Top 10 Pickleball Injuries and How to Help Prevent Them

Published by Dr. C.J. DeFabio, D.C. | March 19, 2024

Top 10 Pickleball Injuries and How to Help Prevent Them

Pickleball has grown quickly because it is fun, social, and accessible to a wide range of ages and fitness levels. But like any sport, it can still lead to injury. Quick starts and stops, lunging, reaching, repetitive paddle swings, and falls can all place stress on the feet, ankles, knees, hips, back, shoulders, elbows, and wrists.

Some pickleball injuries happen suddenly, such as ankle sprains or falls. Others build gradually from overuse, limited mobility, poor warm-up habits, or returning to play too fast after time away.

The good news is that many common pickleball injuries can often be reduced with better preparation, better mechanics, and early attention to symptoms before they become more limiting.

Below is a practical guide to 10 common pickleball injuries, how to help reduce your risk, and when it may be time to consider a professional evaluation.

Important: This article is for general educational purposes only and is not a diagnosis. Persistent pain, weakness, swelling, numbness, loss of motion, or pain that interferes with play or daily life should be evaluated by a qualified healthcare professional.

Ankle Sprains

Ankle sprains are one of the most common pickleball injuries because the sport involves quick side-to-side movement, sudden stops, and reaching outside your base of support. A missed step, awkward landing, or fast change of direction can overstretch the ligaments around the ankle.

How to help prevent ankle sprains during Pickleball

• Wear court shoes with good lateral support
• Warm up before play
• Improve ankle mobility and lower-leg strength
• Build balance and single-leg stability
• Avoid playing on slippery or uneven surfaces
• Conservative care strategies

Due to the risk of future ankle injuries once you’ve had one, it is really important to make sure that you build back that proprioception or balance training sense.

Mild ankle sprains may improve with load modification, mobility work, physical therapy, and balance training. If stiffness, weakness, or swelling lingers, treatment may also include guided exercise and soft tissue care.

Class IV laser therapy may be considered in some cases to help manage pain and support recovery in irritated soft tissues.

When to get evaluated

Consider an evaluation if swelling is significant, walking is painful, the ankle feels unstable, or symptoms are not improving over the next several days.

Knee Pain

Pickleball places repeated stress on the knees through lunging, deceleration, pivoting, and quick directional changes. Knee pain may be related to tendon irritation, joint overload, weak hip support, poor landing control, or mobility restrictions above and below the knee.

How to help prevent knee pain

• Strengthen the hips, glutes, and leg muscles
• Improve ankle and hip mobility
• Practice balance and landing mechanics
• Warm up before competitive play
• Increase court time gradually rather than all at once

Conservative care strategies

Knee pain care depends on the source of the problem. Conservative strategies may include:

• Physical Therapy
• SFMA movement assessment
• strengthening
• mobility work
• load management

When soft tissue irritation or tendon overload is involved, Class IV laser therapy may be considered.

For certain chronic tendon-related presentations, shockwave therapy may also be part of care when clinically appropriate.

When to get evaluated

A professional evaluation is a good idea if knee pain affects stairs, squatting, lunging, pivoting, or court movement, or if you notice swelling, locking, or instability.

Achilles Tendon Pain

The Achilles tendon helps transfer force during pushing off, sprinting, and changing direction. In pickleball, repeated starts and stops can overload this area, especially if calf strength, ankle mobility, or recovery capacity is limited.

How to help prevent Achilles pain

• Warm up the calves and ankles
• Build calf strength gradually
• Improve ankle mobility
• Avoid sudden jumps in frequency or intensity
• Do not ignore early morning stiffness in the tendon
• Conservative care strategies

Achilles pain often responds best when treated early.

Conservative care may include:

• progressive calf strengthening
• mobility work
• load modification
• gait and movement assessment
• return-to-play planning

Class IV laser therapy may be considered to help manage pain and support tissue recovery.

For more chronic tendon-related cases, shockwave therapy may also be considered when appropriate.

When to get evaluated

Seek an evaluation if the tendon is painful to push off, remains sore after rest, feels thickened, or if symptoms are getting worse instead of better.

Plantar Fascia or Heel Pain

Pickleball involves frequent impact and short bursts of force that can stress the bottom of the foot. Players may notice heel pain first thing in the morning, pain after playing, or soreness when first standing after sitting.

How to help prevent heel pain

• Wear supportive court shoes
• Improve calf and foot mobility
• Build foot and lower-leg strength
• Avoid sudden increases in playing time
• Address tight calves and stiff ankles early

Conservative care strategies

Heel pain often responds to a combination of:

• mobility work
• calf and foot strengthening
• load modification
• footwear review
• physical therapy

Class IV laser therapy may be considered in some cases.

If chronic soft tissue irritation or plantar fascia overload is present, shockwave therapy may also be considered when clinically appropriate.

When to get evaluated

It is worth getting checked if heel pain keeps returning, affects your first steps in the morning, or starts interfering with walking or court movement.

