The 5 Most Common Pickleball Injuries and How to Prevent Them

Injuries like ankle sprains and tennis elbow are common when playing pickleball, but there are exercises you can do to prevent them.
Image Credit: RichLegg/E+/GettyImages

Summer means more people are headed outdoors to play pickleball. It also means more players are getting sidelined by injuries.

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"Given that pickleball requires a lot of quick stopping and going and changing directions in a population that has a higher number of older participants, there are are many opportunities for an athlete to get hurt," says Rob Andrews, PT, DPT, a physical therapist with the Hospital for Special Surgery in New York City.

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Pickleball injuries have been on the rise for some time, especially among the sport's mostly older fanbase. Older adults account for a whopping 85 percent of reported pickleball injuries, according to a May 2021 study in Injury Epidemiology.

"It's important that athletes take care of their bodies to prepare for the demands of the sport," Andrews tells LIVESTRONG.com.

Below, we'll take a look at five of the most common pickleball injuries, along with exercises and stretches you can do to prevent them.

1. Sprained Ankle

Court sports like pickleball call for quick direction changes from side to side. As such, it's common for athletes to roll an ankle or experience a lateral ankle sprain, Andrews says.

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According to the American Academy of Orthopedic Surgeons (AAOS), an ankle sprain occurs when the ligaments (tough tissue that connects two bones) in the ankle stretch too far and tear. Tears can be tiny or major, but they're typically accompanied by swelling and pain during movement and at rest.

Anyone can sprain an ankle, but you're more likely to do it if your ankle is weak and unstable. Do the following two moves to help strengthen your ankles.

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Prevention Exercises

Lateral Banded Walk

Strengthening the muscles on the side of your leg and hip — particularly the gluteus medius (the muscle on the side of your butt) and peroneals (muscles in your lower legs) — can help your ankle stabilize during quick direction changes. The lateral banded walk targets these muscles, helping reduce your odds of rolling an ankle, Andrews says. He suggests adding the lateral banded walk to your pickleball warmup routine.

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Sets 3
Reps 10
  1. Loop a small resistance band around both feet and stand with feet hip-width apart.
  2. Bend your knees into a quarter-squat.
  3. Step to your left side with your left foot.
  4. Step your right foot toward your left foot to return your feet to hip-width apart.
  5. Keep your knees bent as you continue stepping to the left. Avoid rocking motions; aim to keep your hips level as you go.
  6. Take 10 steps to the left before switching directions.
  7. Do 2 to 3 sets.

Single-Leg Romanian Deadlift

Building balance and proprioception (your awareness of where your body is in relation to your environment) is also key for preventing ankle sprains, Andrews says. This single-leg exercise challenges your balance and strengthens the intrinsic foot muscles that contribute to proprioception. The single-leg Romanian deadlift (RDL) also has the added bonus of strengthening your glutes. Incorporate the single-leg RDL into your pickleball warmup routine.

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Sets 2
Reps 10
  1. Stand with your feet shoulder-width apart and knees slightly bent. Hold a dumbbell in your right hand, palms facing in, arms by your sides.
  2. Shift your weight onto your left leg and lift your right foot foot a few inches off the floor behind you.
  3. Extend your left arm to the side and make a fist. This will help you balance.
  4. Keeping your back flat, push your hips back and lower your torso forward and then down toward the floor.
  5. As you do, allow your elevated foot to lift toward the ceiling and the dumbbell to reach toward the ground. Stop once your torso is parallel with the floor.
  6. Press your left foot into the ground as you straighten your hips to return to standing. Repeat.
  7. Keep your hips and shoulders facing forward throughout the movement.
  8. Do two sets of 10 reps per leg.

Tip

If you struggle with balance, set one end of a foam roller on the floor and place your free hand on the other end for support.

2. Plantar Fasciitis

"Plantar fasciitis is an overuse injury that results in pain on the bottom of the foot or heel," Andrews says. It occurs when the plantar fascia (a thick band of connective tissue that supports your foot arch) becomes irritated and inflamed, per the Cleveland Clinic. The sensation can range from a dull, constant ache to a sharp, stabbing pain in your heel or along the bottom of your foot.

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The plantar fascia is designed to absorb the forces we place on our feet when walking or navigating the pickleball court. However, when there's too much pressure, the tissue becomes damaged, leading to inflammation and pain, according to the AAOS. Repetitive foot movements, unsupportive shoes and tight calf muscles can all strain the plantar fascia and increase your risk of pain, Andrews says.

Do the following move to help stretch your calves and plantar fascia.

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Prevention Exercises

Runner's Stretch

Aside from wearing supportive shoes and varying your foot movements, stretching your calves and plantar fascia with the runner's stretch can ease tension along the bottom of your feet. This may relieve pressure on your feet, helping prevent plantar fasciitis.

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Andrews recommends doing this stretch before and after your pickleball session.

Sets 4
Time 20 Sec
  1. Begin standing in front of a wall at arm’s length from it with your feet hip-width apart.
  2. Place both hands flat against the wall and bend your right knee.
  3. Step your left foot back so your left leg is straight and your left heel is flat on the ground.
  4. Keep both feet pointed forward and gently press into the wall until you feel a stretch in your left calf and heel.
  5. Hold for 20 seconds and repeat on the other side.
  6. Do 4 sets per leg.

