Pickleball Injury Prevention: Common Injuries and How to Avoid Them

This article is general information for healthy recreational play, not medical advice. It is not a substitute for evaluation by a physician, physical therapist, or athletic trainer. If you have an existing injury, a chronic condition, or you're in pain right now, talk to a qualified clinician before you use anything here to change how you play. Where we cite a specific number or claim, we link the study or clinical source it came from — check the "Sources" section at the bottom for the full list.

Why pickleball's injury numbers keep coming up

Pickleball's injury profile has become a genuine research topic, not just anecdote. A 2025 analysis of the National Electronic Injury Surveillance System (NEISS) — the database emergency departments report into — tracked pickleball-related ED visits from 2013 to 2022 and found the estimated national injury count rose from about 611 documented cases in 2013 to roughly 13,690 in 2022, a statistically significant increase that tracks the sport's own explosive growth over the same period (PMC, 10-year epidemiologic analysis). More people playing means more injuries in absolute terms almost by definition — that alone isn't a red flag. What's more specific to pickleball is who gets hurt and how.

That same study put the mean age of an ED-treated pickleball injury patient at 64, with 61% of cases in the 65-to-80 age range. That's a real signal, but it needs a caveat: pickleball's overall player base has gotten younger in recent years, not older — industry surveys from the Association of Pickleball Professionals put the average participant age at around 35 as of 2026, with the 25-to-34 bracket now the single largest age group on court. So the injury data isn't saying "pickleball players are old." It's saying that within a sport increasingly played by people of all ages, the injuries requiring emergency care are disproportionately concentrated in players over 60 — likely because bone density, tendon elasticity, and fall recovery all change with age, not because the game itself is uniquely dangerous to try.

The mechanism data backs that up. Falls accounted for 65.5% of all pickleball ED visits in the NEISS analysis, and among players over 81 that figure jumps to 96%. Fractures (32.7% of cases) and strains/sprains (30.8%) were the two leading diagnoses overall, with women accounting for 69.1% of all fractures. The wrist was the single most commonly injured body part (12.7% of cases), which lines up with an instinctive brace-your-fall reflex. Separately, a court-movement pattern specific to pickleball and tennis — moving backward then quickly forward while staying upright with your feet pointed straight ahead — has been linked to a documented rise in Achilles tendon ruptures in players over 50, who account for 82.5% of pickleball-related Achilles ruptures versus 32.6% in tennis (Cedars-Sinai).

Put together: pickleball isn't dangerous in the way a contact sport is dangerous. It's dangerous the way any activity that asks a body — often a body that hasn't sprinted, lunged, or reached overhead in years — to suddenly do quick lateral starts, hard stops, and overhead swings is dangerous. The injuries below are largely predictable and largely preventable once you know what to look for.

The most commonly reported injuries

1. Falls and fall-related fractures

This is the largest single injury category in the ED data, and it's the one prevention advice tends to underweight because "don't fall" sounds too obvious to say. But the mechanism matters: most falls happen chasing a wide shot, backpedaling for a lob, or getting crossed up at the kitchen line and stepping on your own or a partner's foot. Falls are more common on outdoor courts with surface debris or uneven pavement, and more common in players who haven't done any lateral-movement conditioning outside of the game itself.

2. "Pickleball elbow" (lateral epicondylitis / tennis elbow)

Despite the newer name, this is the same condition tennis players have dealt with for decades — inflammation and micro-tearing where the forearm tendons attach at the outside of the elbow, from repetitive gripping and wrist extension. Clinicians who treat it note a specific pickleball wrinkle: pickleball's ball is hard plastic and the paddle face doesn't flex the way a strung tennis racquet does, so mishits and off-center contact transmit more shock straight into the forearm than an equivalent tennis mishit would (Baptist Health). Symptoms: burning or aching pain on the outside of the elbow, tenderness to touch, pain that gets worse gripping or lifting, sometimes radiating down toward the wrist.

3. Rotator cuff strain and shoulder pain

Overhead shots — smashes, lobs, hard serves — put repeated stress through the rotator cuff, the group of muscles and tendons stabilizing the shoulder joint. Several orthopedic groups treating recreational players describe rotator cuff tears and strains as among the most common upper-body pickleball complaints they see, tied directly to players swinging overhead without adequate shoulder mobility or warm-up (Franciscan Health). Symptoms range from a dull ache after play to sharp pain on overhead reach, weakness lifting the arm, or pain that disrupts sleep.

4. Achilles tendon strain and rupture

Less common than a sprained ankle in raw count, but disproportionately serious: Achilles ruptures typically require surgical repair (88.1% of cases in one series) and roughly nine months before a return to competitive-level play. As noted above, the mechanism is specific — an upright stance with feet pointed forward while pushing off hard to change direction, a very common pickleball movement pattern for players who haven't adapted their footwork from a more sedentary baseline.

5. Ankle sprains

The classic racquet-sport injury: quick lateral cuts and pivots roll the ankle, especially on outdoor courts with any surface irregularity or when footwear doesn't provide lateral support. Twist/inversion injuries were the leading mechanism specifically among players aged 18–34 in the NEISS data, distinct from the fall-dominated pattern in older age brackets.

6. Wrist and hand injuries

The single most commonly injured body part across all ages in the NEISS dataset (12.7% of cases) — a mix of fall-related fractures (bracing a fall with an outstretched hand) and overuse strain from paddle grip and repetitive wrist snap on dinks and drives.

