Pickle Ball Injuries

Pickleball was started in 1965 in Washington State. It has recently become one of the fastest growing sports in America. In fact, in the past 3 years pickleball participation has increased by nearly 160%. Not surprisingly, this increase in popularity has come with an increase in injuries and this increase in injury rates is outpacing the growth rate of pickleball. Data suggests 32% of pickleball players suffer an injury each year with higher rates among older players. Injury rates are highest among players 65 to 80. From 2017 to 2022, injury rates increased by 6.8 times overall and by 6.5 times involving the foot and ankle. Data taken over a longer period of time from 2002 to 2022 revealed a 90-fold increase in all fractures among pickleball players.

Recent studies have evaluated injury trends among pickleball players and their research has provided insight into injury trends. A 2021 study found that most pickleball injuries occur with a slip, strip, fall, or dive. This accounted for over 63% of all injuries. Interestingly, more injuries occur in the first 3 months of the year than other quarters during the year. Theories behind this trend include New Year’s resolutions leading to more physical activity after the turn of the new year and snowbirds who winter in warmer climates during the first three months of year. Risk factors for injury include: male gender, lower BMI, and number of hours played per week.

A 2024 study examined injury rates among pickleball players and found that most injuries occur in the lower extremity. The most common lower extremity injury was ankle sprain followed by Achilles tendon rupture. Most sport-related injuries occur when the body quickly decelerates. Think about of moving sideways to hit the ball but needing to come to a quick stop to make the hit and avoid running off the court. The same applies for moving forward and backward. There are differences in the balls used with outdoor play and indoor play. Outdoor balls tend to be harder and move faster – 30-40 mph. This can result in the need for fast reaction times and equally quick movement patterns.

Any sport, pickleball included, can lead to overuse injuries (tendinitis, fasciitis, etc). Factors influencing overuse injuries include movements unique to court sports, age, training status, fitness level, and shoes. It’s relevant that pickleball attracts participants who find it easier than tennis and other more demanding sports. As a result, this may cause individuals who are less trained to pick up the sport and thus be at risk for injury. Treatment of overuse injuries follows the same course as injuries with other sports. Generally, avoiding treatment for an overuse injury will lead to delayed recovery and the need for more invasive care. As a result, it’s important to seek medical evaluation to determine which treatments are appropriate in a given situation. It’s equally important to adopt prevention strategies that reduce injury risks. Incorporating strength training, balance and coordination training, and overall cardiovascular fitness can reduce the rate of injury.

So why does pickleball have so many injuries? The answer lies in the nature of the sport; it requires quick movements in all directions. These bursts of movement require several things to work together in a short amount of time. Reaction time, balance, coordination, strength, flexibility, and hand-eye coordination all play a role in how efficient a pickleball player moves. If one or more of those factors is not optimized, injuries can occur. Additionally, newer pickleball players may lack proper equipment for the sport. For example, inexperienced athletes in any sport may use improper shoes for an activity. This makes sense since these newer athletes may be “trying out” the sport to see if they like before investing in more expensive equipment, including shoes. So, what factors should pickleball players consider when it comes to shoe selection. Let’s examine a few of these.

Pickleball is played on a court, similar to tennis, with unique needs due to the playing surface. Court shoes – those designed specifically for court surfaces – differ from traditional running shoes. The latter are designed for the straight-line motion of running forward. Although pickleball does have some of that motion, it involves side-to-side motion with quick starts and stops. Therefore, court shoes have features conducive to a court environment. For example, the soles of court shoes provide traction to enhance stability with lateral motion in addition to allowing for twisting of the foot on the court surface. Court shoes typically have a reinforced toe to protect the shoe from wear-and-tear when the toe drags across the court surface with some pickleball movements. Finally, court shoes are generally stiffer in design to enhance stability of the foot. All of these factors should be considered when selecting a shoe. In the end, the most important factor to consider when selecting a shoe of any kind is fit. Multiple studies have demonstrated that fit and comfort are the two most reliable indictors of the correct shoe.

Overall, pickleball is an excellent sport which appeals to a wide range of ages and fitness levels. Any exercise is better than no exercise so pick a sport which appeals to your individual needs and expectations. For some, socialization is an important part of exercise and pickleball is a great social environment. Keep in mind that balanced training is important for any athlete, pickleball players included. So, incorporate other physical training into your exercise regimen to guard against injury and give yourself freedom to continue playing the sport you love. This should include a mix of strength training, plyometrics (jumping and running), stretching and mobility, along with balance training. Through these efforts, you will give the body the tools it needs to successfully complete the physical challenges you’ll throw at it.