Physical Therapy for Pickleball Injuries
Pickleball is one of the fastest growing sports in the United States, played on a tennis-like court using a softball-sized, hard-plastic ball and a wooden racket to serve and volley the ball back and forth. While fairly easy to pick up, pickleball requires fast movements of the upper and lower body, sudden pivots and cuts, and side-to-side shuffling, which can contribute to injury. Common injuries include ankle sprains, Achilles’ tendonitis, meniscus or ligament strains, plantar fasciitis, and pickleball elbow. Physical therapy can help pickleball players not only recover from an on-court injury, but also prepare for a successful pickleball season through targeted strength and conditioning.
What is Pickleball?
Pickleball is one of the fastest growing sports in the United States with 4.8 million people playing the sport recreationally and competitively. Pickleball is particularly popular among older individuals with 75% of players aged 55 or older and 42% over age 65.
Pickleball is a great form of low-impact exercise that combines tennis, badminton, and ping-pong. The game is played on a court slightly smaller than a tennis court using a softball-sized, hard-plastic ball with holes (like a wiffle ball) and a wooden or composite racket that is larger than a ping-pong paddle but smaller than a tennis racket. Serving is underhand, such that the server makes contact with the ball below the waist.
As a sport, pickleball requires fast motions of the upper and lower body. Players must make quick starting and stopping movements forward and backward, pivots and cuts, lunges for shots, side-to-side shuffling, and backward pedaling.
Common Pickleball Injuries
Pickleball is a fairly easy sport to pick up. However, this can lead to players overexerting themselves during play and not being properly conditioned to play long-term. In fact, new pickleball players sustain about 50% of injuries during the first year of playing pickleball. In addition, many pickleball players are aged 55 and older. As we age, our muscles undergo a progressive loss of muscle mass and strength, which can negatively impact our ability to react and change direction with speed and stability and contribute to injury.
Acute and chronic injuries can occur when playing pickleball. Acute pickleball injuries can result from a fall when lunging or back pedaling to hit the ball or after suddenly turning or pivoting.
Acute injuries can include:
ankle sprains due to short runs and quick agility movements that can overstretch the ankle ligaments beyond their normal capacity.
Achilles’ tendon injury due to high-impact movements like jumping on the court, causing the Achilles’ tendon connecting the calf muscle and foot to strain and even partially tear from the stress placed on the tendon.
meniscus or ligament sprains like the LCL or MCL due to quick pivoting, which can twist the knee meniscus and supportive ligaments.
sprain or fracture of the wrist due to falling on the wrist when lunging for the ball or from tripping during a sudden movement during play and using the wrist to break your fall.
shoulder strains due to reaching overhead to hit the ball and volley it over the net, causing strain to the rotator cuff muscles.
hamstring, quadricep, hip flexor or adductor, & calf strains can occur during sudden movements and pivots during the game, causing a partial tearing in the muscle or tendon.
Chronic injuries can include:
plantar fasciitis and heel contusions can develop when playing on the hard court for extended periods of time without sufficient rest. Plantar fasciitis involves inflammation and pain along the plantar fascia of the foot.
lumbar (lower back) muscle strains can occur due to forward bending and repetitive trunk rotations when striking the ball.
pickleball elbow occurs when the tendons that connect your lower arm to the outside of the elbow bone become swollen and inflamed. This can occur due to backhanding when hitting the pickleball or hitting the ball with poor technique.
flexor and extensor wrist tendon strains can develop due to repetitive strain on these muscles when serving and hitting the ball incorrectly. Many players hit the ball using only their arm strength, placing undue stress on the wrist tendons, rather than using core, trunk, and shoulder strength for a powerful hit.
rotator cuff tendinitis can occur due to overhand volleys or repetitive stretching to reach the pickleball, causing inflammation and pain along the muscles and tendons at the top of the shoulder.
Physical Therapy for Pickleball Injuries
Physical therapy can help pickleball players not only recover from an on-court injury, but also prepare for a successful pickleball season through targeted strength and conditioning. For all injuries, physical therapists initially manage pain and inflammation using ice, and incorporate manual therapy soft tissue and joint mobilizations to gently move the affected area, increase range of motion, and decrease pain.
For lower extremity injuries like ankle sprains, hamstring or quadriceps strains, Achilles’ tendon injuries, and meniscus or knee ligament strains, physical therapists guide the individual through targeted strengthening and stretching of the leg, ankle, and foot muscles and aerobic conditioning to maintain and improve fitness without placing stress on the injured area. The therapist then progresses the individual to agility, balance, and coordination training drills.
For upper extremity injuries like pickleball elbow, rotator cuff tendinitis, wrist flexor and extensor tendon strains, and lumbar strains, the physical therapist implements a progressive strength and conditioning program for the rotator cuff muscles, elbow and wrist muscles, and upper and lower trunk muscles. The therapist will also implement functional sport-specific training as tolerated by the athlete.
A physical therapist can provide an assessment prior to pickleball season to evaluate any muscle weaknesses or imbalances and address these issues to reduce the risk of injury. The physical therapist can also target coordination and balance problems. Good coordination requires selecting the right muscle to execute a smooth, accurate, controlled response to perform an activity. The therapist works on training muscles to contract with the appropriate speed, distance, direction, and timing to execute the desired pickleball activity. The therapist may also implement dynamic balance training drills the mimic the side-to-side and quick movements of pickleball.
To prevent injury during pickleball season:
Always warm up with a light jog, slow walk with high knees, and do some side shuffles. Stretch your shoulders, calves, neck, wrists, hamstrings, and quadriceps to prepare your muscles for activity.
Make sure that your shoes fit properly, wearing cross-training or court shoes to provide lateral stability and reduce excess friction on the foot.
Start slow and ease into playing pickleball. Going too hard too fast can set you up for injury. Take time for recovery, spacing out your pickleball games such that your muscles can recover before the next game.
Use correct form when hitting the ball. Don’t rely on your arms to hit the ball. Rather, translate momentum and power from the rest of the body, from the legs through the trunk to the shoulder and arm to generate a powerful hit.
Engage in pre-season strength and conditioning to prevent injury, addressing muscle imbalances or weaknesses ahead of time.
Pickleball is a popular and fun sport for all ages! As the season begins, check in with your physical therapist for an evaluation to prepare you for a successful, injury-free pickleball season!
