Pickleball: Fun, but play it safe

Pickleball, a sport that combines elements of tennis, badminton, and table tennis, is becoming increasingly popular thanks to its easy-to-learn nature, low-contact gameplay, and suitability for people of all ages, from children to older adults. This sport offers numerous physical and mental health benefits, helping improve endurance, flexibility, and reflexes while strengthening community connections. However, alongside these benefits, pickleball also carries various injury risks if players do not take the necessary precautions and prepare adequately. This article from University Medical Center Ho Chi Minh City will help you understand the risks, recognize warning signs, and apply effective prevention strategies to enjoy pickleball safely and sustainably.

1. What you need to know about pickleball injuries

1.1. Pickleball and the rise in injuries

The rapid growth of pickleball worldwide has led to a significant increase in sports-related injuries associated with this activity. According to a study conducted in the United States, the number of emergency department visits related to pickleball has increased significantly over the past 10 years [3]. This is not only due to the growing number of players but also because many people participate without adequate physical preparation or knowledge of injury prevention.

1.2. People at higher risk of injury

Although pickleball is considered a low-impact sport, certain groups may be at higher risk of injury:

• Older adults (>55 years): This age group accounts for a large proportion of pickleball players [1, 3, 4, 5]. Older adults often have lower bone density, reduced muscle strength, and slower reaction times, which can increase the risk of falls and fractures [3, 4, 5].
• Women: Women, particularly older women, have a higher risk of fractures than men due to osteoporosis [3, 4].
• Inexperienced players (<5 years of experience): Beginners or players with limited experience may not yet have mastered proper techniques, may move inefficiently, and may be more likely to make mistakes that lead to injury [4].
• Players who participate frequently at high intensity: Playing pickleball too frequently or at high intensity without adequate rest and recovery can lead to overuse injuries [4].

2. Common types of pickleball injuries

Pickleball injuries range from minor soft-tissue injuries to serious fractures. The following are some of the most common types:

2.1. Musculoskeletal injuries

These injuries commonly occur due to rapid movements, sudden stops, twisting, or excessive stretching during play.

• Lower-extremity injuries:
  • Ankle sprains: One of the most common injuries, occurring when the ligaments around the ankle are overstretched or torn due to twisting or improper landing [1, 5].
  • Achilles tendinitis/tendon rupture: Jumping, sprinting, and sudden stops can place excessive stress on the Achilles tendon, leading to inflammation or even tendon rupture [1, 5].
  • Knee injuries: These include ligament sprains, particularly of the anterior cruciate ligament (ACL) and collateral ligaments, as well as meniscal tears caused by forceful twisting or rotation of the knee [1].
  • Muscle strains: Commonly affecting the calf muscles, hamstrings, quadriceps, and groin muscles due to inadequate warm-up or overexertion [1].
  • Plantar fasciitis: Pain in the sole of the foot, particularly in the morning, caused by repeated stress on the plantar fascia [1].
• Upper-extremity injuries:
  • Wrist sprains/fractures: Very common, particularly Colles fractures (distal radius fractures) caused by using the hands to break a fall [1, 4, 5].
  • Wrist and elbow tendinitis (tennis elbow): Inflammation or pain in the tendons around the elbow, often caused by repetitive twisting or repeated movements [1, 5].
  • Rotator cuff injuries: Excessive or improper racket swings can strain or tear the rotator cuff tendons [1].
• Back injuries: Lower back muscle strains are common due to twisting, bending, or swinging the racket [1].

2.2. Fractures

Fractures are more serious injuries and are particularly common among older adults due to reduced bone density.

• They commonly occur in older adults, especially women, due to osteoporosis [3, 4].
• Common sites include the wrist (from breaking a fall with the hands), hip, and pelvis (from direct falls) [3, 4].

2.3. Other types of injuries

• Fall-related injuries: Falls are the most common mechanism of injury in pickleball and account for a high proportion of emergency department visits [3, 4]. Falls can result in sprains, dislocations, fractures, or soft-tissue injuries.
• Head and facial injuries: These include injuries caused by balls striking the eyes or head, or by collisions with a racket [3, 4, 5].

