Pickleball Injuries: Common Risks, Prevention Tips and Safe Play Strategies

CALIFORNIA POSITIVE

By Nicholas Redden

Pickleball has become one of the fastest-growing sports in America, drawing players of all ages to courts in community centers, retirement communities, parks, and back yards. For older adults especially, it offers a compelling combination of social connection, light-to-moderate aerobic exercise, and competitive fun. But as pickleball’s popularity has soared, so too have pickleball injuries. According to Cleveland Clinic physical therapist Nicholas Redden, PT, DPT, ATC, nearly seven in 10 pickleball players experience at least one injury annually, 40% of those injuries cause a halt in play, and 33% of those injured play through pain.

Why is pickleball so popular?

Pickleball has been around since the 1960s, but interest and participation in it has grown exponentially in recent years. In fact, according to the Sports & Fitness Industry Association (a trade group), pickleball participation in the United States increased from about 4.2 million “picklers” (as pickleball players are known) in 2020 to more than 24 million in 2025.

In pickleball, players hit a plastic ball using paddles about 16 inches long by 8 inches wide. The game can be played as singles or doubles on a court similar in size to a badminton court but smaller than a tennis court. As such, pickleball is an attractive alternative for individuals who no longer can cover the ground on the larger tennis court. It can be tailored for varying skill levels and physical capabilities, while still providing a good aerobic workout, improving overall fitness, balance, and coordination, and giving players an opportunity for social interaction. Plus, pickleball doesn’t require a huge financial investment.

Who is most at risk for pickleball injuries?

Accompanying the growth of pickleball has been an uptick in pickleball injuries. For instance, a recent survey of 1,758 pickleball enthusiasts found that about one-third reported experiencing an upper-extremity injury (most commonly sprains and strains) in the previous year (JOSPT Open, online April 15, 2026).

While pickleball attracts players of all ages, data clearly points to adults ages 60 to 69 at highest risk of injury. About 90% of emergency department visits for pickleball injuries involve players ages 50 and older. The combination of factors most predictive of injury are (1) being in that 60 to 69 age range, (2) having played for fewer than five years, and (3) playing more than three times per week.

In other words, the enthusiastic new retiree who has just discovered pickleball and is playing every day is precisely the person most at risk for injury. Men are more commonly injured overall, experiencing sprains and strains 3½ times more frequently than women. Women, however, tend to sustain more serious injuries when they do fall. Fractures occur 3½ times more often in female versus male players. This disparity is largely attributed to bone density loss after menopause, which increases fracture risk in older women.

The most common pickleball injuries

Pickleball overuse injuries top the list, accounting for approximately 38% of all injuries among picklers. Ligament and joint sprains and strains comprise about 22%, and muscle strains make up around 17%. Pickleball players also face risks of eye and head injuries.

Also called repetitive stress injuries, overuse injuries develop gradually when a joint or muscle group is used repeatedly without adequate rest. The most common example in pickleball is lateral epicondylitis, better known as tennis elbow (or, increasingly, “pickleball elbow”). This condition affects the tendons on the outside of the elbow and is caused by the repetitive wrist-flicking motion involved in backhand shots.

“It’s typically an inflammatory condition,” Redden says. “The majority of those will resolve spontaneously with rest and modification of the activity, but physical therapy can be very beneficial for helping to build strength, improve flexibility, and expedite healing.”

Achilles tendinitis is another common overuse injury, particularly in players who have ramped up their activity level quickly.

Sprains and strains from pickleball most often occur in the lower extremities. The ankle is the number one site of acute joint injury, and the anterior talofibular ligament is the most frequently sprained structure. Knee ligament injuries can also occur, although Redden notes they are less common than ankle injuries in older pickleball populations. Fractures, while less frequent, are a concern particularly for older women. Lunges, when a player reaches outside their base of support to return a ball, are the most common cause of falls on the pickleball court and can result in wrist, hip, or ankle fractures.