3. Lumbar Strain/Lower Back Pain

Acute (short-term) and chronic back injuries are fairly common in pickleball. "Because the sport involves staying in a somewhat flexed-spine position for most of the play, in addition to the rotation involved to hit the ball, the spine can be an easy target for an injury," Andrews says.

Spending so much time with your spine flexed (bent) can lead to chronic pain, particularly in the lumbar (lower) spine. In addition, the sudden twisting required to return a serve puts the muscles and tendons in your spine at risk of an acute injury like a pull or strain. The tell-tale signs of a strain include pain that gets worse when you move, muscle cramping or spasms and decreased range of motion (difficulty walking, bending forward or sideways, or standing straight).

Do the following moves to help improve your spinal mobility.

Prevention Exercises

Cat-Cow Pose

Improving spinal mobility is an easy way to decrease your likelihood of back pain, Andrews says. The better your spine can move through its full range of motion, the lower your chances of pulling or straining a muscle or tendon. Cat-cow pose is a great mobility exercise for moving the spine in two basic positions: extension (lengthening) and flexion (bending).

Do cat-cow pose during your warmup to help loosen your spine before playing pickleball, Andrews suggests. You can also perform the move afterward to ease any tightness from playing with your spine in a mostly flexed position.

Sets 1
Reps 15
  1. Begin on your hands and knees with your hands under your shoulders and knees under your hips.
  2. Inhale deeply. As you exhale, push into your hands and shoulders as you round your back toward the ceiling, tuck your tailbone and bring your chin toward your chest. You should feel a gentle stretch along your spine. Hold for 2 to 3 seconds.
  3. Then, inhale deeply as you drop your stomach toward the floor, pull your shoulders back and lift your chest and head toward the ceiling. Hold for 2 to 3 seconds.
  4. Repeat this sequence 10 to 15 times.

Open-Book Exercise

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Your spine must also be able to twist from side to side. If it can't, you're more likely to strain it during sudden movements. The open-book exercise teaches your spine to twist, helping you avoid pain and injury. It's another great movement to include in your pickleball warmup, Andrews says.

Sets 2
Reps 15
  1. Lie on your left side with your hips and knees bent at a 90-degree angle. Extend your arms on the floor in front of your torso so your palms touch.
  2. Without moving your lower body, twist your torso to lift your top arm and reach it as far behind as you as possible.
  3. Aim to touch your hand to the floor, but don’t worry if you can’t.
  4. Hold for 5 seconds.
  5. Reverse the movement to return to the starting position. Repeat.
  6. Do 10 to 15 reps per side.

4. Tennis Elbow

Lateral epicondylitis, or "tennis elbow," is an overuse injury of the extensor tendon in your forearm that bends your wrist backward away from your palm. "[The tendon] is especially used during the backhand shot," Andrews says.

Repetitive movements, such as the backhand shot, can aggravate the tendon, causing pain and tenderness outside your elbow. The pain often begins as mild and gradually worsens over time, becoming most noticeable when you grip your racket, per the AAOS.

Do the following move to help strengthen and lengthen your wrist extensors.

Prevention Exercises

Eccentric Wrist Extension

This move strengthens your wrist extensors while lengthening them. This helps prepare the tendons for the repetitive movements of a pickleball game, so they're less likely to become damaged and inflamed. Andrews suggests performing this exercise three to five times per week.

Sets 2
Reps 10
  1. Sitting down, grip a weight in your right hand.
  2. Rest your right arm on a flat surface so your palm faces down and your wrist relaxes over the edge.
  3. Maintain a grip on the weight and use the opposite hand to gently lift your left wrist as far back as you comfortably can.
  4. Release your helping hand and slowly lower your wrist with the weight back to the starting position, taking 5 to 10 seconds. Repeat.
  5. Do 10 reps on one arm before switching sides. Do 2 sets per arm.

5. Achilles Tendinopathy

This is another overuse injury involving tendons — this time, in the Achilles tendon that connects your calf muscles to your heel bone, Andrews says. This tendon is recruited whenever you walk, run, jump or push up on your toes.

Pickleball involves many of these movements, making the Achilles tendon susceptible to injury when these movements become intense or repetitive. The pain typically begins as a mild ache in the back of your leg or above your heel and may become more severe after prolonged periods of play.

Do the following move to help stretch and strengthen your Achilles tendon and the muscles around it.

Prevention Exercises

Eccentric Heel Raise

Andrews recommends the eccentric heel raise to lower your risk of Achilles tendinopathy. Eccentric heel raises keep tension on the Achilles tendon and calf muscles while they lengthen into a stretched position, he notes. This strengthens the tendon and surrounding muscles through their full range of motion, so they're less likely to become strained when running, jumping and pushing up on your toes.

Incorporate the eccentric heel raise into your pickleball warmup, Andrews suggests.

Sets 2
Reps 10
  1. Stand on a step, ledge or box with your feet hip-width apart; allow your heels to relax off the edge. Hold onto a railing or wall to help with balance if needed.
  2. Keeping your knees soft, rise onto the balls of your feet, squeezing your calf muscles at the top.
  3. Shift your weight onto your right leg and slowly lower your right heel toward the floor, taking 5 to 10 seconds to do so.
  4. Repeat, lifting onto the balls of both feet before lowering one heel.
  5. Do 2 sets of 10 reps per leg.
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