3. Warning signs and when to see a doctor

Recognizing injuries early and seeking timely medical care is essential for achieving the best possible recovery.

3.1. Signs of acute injury

Symptoms that appear immediately after an injury include:

• Sudden, severe pain at the site of injury.
• Rapid swelling or bruising.
• Reduced ability to move or inability to bear weight on the injured limb.
• Visible deformity of a joint or limb.

3.2. Signs of chronic injury

Symptoms that develop gradually or persist after the initial injury include:

• Persistent dull pain that worsens with movement or after playing pickleball.
• Joint stiffness and reduced flexibility in the affected area.
• Mild swelling or tenderness.
• Muscle weakness or reduced strength.

3.3. When should you seek medical attention?

You should see a doctor immediately if you experience any of the following [1]:

• Severe pain that does not improve with rest or over-the-counter pain medication.
• Inability to bear weight on the injured limb or inability to move the joint.
• Significant or extensive swelling or bruising.
• Signs of concussion after a head injury, including severe headache, dizziness, nausea, vomiting, loss of consciousness even if brief, or confusion.
• Changes in vision, eye pain, eye redness, or a foreign body in the eye following an injury to the face or eye.
• Numbness or tingling in the injured limb.

4. Effective strategies for preventing pickleball injuries

Prevention is always better than treatment. The following strategies can significantly reduce the risk of injury:

4.1. Preparing before playing

• Warm up thoroughly: Spend 5–10 minutes warming up before playing. Perform gentle joint-mobility exercises for the neck, shoulders, elbows, wrists, hips, knees, and ankles. Follow these with gentle stretching and low-intensity movements that simulate pickleball [1, 3, 5].
• Stretching: After warming up, focus on the major muscle groups used during pickleball, including the legs, arms, shoulders, and back. Stretching helps improve flexibility and reduce the risk of muscle strains [1, 5].
• Physical conditioning: Maintain good fitness, endurance, and flexibility through cardiovascular exercises (such as jogging and swimming), strength training (such as gym workouts, yoga, and Pilates), and balance exercises outside of pickleball sessions. A well-conditioned body is better able to withstand the physical demands of the sport [1, 5].

4.2. Appropriate equipment and gear

• Specialized shoes: Choose court shoes specifically designed for sports involving lateral movements, with good traction, cushioning, and ankle stability. Avoid running shoes, as they do not provide sufficient stability for lateral movements and sudden stops [1, 5].
• Appropriate paddle: Use a paddle with a weight and size appropriate for your physical condition and skill level. Beginners should start with a lighter paddle for easier control and reduced stress on the wrists and elbows [5].
• Protective eyewear: Wear protective eyewear to protect your eyes from flying balls or contact with a paddle. This is a simple but highly effective measure for preventing serious eye injuries [3, 5].
• Other supportive equipment: If you have a history of injury or feel unstable, you may use ankle wraps, knee braces, or elbow supports for additional support [1].

4.3. Safe playing techniques and strategies

• Learn basic techniques: Take lessons or work with a coach to learn proper techniques for hitting, moving, and serving. Proper technique reduces unnecessary stress on muscles and joints, thereby lowering the risk of injury [1, 5].
• Move appropriately: Avoid unnecessary sprinting, sudden stops, or excessively rapid changes in direction, particularly in the “non-volley zone” near the net. Controlled movement and good anticipation can help prevent falls [5].
• Take regular breaks: Do not overexert yourself. Allow sufficient rest between matches and training sessions so your body can recover. Playing while fatigued increases the risk of injury [4].
• Adapt to the environment: Check the court surface before playing to ensure there are no obstacles, cracks, or slippery areas that could cause falls [5]. Playing in intense sunlight can lead to dehydration and exhaustion, so choose an appropriate time or take protective measures.

4.4. Nutrition and bone health

• Calcium and vitamin D: Maintain a diet rich in calcium and vitamin D to support bone health, which is particularly important for older adults and women in preventing osteoporosis and fractures [3].
• Balanced diet: Consume adequate protein, complex carbohydrates, and healthy fats to provide energy, support muscle recovery, and maintain a healthy body weight. Drink enough water to prevent dehydration and muscle cramps.