Causes and contributing factors

Understanding why pickleball injuries happen is the first step toward preventing them. Overuse is, by definition, doing too much. But what counts as “too much” depends heavily on your baseline fitness level. A lifelong tennis player who transitions to pickleball in his or her 60s is far less likely to develop an overuse injury than someone who goes straight from the couch to playing pickleball five days a week. A useful guideline from Redden: If you finish playing and experience soreness that hasn’t resolved before your next session, or if your pain progressively worsens during play and lingers after you stop, you’re probably overdoing it.

Skipping the warmup is a major and preventable contributing factor in pickleball injuries. Cold muscles and stiff joints are more vulnerable to sprains and strains, yet many recreational players head straight from the parking lot to the court.

Improper equipment matters more than many players realize. Pickleball-specific shoes, which feature a higher lateral heel rise and court-appropriate grip, provide meaningful protection against ankle rolls, compared with running shoes or casual sneakers. Paddle grip size also makes a difference. When you wrap your hand around the grip, you should be able to fit no more than one finger between your fingertips and your palm. A grip that is too small or too large puts extra strain on your forearm muscles.

Poor body mechanics, particularly among newer players, also contributes to injury. Running backward—a tempting strategy when a lob sails overhead—significantly increases fall risk. “You’re just not seeing where you’re going,” Redden explains. A safer alternative is to play a little deeper on the court so you can come forward to retrieve balls rather than retreating.

Prevention: how to stay safe on the court

Many pickleball injuries can be avoided. Practice pickleball injury prevention by taking these important steps:

• Warm up before every session. A proper warmup doesn’t need to be elaborate—even two to five minutes of moving every joint from head to foot can make a meaningful difference for recreational players. The goal is to move every major joint through its full range of motion and activate the muscles you’ll be using.
• Stretch when you’re done. Stretching after play helps the body recover more effectively.
• Wear the right shoes. Sport-specific pickleball shoes or court shoes designed for lateral movement are worth the investment.
• Master the ready position. Stand with your feet roughly shoulder-width apart, one foot slightly staggered in front of the other, and knees slightly bent.
• Limit play to three or four times per week. On off-days, engage in other activity you enjoy, like walking, cycling, or swimming.
• Hydrate consistently. Dehydration is both an injury risk and a serious health risk.
• Consider protective eyewear. Pickleball-specific eyewear is available and recommended, particularly for players who have had eye conditions or those who play at competitive levels, where balls travel at high speed.

“Skipping the warmup is a major and preventable contributing factor in pickleball injuries.”

What to do if you get injured

If you sustain an injury on the court, the first step is to stop the activity that caused it. For most sprains and overuse injuries, applying ice to the affected area helps control pain and swelling. Contrary to old advice, you generally do not want to completely immobilize the injured joint. Movement within a pain-free range of motion supports healing.

Under many insurance plans, you can go directly to physical therapy without a referral. Or contact your primary care provider (PCP) for a referral to physical therapy. In most cases, Redden says, a PCP will readily approve a physical therapy referral for a sports-related injury. Visit urgent care or an emergency department immediately if any of the following apply:

• You are unable to bear weight on an injured leg.
• You hear or feel a pop at the moment of injury.
• You can see bone or there is significant bleeding.
• You lose consciousness after a fall.

“The majority of pickleball injuries are not going to be those severe types,” Redden reassures. “They’re going to be sprains, strains, overuse—those types of things. Get in to see your physical therapist as soon as possible.”

Comparing pickleball to other sports

Players who assume pickleball is inherently safer than tennis or racquetball may be surprised to learn that the types and severity of injuries are quite similar across racket sports. Pickleball is generally considered lower impact than tennis—the court is smaller, rallies are shorter, and the ball moves more slowly—and the overall prevalence of injury may be somewhat lower. But lateral movement, overhead reaches, and the risk of falls are present in all of these sports, and the injury patterns reflect that.

Pickleball is a wonderful sport for people of all ages and fitness levels, and its benefits, including improved cardiovascular health, coordination, and social engagement, are well worth pursuing. With the right preparation, equipment, and awareness of your body’s limits, you can keep playing for years to come.