30s of Therapy: Pickleball Injuries: What Physical Therapists Should Know About Prevention and Rehabilitation

Pickleball is one of the fastest-growing sports worldwide, but with its rise comes an increase in pickleball injuries. From Achilles tendon strains to patellofemoral knee pain, physical therapists are seeing a surge of patients affected by the sport’s specific demands.

Understanding how and why these injuries occur can help PTs prevent them, guide rehabilitation, and safely return athletes to play.

Why Pickleball Injuries Are Becoming More Common

Although often considered low-impact, pickleball involves movements that can stress muscles, tendons, and joints:

• Rapid acceleration toward the net

• Sudden deceleration during returns

• Repetitive deep knee flexion

• Twisting movements through the hips and trunk

Many players increase their playing frequency too quickly and often stop strength training or conditioning, leaving their bodies unprepared for these stresses. This mismatch between activity demand and physical readiness is a key contributor to pickleball injuries.

The Most Common Pickleball Injuries

Achilles Tendon Injuries

Achilles injuries are prevalent among middle-aged recreational players. They often occur during sudden sprints or quick changes in direction. Typical injuries include:

• Achilles tendinopathy

• Calf strains

• Achilles tendon rupture

The mechanism usually involves rapid acceleration from a stationary position, such as rushing to reach a drop shot.

Hamstring Strains

Hamstring injuries are typically caused by eccentric overload.

For example, a player may sprint toward the net, then stop suddenly while bending forward to reach a low ball. This sudden deceleration while the hamstring is lengthened increases the risk of strains. Players who lack explosive strength or proper conditioning are especially vulnerable.

Patellofemoral Knee Pain

Pickleball requires frequent semi-squat positions, especially near the net. Repetitive knee bending can lead to patellofemoral pain syndrome, often presenting as:

• Knee discomfort during play

• Pain descending stairs

• Post-activity knee stiffness after prolonged sitting

Physical therapists often observe weak hip abductors and dynamic valgus during movement, which can exacerbate patellofemoral stress.

Hip and Groin Pain

Rapid pivoting and rotational movements place load on the hip joint. Many players develop:

• Hip impingement or labral irritation

• Groin pain

• Posterior hip or low back discomfort

Load management and movement training are critical to prevent flare-ups, especially in players who abruptly increase practice intensity.

The Role of Load Management in Pickleball Injuries

A common theme among pickleball injuries is poor load management. New players often:

• Play several hours daily

• Skip strength and conditioning

• Drill intensively without recovery

This overload can cause overuse injuries, tendon strain, and joint pain. Educating patients on gradual progression and structured training is crucial to prevent recurrence.

How Physical Therapists Can Prevent and Treat Pickleball Injuries

Start Functional Strength Training

Rehabilitation should include sport-specific exercises that mimic pickleball movements:

• Single-leg squats

• Standing hip strengthening

• Dynamic balance drills

These exercises strengthen muscles in positions used during play, reducing injury risk.

Incorporate Plyometrics and Speed

Pickleball requires rapid acceleration, deceleration, and directional changes. Rehabilitation should progressively add:

• Plyometric exercises

• Agility and reactive drills

• Dynamic control training

This ensures players are prepared for real-game conditions.

Educate Patients on Gradual Load Progression

Players rarely want to stop playing entirely. PTs can guide them to:

• Reduce daily session duration temporarily

• Alternate play and training days

• Gradually increase intensity over time

This approach balances enjoyment with safety and decreases recurrence risk.

Key Takeaways for Physical Therapists

• Pickleball injuries are on the rise—clinics must be prepared.

• Load management is often more important than technique alone.

• Strength, plyometrics, and sport-specific rehab are essential for safe return to play.

• Educate athletes on gradual progression to prevent overuse injuries.

  
  

By understanding the mechanisms behind pickleball injuries, physical therapists can design effective treatment plans and help players enjoy the sport safely.