Common pickleball injuries and how to prevent them

Pickleball has exploded in popularity partly because it is easier on the body than tennis. Shorter court, lighter paddle, less explosive sprinting. For older players returning to sport after years away, that accessibility is the whole point.

And yet sports medicine clinics are booking up with pickleball patients at a rate nobody expected. The sport's approachability works against players. New players jump in cold, without conditioning. Experienced players push through five-day-a-week schedules without rest. Both groups end up hurt.

Here is a clear-eyed breakdown of the most common pickleball injuries, what causes them, and how to stay on the court long-term.

Pickleball elbow

This is the injury the sport is becoming known for. Lateral epicondylitis, borrowed from tennis, produces pain along the outside of the forearm near the elbow. It flares when you grip the paddle, swing, or sometimes just shake someone's hand.

The culprit is repetitive strain on the extensor tendons that attach at the lateral epicondyle. Players who come from tennis backgrounds often struggle here because their stroke mechanics do not transfer cleanly. A two-handed backhand grip that worked fine with a heavy racket creates very different forces on the forearm with a light composite paddle.

What to do about it:

• Switch to a lighter paddle. Anything over 8.5 oz adds cumulative stress if you play three or more days a week.
• Strengthen the forearm with wrist extension curls. Two sets of 15 repetitions with a 2-lb dumbbell, three times a week. Simple and well-supported by the research.
• Review your grip pressure. Most players hold far too tight at contact. A relaxed grip transmits less vibration to the tendon.
• Rest actually rests. Playing through elbow pain turns a minor strain into a multi-month problem.

Shoulder and rotator cuff strain

The rotator cuff keeps the shoulder joint centered through overhead and reaching movements. It is four muscles working together: supraspinatus, infraspinatus, teres minor, and subscapularis. Overhead serves, hard smashes, and aggressive put-aways load them repeatedly.

Most players do not notice a sharp injury. They notice a dull ache after long sessions that gets worse each week if ignored. Rotator cuff tendinitis and partial tears are common in players over 40 who play without any shoulder conditioning.

What to do about it:

• External rotation with a resistance band. This is the best-evidenced exercise for shoulder injury prevention in overhead sports. Three sets of 15, three days a week.
• Warm up your shoulder before you pick up a paddle. Two minutes of arm circles and band pull-aparts moves blood into tendons that need it.
• If overhead work consistently hurts, get your serve mechanics reviewed. Compensation patterns are where most shoulder injuries live, not the movement itself.

Knee pain

The kitchen lunge, the lateral shuffle, the split-step return: pickleball loads the knee through dozens of cutting and stopping movements every session.

Patellar tendinopathy (pain below the kneecap, sometimes called jumper's knee) develops when the patellar tendon is loaded faster than it can recover. It shows up most often when players ramp their schedule too quickly.

Meniscus problems are more acute. A sharp twist or deep squat at the wrong angle can catch and tear cartilage, especially in players over 45 who have less cartilage reserve.

What to do about it:

• Build quad and glute strength off the court. Squats and lunges done properly share load across more muscle groups and protect the knee during court movement.
• Learn to land softly. Absorb impact with your hips and knees, not just your joints. This is a trainable skill.
• Wear court-specific shoes. Running shoes are built for forward motion and lack the lateral stability that pickleball requires.

Ankle sprains

Ankle sprains are the most common acute injury in court sports. They happen on lateral steps, awkward landings, and moments when momentum and foot placement do not agree.

Most are grade I or II: minor to moderate ligament stretching that heals in one to four weeks. The reinjury problem is real. An ankle that was not fully rehabilitated loses proprioceptive stability and makes every subsequent sprain easier to sustain.

What to do about it:

• Single-leg balance work. Stand on one foot for 30 seconds. Progress to a wobble board. This rebuilds the stabilizing systems that ankle sprains damage.
• Consider high-top court shoes if you have any history of ankle rolling.
• Give sprains real rest. A grade I sprain needs a full week before aggressive return. Grade II needs two to four weeks plus progressive rehab.