Medical consultation: Specialist Level II Physician Bui Thi Minh Phuong — Department of Rehabilitation, University Medical Center Ho Chi Minh City

5. Frequently asked questions (FAQ)

1. Is pickleball a safe sport for older adults? Yes. Pickleball is considered a relatively safe sport for older adults because it is low-impact and does not require as much strength or speed as some other sports. However, older adults should pay particular attention to thorough warm-ups, use appropriate protective equipment, and avoid overexertion to minimize the risk of injury, especially falls and fractures.
2. How can I tell the difference between a sprain and a fracture? Both sprains and fractures can cause pain, swelling, and difficulty moving. However, fractures often cause more severe pain and may be accompanied by obvious deformity of the limb, a cracking or snapping sound at the time of injury, and an inability to bear weight fully. Sprains generally cause less deformity. For an accurate diagnosis, seek medical attention for an examination and X-ray.
3. What should I do immediately after a pickleball injury? Immediately after an injury, you should follow the RICE method:
   • R (Rest): Stop playing immediately and rest the injured limb.
   • I (Ice): Apply an ice pack to the swollen area for 15–20 minutes, repeating every 2–3 hours to reduce swelling and pain.
   • C (Compression): Gently compress the injured area with an elastic bandage to limit swelling.
   • E (Elevation): Elevate the injured limb above the level of the heart to reduce swelling. Then see a doctor for appropriate diagnosis and treatment.
4. How are pickleball shoes different from other athletic shoes? Pickleball shoes (court shoes) are specifically designed to support lateral movements, sudden stops, and turning on hard courts. They have a firmer, flatter outsole with better traction along the sides to enhance stability. In contrast, running shoes are designed for forward movement, with thicker cushioning and a more flexible outsole, making them less suitable for the multidirectional movements required in pickleball.
5. How soon can I return to pickleball after an injury? The time required to return to pickleball depends on the severity and type of injury, as well as each individual's recovery process. For a mild injury such as a grade 1 sprain, recovery may take several days to a few weeks. More serious injuries, such as fractures or ligament tears, may take several months and require rehabilitation. It is important to follow the guidance of your doctor and rehabilitation specialist and return to play only when you are pain-free and have regained full strength, flexibility, and balance.

6. Medical review and references

Medical consultation:

• Specialist Level II Physician Bui Thi Minh Phuong — Department of Rehabilitation, University Medical Center Ho Chi Minh City

References

• [1] Greiner, N. (2019). Pickleball: Injury Considerations in an Increasingly Popular Sport. Mo Med, 116(6), 488–491. Accessed: 2025-12-19.
• [2] Azar, F. M., Lamplot, J. D., Bernholt, D. L., & Spence, D. D. (2024). Pickleball: A Standard Review of Injury Prevalence and Prevention in a Rapidly Growing Sport. J Am Acad Orthop Surg, 32(22), e1130–e1141. Accessed: 2025-12-19.
• [3] Yu, J., Yendluri, A., Linden, G. S., Namiri, N. K., Corvi, J. J., Song, J., Parsons, B. O., & Parisien, R. L. (2025). Increasing Incidence of Pickleball Injuries Presenting to US Emergency Departments: A 10-year Epidemiologic Analysis of Mechanisms and Trends. Orthop J Sports Med, 13(1), 23259671241305364. Accessed: 2025-12-19.
• [4] Owoeye, O. B. A., Yemm, T., Blechle, R., Wayne, M., Kennedy, D., Mourad, W., Stamatakis, K., & Howell, T. (2025). Understanding Injury Patterns and Predictors in Pickleball Players: A Nationwide Study of 1,758 Participants. Sports Med Open, 11(1), 100. Accessed: 2025-12-19.
• [5] Touhey, D. C., Bozorgmehr, C. K., Tartibi, D. S., Smith, M. V., & Knapik, D. M. (2024). Pickleball Injuries in the Aging Athlete: A Critical Analysis Review. Cureus, 16(9), e69950. Accessed: 2025-12-19.

The information above is for reference purposes only and is not intended as medical advice. Please contact your doctor for detailed medical consultation.