Low Back Pain

Low back pain is common in pickleball because the sport combines rotation, bending, reaching, and quick reactions. Repeated twisting, limited hip mobility, weak core support, or disc-related irritation can all contribute.

How to help prevent low back pain

• Warm up before play
• Improve hip and thoracic spine mobility
• Build core and glute strength
• Avoid playing through pain
• Work on footwork instead of constantly reaching from poor positions

Conservative care strategies

Effective conservative strategies for pickleball-related low back pain often begin with a focused exam to identify whether the main issue appears to involve disc irritation, joint restriction, muscular overload, nerve irritation, or a movement-control problem.

Depending on the findings, treatment may include:

• chiropractic care when appropriate
• physical therapy and progressive rehab
• movement retraining
• core and hip strengthening
• Class IV laser therapy
• non-surgical spinal decompression in selected cases involving disc-related symptoms or nerve compression patterns
• other conservative modalities based on clinical need

*Non-surgical spinal decompression may be considered for some patients with low back pain that appears related to disc injury, disc bulge, radicular symptoms, or nerve compression, but it is not right for everyone and should follow an exam.

When to get evaluated

Seek an evaluation if back pain lasts more than a few days, shoots into the leg, causes numbness or tingling, limits your movement, or keeps returning after play.

Shoulder Pain

Serving, overhead shots, repetitive paddle swings, and reaching for hard-to-return balls can all stress the shoulder. Some players develop pain from overuse, while others notice it after one awkward shot or a fall.

How to help prevent shoulder pain

• Warm up the shoulders before playing
• Improve thoracic spine mobility
• Strengthen the rotator cuff and shoulder blade stabilizers
• Build playing volume gradually
• Avoid repeatedly serving at full effort when deconditioned
• Conservative care strategies

Shoulder pain often improves best when treatment matches the specific cause.

Conservative options may include:

• physical therapy and mobility work
• rotator cuff and scapular stabilization exercises
• manual therapy
• SFMA movement assessment

For some patients with persistent inflammation or soft tissue irritation, Class IV laser therapy may be used to help reduce pain and support tissue recovery.

When chronic tendon overload or stubborn soft tissue restriction is involved, shockwave therapy may also be considered.

When to get evaluated

A professional exam is a good idea if you have pain lifting the arm, pain reaching overhead, night pain, weakness, or recurring shoulder pain during play.

Tennis Elbow or Pickleball Elbow

Even though many people call it “tennis elbow,” this type of pain can happen in pickleball too. Repeated gripping, backhand shots, paddle mechanics, and forearm overload can irritate the tendons on the outside of the elbow.

How to help prevent elbow pain

• Warm up the forearm, wrist, and shoulder
• Build grip and forearm strength gradually
• Review paddle grip size and mechanics
• Avoid playing through increasing elbow pain
• Balance playing volume with recovery
• Effective conservative strategies for pickleball elbow

For many patients, conservative care works best when it addresses both the irritated tendon and the movement patterns contributing to overload.

Depending on the exam findings, conservative treatment may include:

• activity modification
• physical therapy exercises for the forearm and shoulder
• manual therapy
• grip and load-management strategies
• Class IV laser therapy
• shockwave therapy

Class IV laser therapy may be used to help manage pain and inflammation while supporting the healing environment of irritated soft tissues.

Radial shockwave therapy may be considered for more chronic tendon-related pain patterns, especially when symptoms have lingered and standard rest alone has not been enough.

When to get evaluated

Consider an evaluation if elbow pain has lasted more than 1 to 2 weeks, hurts with gripping, or starts interfering with daily use, paddle control, work, or sleep.

Wrist Pain

Wrist pain in pickleball may come from repeated impact, gripping, paddle control demands, awkward contact, or falls onto an outstretched hand. It may show up as soreness, sharp pain, weakness, or reduced tolerance for hitting.

How to help prevent wrist pain

• Warm up before play
• Build forearm strength and endurance
• Avoid oversized jumps in court time
• Use sound paddle mechanics
• Address falls or sudden wrist pain promptly

Conservative care strategies

Depending on the cause of wrist pain, conservative treatment may include activity modification, soft tissue therapy, guided exercises, and physical therapy.

Class IV laser therapy may be considered in some cases to support tissue healing and help manage pain and inflammation.

If scar tissue, tendon overload, or chronic soft tissue irritation is suspected, shockwave therapy may also be considered as part of a broader treatment plan when clinically appropriate.

When to get evaluated

It is smart to get the wrist checked if pain lasts more than several days, limits grip strength, causes swelling, or began after a fall.

Hamstring or Calf Strains

Fast pushes to the ball, sudden stopping, lunging, and recovering from wide shots can overload the hamstrings and calves. These injuries are more likely when players are tight, deconditioned, or playing intensely without warming up.

