Pickleball Injuries: Symptoms, Treatment & Physiotherapy

Reviewed by the Physiotherapy Team at Waterloo Sports Medicine Centre 

Pickleball is a fun, social sport that combines quick movements, short sprints, lunges, and repetitive paddle swings. As participation continues to grow, so does the number of pickleball-related injuries.  

Why Do Pickleball Injuries Happen? 

Pickleball is often considered a relatively low-impact sport, but it still requires frequent accelerations, decelerations, changes of direction, lunges, reaching, and repetitive swings. 

Common contributors include: 

• Sudden increases in playing frequency 

• Playing for longer sessions than usual 

• Inadequate warm-up 

• Limited strength or conditioning 

• Repetitive movements 

• Sudden changes of direction 

• Reaching or lunging for the ball 

• Falling while moving backward 

• Previous injuries 

• Returning to pickleball too quickly after time away 

  
  

Common Pickleball Injuries 

1. Tennis Elbow (Lateral Epicondylitis) 

Despite its name, tennis elbow is common in pickleball players too. 

Repeated gripping and paddle swings can place stress on the tendons that attach to the outside of the elbow. 

Symptoms may include: 

• Pain on the outside of the elbow 

• Pain with gripping the paddle 

• Discomfort when lifting objects 

• Pain with wrist extension

• Reduced grip strength 

Treatment usually focuses on progressive strengthening of the wrist and forearm, activity modification, and addressing factors such as paddle technique and training volume. 

2. Rotator Cuff Injuries 

The shoulder is repeatedly used during serves, overhead shots, and other paddle movements. 

Overuse can contribute to conditions involving the rotator cuff tendons, including tendinopathy and, in some cases, rotator cuff tears. 

Symptoms may include: 

• Shoulder pain during or after playing 

• Pain reaching overhead 

• Pain reaching behind your back 

• Weakness 

• Difficulty sleeping on the affected shoulder 

Physiotherapy may include rotator cuff and shoulder-blade strengthening, mobility exercises, movement retraining, and gradual return to overhead activity. 

3. Wrist and Hand Injuries 

Pickleball requires repetitive gripping and rapid paddle movements. Players may also injure the wrist or hand when attempting to break a fall. 

Common injuries include: 

• Wrist sprains 

• Tendon irritation 

• Ligament injuries 

• Fractures 

Falls are particularly important because landing on an outstretched hand can transmit significant force through the wrist. Distal radius fractures are among the reported pickleball-related injuries, particularly following falls. 

4. Knee Injuries 

The knee is exposed to repeated loading during: 

• Lunges 

• Squatting 

• Sudden stops 

• Direction changes 

• Forward and lateral movements 

Pickleball players may experience knee strains, sprains, meniscus injuries, or aggravation of existing knee osteoarthritis. 

Physiotherapy can help improve quadriceps and hip strength, balance, single-leg control, and movement mechanics to help the knee tolerate the demands of the sport. 

5. Ankle Sprains 

Ankle sprains can occur when the foot rolls inward during a quick change of direction or when landing awkwardly. 

Symptoms can include: 

• Pain 

• Swelling 

• Bruising 

• Reduced ankle movement 

• Difficulty putting weight through the foot 

Rapid lateral movements and changes of direction make ankle stability particularly important in pickleball. 

Rehabilitation following an ankle sprain should include more than simply waiting for the swelling to disappear. Strength, balance, proprioception, and sport-specific movement should be progressively restored before returning to unrestricted play. 

6. Achilles Tendon Injuries 

The Achilles tendon connects the calf muscles to the heel and is heavily loaded during pushing off, sprinting, and sudden acceleration. 

Pickleball players may develop: 

• Achilles tendinopathy 

• Calf strains 

• Partial Achilles injuries 

• Achilles tendon ruptures 

  
  

7. Calf and Hamstring Strains 

The quick starts, stops, and lunges required during pickleball can place significant demands on the calf and hamstring muscles. 

A strain can cause: 

• Sudden pain 

• Muscle tenderness 

• Pain with walking or running 

• Reduced strength 

• Difficulty pushing off or accelerating 

Returning to full-speed play before adequate strength and function have returned can increase the risk of reinjury.

8. Back Injuries 

Pickleball involves frequent bending, rotation, reaching, and rapid changes in position. 

Some players may experience: 

• Low back pain 

• Muscle strains 

• Irritation of pre-existing spinal conditions 

• Radiating leg symptoms 

Physiotherapy can address contributing factors such as trunk and hip strength, mobility, movement mechanics, and gradual conditioning. 

How Can Physiotherapy Help Pickleball Injuries? 

Physiotherapy is not only useful after an injury. It can also help players reduce injury risk and improve their ability to tolerate the demands of pickleball. 

1. Reduce Pain and Irritation 

Your physiotherapist can help determine which activities are aggravating your symptoms and modify your training while maintaining appropriate movement and activity. 

2. Building Strength 

3. Improve Balance and Agility 

Pickleball requires rapid changes in direction and frequent single-leg movements. 

Exercises targeting balance, proprioception, coordination, and agility can help prepare your body for these demands. 

 4. Improve Movement Mechanics 

Your physiotherapist can assess your movement patterns to help you tolerate repetitive sporting demands. 

5. Create a Return-to-Pickleball Program 

After an injury, returning directly to full games may place too much stress on the recovering tissues. A physiotherapist can gradually progress: 

Rehabilitation exercises → sport-specific movements → hitting drills → controlled play → full games 

How Can You Prevent Pickleball Injuries? 

Warm up before playing 

Spend several minutes preparing your body with dynamic movements such as: 

• Walking or light jogging 

• Leg swings 

• Calf raises 

• Bodyweight squats 

• Lunges 

• Shoulder movements 

  
  

Build your playing volume gradually 

Strength train regularly 

Strengthening the legs, hips, core, shoulders, and forearms can help prepare you for the demands of pickleball. 

Work on balance 

Wear appropriate footwear 

Choose shoes designed for court sports that provide appropriate traction and support. 

Don't ignore persistent pain 

Muscle soreness after playing is common. If pain repeatedly returns every time you play, consider having it assessed rather than continuing to play through it. 

Looking for Pickleball Injury Physiotherapy in Waterloo? 

Pickleball is a great way to stay active! If pain is impacting your ability to play, contact Waterloo Sports Medicine Centre to learn how individualized physiotherapy can help you recover and prevent injuries!