball, instead of using her whole arm.

She also got a paddle with material to help absorb impact. On her forearm, she now wears a small brace to anchor the tendons, while limiting play to once or twice a week.

Her strategies fall under tips that Spokane medical providers often share with other avid players to avoid getting hurt. As the sport’s popularity has exploded the past five years – capturing the 50 and older crowd – the number of pickleball-related injuries also is rising.

The injuries range from fractures, muscle tears and sprains to those overuse issues.

“There has been such a huge explosion in the amount of people playing pickleball in this area, and we are seeing more injuries,” said Brian Cronin, U-District Physical Therapy co-owner and physical therapist.

“We’ll see the calf muscle and Achilles muscle pulls or ruptures – so sprains and tears,” he said.

He’s noticed many more lower-back and hip injuries. Problems can come from quick-stop actions and “a lot of rotation” to reach high and low balls.

Starting the sport about four years ago, Leo Richardson, 70, sees more older people playing pickleball in Spokane.

“It’s just something they can latch onto and get fairly good at, fairly fast,” he said.

Richardson noticed occasional foot or shoulder pain, but nothing serious. Then he got hurt in a December 2022 skiing accident that required knee ligament surgery.

Cronin was his physical therapist in recovery. Richardson used it as a chance to query Cronin on how to get in better shape for pickleball and avoid injuries in that sport.

Richardson learned regular muscle strengthening and balance exercises. He now uses exercise bands, balance balls and “physical therapy” moves to stay in the game.

“Because it’s true, there are older people getting out there with strength and balance issues, and they’re taking falls,” Richardson said. “I’ve personally seen it. It’s usually sprains and strains.”

He said newcomers should take it slow, ask a trainer about getting in shape and talk to experienced pickleball players.

“Talk to somebody who plays about what are the dos and don’ts? People tend to chase balls down that they shouldn’t. Don’t get yourself injured trying to be too competitive.”

Providence Sports Medicine North’s Dr. Ben Howie said pickleball has overall health benefits from people being active, but he also is seeing the injuries.

“Specifically, we’ll see a lot of shoulder, elbow and wrist-type injuries of the upper body, and then for the lower body, it’s usually the knee or ankle,” he said.

When patients ask about injury prevention, his answer depends on their overall fitness and health. People already active can try a gradual increase in the sport, he said.

If their fitness or health isn’t good, he suggested a slow start with other activities first, such as short walks and jump-roping, stationary cycling and resistance training. After multiple weeks, they can try short pickleball sets.

“Big picture is that people would start in a gradual progression, would listen to their body and would gradually start doing more over a set period of time,” Howie said.

Orthopedic surgeon Dr. Tyler Hughes is mainly at the South Hill’s MultiCare Integrated Sports Medicine Clinic. His specialty is foot and ankle orthopedics.

He said he’s seeing more tendon and soft-tissue injuries from pickleball play. Some need surgery, most don’t.

“I see a lot of ankle sprains and Achilles ruptures, like tendon injuries,” Hughes said.

He said fractures in the sport are rare, but some people get hurt by tripping, falling or doing the sudden starts and stops. If someone has a prior knee or ankle issue, he said to try wearing a brace or knee sleeve for extra stability.

“It’s just so fun that people probably just get so into it, and they’re playing, playing, playing,” Hughes added.

“They don’t really take enough time to let their muscles and fitness sort of adapt. It seems like the people who get injured the most are probably in their 50s and 60s, because they just recently took it up, and they’re not necessarily the most athletic people at baseline.”

Age, muscle strength, flexibility and balance are all part of the equation, Cronin added.

“When people are over 50, usually they don’t have as much flexibility or strength, and then they can be susceptible to injury,” he said.

Cronin suggested fitness programs and exercises for the legs, back and core. The core is more than the abdomen and includes the front, back and sides of a body from the upper legs to the chest.

Before starting a game, people should do a dynamic warm-up, a movement-based type of stretching. That can be a short, easy walk or jog in place, hip swings, arm swings and jumping jacks.

Rose Jones, a local pickleball teaching pro, also emphasized a dynamic warm-up before playing, “for the glutes, hamstrings, quads, adductors and calves of the lower body, along with the shoulders and forearms.”

Jones said court shoes are another must. “Court shoes provide lateral support that a running shoe does not have.”

Proper technique can help. She said that includes making contact with a ball out in front with a correct paddle grip to avoid elbow issues and learning to turn sideways when moving backward to avoid a stumble.

Drinking water is another key, Hughes said. “If you’re not drinking, you’ll get tired. When you’re more tired and weak, you’re more likely to have a problem that can cause an injury.”

Howie also urged good sleep, healthy diet and breaks between play, especially when tired or with strain or pain.

An overall plan toward fitness will keep a player in the sport longer, which brings many health benefits, Howie added.

“Pickleball has a very low barrier to entry, so anyone can play and play almost anywhere,” he said. “It’s very social and competitive.

“It’s also a good cardiovascular exercise. You’re active, and because you’re active, we find it’s good for balance, mobility and stability – especially as we age.”