Common Pickleball Injuries and How to Prevent Them

Pickleball has rapidly grown in popularity across Charlotte, North Carolina, and beyond. With its fast-paced rallies and lateral movements, the sport offers fun and fitness for players of all ages. However, as with any sport, injuries can occur. 

To help local players stay safe and active on the court, OrthoCarolina recently hosted a webinar with our sports medicine specialist, Dr. Cregar, highlighting the most common pickleball injuries, treatment strategies, and prevention techniques.

Here’s a detailed summary of what you need to know to protect yourself while enjoying the game.

1. Ankle Sprains: The Most Common Pickleball Injury in Charlotte

Ankle sprains are the single most common injury seen in pickleball players, accounting for a significant portion of clinic visits at OrthoCarolina in Charlotte and surrounding areas. These injuries typically occur during quick lateral movements or sudden pivots.

Treatment Approach

• Immobilization: Patients may be placed in a CAM boot or walking boot for up to 10 days to allow soft tissue recovery.
  
• Therapy Phases:
  
  
  • Phase 1: Focuses on reducing swelling, regaining range of motion, and healing tissue.
  • Phase 2: Emphasizes strengthening exercises and proprioception (the body’s ability to stabilize the ankle during side-to-side motions).

Returning to Play

Before returning to pickleball or any other sport, patients should meet the following criteria:

• No swelling or bruising
• Full range of motion and strength compared to the healthy ankle
• No pain during functional movements like jumping or single-leg hops
• Subjective confidence in ankle stability
  

Even after meeting these criteria, many players benefit from protective bracing or taping, as ligaments may take 6–12 weeks to fully heal.

Prevention Tips

• Strengthen lateral stabilizers (peroneal muscles)
• Wear tennis shoes rather than running shoes to enhance lateral stability
• Use functional bracing if you have a history of ankle sprains
• Incorporate dynamic warm-ups and stretching before playing

2. Achilles Tendon Ruptures: Recognizing the Warning Signs

While less common than ankle sprains, Achilles tendon ruptures are a serious injury among pickleball enthusiasts. The Achilles tendon connects the calf muscles (gastrocnemius and soleus) to the heel and is prone to injury in the vascular watershed area, about four centimeters above the heel attachment.

Mechanism of Injury

Ruptures usually occur from:

• Sudden plantarflexion (pointing toes down forcefully)
• Violent dorsiflexion (toes toward the nose)
• “Pop” sensation at the back of the heel, sometimes audible

Symptoms of a Achilles Tendon Ruptures

• Pain primarily in the lower leg or heel rather than the calf muscle
• Weakness during push-off
• Palpable gap over the tendon in some cases
• Difficulty walking

Risk Factors

• Middle-aged “weekend warriors” (ages 30–50)
• Tight calf muscles or decreased flexibility
• Prior use of certain antibiotics or steroid injections

Prevention

• Regular stretching of gastrocnemius and soleus muscles
• Calf strengthening exercises
• Proper footwear (tennis shoes preferred)
• Dynamic warm-up before playing
  

Expert Tip: Differentiating between a calf strain and Achilles rupture is crucial. Calf strains occur higher in the muscle belly and may allow some weight-bearing, whereas Achilles ruptures present with severe weakness in push-off and lower leg pain.

3. Lateral Epicondylitis: Pickleball Elbow

Also known as tennis elbow, lateral epicondylitis affects up to 50% of racket sport players, including pickleball enthusiasts in Charlotte. It results from overuse of the wrist extensor muscles, leading to microtears in the tendon.

Symptoms

• Pain on the outside of the elbow
• Weakness with gripping or wrist extension
• Discomfort during backhand or forehand strokes
  

Treatment

• Rest and activity modification
• Counterforce brace (therapeutic elbow strap)
• Therapy, including TheraBand isometric exercises for the forearm
• Most cases resolve with conservative treatment within 3–6 months

Prevention

• Strengthen forearm muscles using targeted exercises
• Correct grip size and swing mechanics
• Consider two-handed backhands to reduce stress
• Proper warm-up and stretching

4. Knee and Shoulder Injuries

Although less common than ankle and elbow injuries, knee and shoulder issues can occur, especially in older or less conditioned players.

Knee Safety Tips

• Focus on core-to-floor strength, including hips and lower extremities
• Use single-leg balance exercises to improve proprioception
• Compressive knee sleeves can provide mild support for players with arthritis

Shoulder Safety Tips

• Stretch and strengthen the shoulder before play
• Key stretches: forward elevation (overhead), external rotation, and internal rotation behind the back
• Proper technique helps prevent rotator cuff tendonitis

5. General Safety and Injury Prevention for Pickleball Players

To reduce the risk of injury on the court, OrthoCarolina recommends the following:

Warm-Up and Cool Down: Dynamic warm-ups and stretches to activate muscles and joints.

Strength & Conditioning: Regular programs targeting core, hip, and leg muscles.

Flexibility: Stretch all major muscle groups, especially calves and shoulders.

Proper Footwear: Tennis shoes with low pitch and lateral support are ideal.

Gradual Progression: Beginners should start slowly, focusing on technique before competition.

Hydration and Nutrition: Stay hydrated, and maintain bone health with calcium and vitamin D if needed.

Recovery: Respect rest days and avoid overuse. Build endurance gradually.

6. When to See a Doctor

Immediate medical attention is recommended for:

• Severe pain, deformity, or swelling
• Inability to bear weight or reduced joint motion
• Suspected fractures, tendon ruptures, or dislocations
• Pain that worsens or does not improve with conservative measures
  

For less severe injuries, early intervention with therapy, braces, and activity modification can prevent chronic problems.

7. Returning to Pickleball After Surgery

Players with joint replacements (hip, knee, or shoulder) can often return to pickleball after about 4–6 months, once recovery and strengthening milestones are met. Pickleball is lower impact than tennis, making it suitable for post-replacement activity, especially in doubles play.

Play Smart, Stay Strong: Protect Yourself on the Pickleball Court

Pickleball is a fun, accessible sport for all ages, but like any physical activity, it carries injury risks. Awareness, proper preparation, and preventative strategies can help players stay on the court safely.

At OrthoCarolina, our sports medicine team is dedicated to helping athletes of all levels manage injuries, prevent future problems, and optimize performance. If you experience pain or injury while playing pickleball—or want to start a conditioning program to prevent injury—contact our Charlotte clinic to schedule an evaluation.

Frequently Asked Questions

What are the most common pickleball injuries and how can I prevent them?

The most common pickleball injuries include ankle sprains, Achilles tendon strains, and lateral epicondylitis (pickleball elbow). Prevent injuries by warming up, performing dynamic stretches, strengthening the core and ankle stabilizers, using proper footwear like tennis shoes, and gradually increasing playtime to build endurance.

Can I play pickleball after a joint replacement?

Yes, many patients can return to pickleball after hip, knee, or shoulder replacements. Generally, waiting 4–6 months post-surgery and completing a guided strengthening and conditioning program helps reduce injury risk. Always consult your orthopedic specialist before resuming play.

How do I know if my ankle sprain requires medical attention?

Seek medical evaluation if you experience severe pain, swelling, bruising, inability to bear weight, or a visible deformity. Early assessment ensures proper treatment and can prevent chronic ankle instability or delayed recovery.