• How to help prevent muscle strains
• Warm up before matches
• Improve lower-body mobility
• Build strength progressively
• Increase intensity gradually
• Do not ignore tightness that is getting worse during play
• Conservative care strategies

Muscle strains may respond to:

• temporary load reduction
• physical therapy
• mobility work
• progressive strengthening
• return-to-play planning

Class IV laser therapy may be considered in some cases to help manage pain and support recovery in irritated muscle tissue.

When to get evaluated

An evaluation is helpful if you felt a sudden pull, have bruising, cannot move normally, or symptoms are not improving as expected.

Falls and Traumatic Injuries

Because pickleball involves quick movement and reactive play, falls can happen during lunges, backward steps, or collisions near the kitchen line. Falls may affect the wrist, shoulder, hip, knee, head, or back.

How to help prevent fall-related injuries

• Wear shoes with good traction
• Improve balance and reaction control
• Avoid backing up carelessly for lobs
• Keep courts dry and clear
• Play within your movement capacity, especially when returning after time away

Conservative care strategies

Traumatic injuries require the right level of care based on severity. Some falls may cause simple bruising or soft tissue strain, while others may require urgent evaluation, imaging, or emergency care.

If a more serious injury has been ruled out, conservative treatment may help with recovery from soft tissue strain, joint stiffness, or post-injury movement limitations.

Get urgent care right away for:

• head injury symptoms
• possible fracture
• severe swelling
• inability to bear weight
• loss of consciousness
• significant weakness or numbness

When Pickleball Pain May Mean It Is Time for an Evaluation

It is a good idea to schedule an evaluation if:

• pain lasts longer than a few days
• symptoms keep returning every time you play
• you notice weakness, numbness, or tingling
• pain affects sleep, work, or daily activities
• your movement has changed because you are guarding an area
• you are not sure whether you are dealing with simple soreness or a real injury

At Ravenswood Chiropractic & Wellness Center, we look at more than just the painful spot. We evaluate mobility, strength, movement quality, loading patterns, and whether the problem appears to involve joints, muscles, tendons, nerves, or disc-related spinal pain.

For pickleball players in Andersonville, Ravenswood, Uptown, Lincoln Square, and nearby Chicago neighborhoods, conservative care may include a combination of:

• chiropractic care when appropriate
• physical therapy and rehab
• Class IV laser therapy
• shockwave therapy
• non-surgical spinal decompression for select spine-related cases
• return-to-play guidance based on your presentation and goals

Pickleball Injury Prevention Tips That Matter Most

If you only focus on a few things, start here:

1. Warm up before you play: A few minutes of mobility and activation work is better than stepping onto the court cold.
2. Build volume gradually: A sudden increase in games, league nights, or tournament play is a common setup for overuse pain.
3. Improve mobility where pickleball players need it most: The ankles, hips, thoracic spine, shoulders, and wrists all affect movement and shot tolerance
4. Strengthen the muscles that control force: Calves, glutes, core muscles, rotator cuff muscles, and forearms all matter.
5. Do not ignore recurring pain: Pain that keeps coming back is often a sign that something in your mechanics, mobility, or tissue load needs attention.

FAQ: Pickleball Injuries, Elbow Pain, and Conservative Care

What are the most common pickleball injuries?

Some of the most common pickleball-related complaints involve the ankle, knee, low back, shoulder, elbow, wrist, and Achilles tendon. Falls and overuse injuries are both common.

Can pickleball cause elbow pain?

Yes. Repeated gripping, paddle swings, and forearm overload can irritate the tendons around the elbow, especially on the outside of the elbow.

Is pickleball hard on the knees?

It can be, especially if you already have knee irritation, poor landing mechanics, weak hip support, or limited ankle mobility. Quick changes of direction can increase knee stress.

Can pickleball cause low back pain?

Yes. Repeated bending, twisting, reaching, and reacting can aggravate the low back, especially if hip mobility and core support are limited.

What conservative treatment may help pickleball elbow or tendon pain?

Depending on the cause and severity, conservative care may include activity modification, rehab exercises, soft tissue treatment, Class IV laser therapy, and radial shockwave therapy when clinically appropriate.

Can non-surgical spinal decompression help pickleball-related back pain?

For some patients with disc-related or nerve-related low back symptoms, non-surgical spinal decompression may be part of a conservative treatment plan after an exam. It is not appropriate for every cause of back pain.

Should I keep playing pickleball through pain?

Not usually. Mild muscle fatigue is one thing, but repeated or worsening pain may increase irritation and delay recovery.

When should I see a provider for pickleball injuries?

A good rule is to get checked if symptoms last more than a few days, recur with play, limit motion, affect sleep, or interfere with work or daily function.

Do you treat pickleball injuries in Chicago?

Yes. Ravenswood Chiropractic & Wellness Center evaluates and treats many common pickleball-related musculoskeletal complaints for patients in Andersonville, Ravenswood, and surrounding Chicago neighborhoods.