Prevention: what actually reduces risk

None of this is exotic. The prevention advice that shows up consistently across orthopedic groups, physical therapists, and sports-medicine writers boils down to five things, and they map directly onto the injuries above.

Warm up for real, not just a few practice serves. A genuine warm-up before you start playing points — five to ten minutes of light cardio (brisk walking, easy jogging in place, jumping jacks) to raise blood flow, followed by dynamic stretches: arm circles, shoulder rolls, cross-body arm swings, leg swings, and a few bodyweight lunges. This is the single most consistently repeated piece of advice across the sources we reviewed for this piece, from Hospital for Special Surgery to AAOS-linked guidance — a proper warm-up prepares the exact tissues (shoulder, forearm, Achilles, ankle) that show up most in the injury data (HSS). Static stretching (holding a stretch 20–30 seconds per muscle group) is better saved for after you play, once the muscle is already warm.

Footwear matters more than people assume. Running shoes are built for forward motion and have minimal lateral (side-to-side) support — exactly the wrong tradeoff for a sport defined by quick side steps and hard stops. Court shoes with a stiffer lateral chassis and an outsole matched to your surface (indoor vs. outdoor tread patterns differ) meaningfully reduce ankle-roll risk. We cover the specific footwear tradeoffs, and pick shoes by surface and foot type, in our pickleball shoes guide.

Get your grip size right. An undersized paddle grip forces you to squeeze harder than necessary to keep the paddle stable, and that sustained forearm tension is a documented contributor to lateral epicondylitis — the mechanism behind "pickleball elbow." Measuring your hand and sizing (or adding overgrip tape to) your paddle grip correctly is a five-minute fix that several orthopedic sources specifically call out as tennis-elbow prevention. We walk through exactly how to measure your grip size and when to add overgrip in our full paddle-buying guide.

Change how you move, not just how much you train. Two specific technique adjustments show up repeatedly in the clinical literature. First, for Achilles protection: play from a lower, more athletic stance with your feet pointed slightly outward rather than standing tall with feet square, and use small adjustment steps rather than a single hard forward lunge when you change direction — Cedars-Sinai's tendon specialists specifically describe this "duck stance" cue. Second, for fall prevention generally: resist the instinct to backpedal fast for a lob; instead turn and run, or call it and let it go, since backward sprinting on a hard court is a disproportionately common fall trigger, especially past age 60.

Ramp up volume gradually and cross-train. Sports-medicine and senior-fitness sources (AARP, National Council on Aging) consistently flag "too much, too soon" as an underlying driver of overuse injuries in new players — going from zero racquet-sport activity to four two-hour sessions a week in month one. Building court time up gradually, and adding low-impact cross-training (swimming, cycling, resistance work for the rotator cuff and forearm) on off days, shows up as standard advice for reducing both overuse injuries (elbow, shoulder) and fall risk (better balance and leg strength).

When to rest and self-care vs. when to see a doctor

This is where general information has to stop and individual judgment — yours and a clinician's — has to start. As a general framework, not a diagnosis:

Self-care is reasonable for: mild, generalized soreness after a session that improves within a day or two; minor stiffness that responds to rest, ice, and over-the-counter anti-inflammatories; low-grade elbow or shoulder ache that isn't sharp, doesn't limit your range of motion, and doesn't persist past a few days off the court.

See a doctor — don't try to play through it — for: any suspected fracture (deformity, inability to bear weight, severe localized pain after a fall); a sudden, sharp pop or snap sound followed by pain and difficulty pushing off the affected leg (a classic Achilles-rupture presentation); any head injury, even a "minor" one, especially with dizziness, confusion, or nausea; joint pain with visible swelling, instability, or a joint that feels like it's giving way; shoulder or elbow pain that's sharp (not just achy), that wakes you up at night, or that doesn't meaningfully improve after a week of rest; and any pain that's getting worse rather than better despite rest.

If you're not sure which category you're in, that uncertainty is itself a reason to get it looked at rather than guess. A same-week visit to a primary care doctor, physical therapist, or urgent care is a much smaller time cost than turning a manageable strain into a chronic injury by playing through it — which several of the clinical sources cited above specifically identify as how a recoverable tendon strain becomes a multi-month layoff.

The honest summary

Pickleball's injury numbers are real and well-documented, but they're not evidence the sport is unusually dangerous — they're evidence that a fast-growing sport with quick lateral movement, hard stops, and overhead swings deserves the same basic preparation any racquet sport does: a real warm-up, court-appropriate shoes, a paddle grip sized to your hand, technique that respects your joints (especially the Achilles and shoulder), and a training ramp that doesn't go from zero to five sessions a week overnight. None of that is exotic, and none of it requires giving up the sport — it requires about ten extra minutes before you start playing and a little bit of self-awareness about what your body is telling you mid-session.

Again: this is general information, not medical advice. If something hurts in a way that's new, sharp, or not improving, talk to a real clinician who can actually examine you.

Sources

Once you're back on court, gear matters. Court-appropriate shoes and a correctly sized paddle grip are two of the cheapest, most effective injury-prevention steps available — see our pickleball shoes guide and our full paddle-buying framework for specifics. And if you're looking for a place to play, The Court Scout maintains a verified directory of pickleball courts across the US, every listing confirmed against a primary source.