Wrist injuries

The wrist takes impact during falls and during aggressive soft-game exchanges that demand quick directional flicks. TFCC (triangular fibrocartilage complex) tears and wrist tendinitis are showing up more frequently as the sport grows.

What to do about it:

• Learn proper dinking mechanics. The wrist stays firm through contact. Power and direction come from shoulder rotation and arm positioning, not a wrist snap.
• Ten wrist circles each direction and ten flexion-extension repetitions before play reduce pre-session stiffness.
• When you fall, try to roll through the impact rather than catching yourself on a locked wrist.

Common mistakes that lead to injury

Most pickleball injuries are preventable, and most trace back to the same handful of patterns.

Playing every day without rest. The sport is fun and the social element makes it hard to skip. But tendons have limited blood supply and recover slowly compared to muscle. Daily play without rest days is the fastest path to chronic tendinopathy.

Ramping up too quickly. Going from twice a week to five times a week in two weeks is a reliable recipe for overuse injury. Increase playing volume by no more than 10% per week.

Ignoring early warning signs. A little tightness that goes away after warm-up is the body's first signal. Most players ignore it until the pain stops going away. Starting treatment at the tightness stage is vastly easier than treating established tendinopathy.

Playing through pain. Pickleball culture encourages showing up. Playing hurt is treated as normal in a way that is actively harmful. One week off at the first sign of trouble is a far better trade than two months off once the problem is established.

A five-minute pre-play warm-up

Most injuries happen in the first 15 minutes of play, when cold muscles and tendons are asked to perform at full effort, or in the last 15 minutes, when fatigue breaks down form. A brief warm-up addresses the first window.

Here is one that works:

1. Light jog or fast walk around the court, 2 minutes
2. Arm circles, 10 each direction
3. Hip circles, 10 each direction
4. Lateral shuffles, two court widths, twice each direction
5. Ten bodyweight squats
6. Resistance band pull-aparts for the shoulder, if you have a band

Five minutes. Blood flow, joint mobility, neuromuscular readiness. That is the whole goal.

Recovery between sessions

What you do after a session determines how you feel at the next one.

Spend five minutes walking and stretching after play: hamstrings, hip flexors, calves, forearms. If any area feels warm or swollen, ice it for 15 to 20 minutes within the first hour. Anti-inflammatory measures taken early reduce swelling and speed recovery.

Sleep is the most underused recovery tool in recreational sport. If you are playing four or five days a week, your sleep schedule is part of your training plan. Most overuse injuries are under-recovery injuries in disguise.

One to two full rest days per week is not optional for players over 40. It is maintenance.

Footwear: the cheapest upgrade you can make

Court-specific shoes are the single easiest equipment upgrade for joint health. Running shoes are built for forward motion. Pickleball requires lateral cuts, pivots, and quick directional changes that running shoes do not support.

A proper court shoe has a wider base, lateral reinforcement, and cushioning optimized for hard-surface multi-directional impact. If your knees and ankles have been giving you trouble and you have been playing in running shoes, switch first before trying anything else.

When to see a professional

Pain that lasts more than two weeks, limits your range of motion, or wakes you up at night needs a professional evaluation. Sports medicine physicians and orthopedic specialists are seeing pickleball injuries constantly now.

Most common pickleball injuries respond well to physical therapy if caught early. Many become chronic or require surgery if the player keeps playing for months.

Find courts with better surfaces near you

Playing surface affects your joints too. Cushioned hardcourt systems absorb significantly more impact than bare concrete or asphalt. This matters most for players managing existing knee or hip issues.

Browse courts in Austin, Denver, Seattle, and Portland to find venues with cushioned indoor surfaces. Filter for indoor courts to access facilities that typically have higher-quality flooring than outdoor public parks. Or look for drop-in sessions to test different venues before committing to a membership.