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Part of Pickleball and your body

Common pickleball injuries

There is no single pickleball injury: there are two clusters. Falls produce broken wrists, bumped heads and bruised hips, mostly in players past 60 and more often in women. Pushing off and lunging produce Achilles ruptures, strained calves, sore knees and complaining shoulders, more often in men. Which cluster fills a study depends almost entirely on where the researchers looked: emergency department databases are full of fractures and falls, foot and ankle clinics are full of Achilles ruptures, and questionnaires handed to players are full of slow aches that never reached a doctor at all. None of them can give you your own odds, because none of them counted how many people played or for how long.

Read the study type before the number

Four kinds of evidence exist on this subject and they disagree, politely, about almost everything. Emergency department databases weight a sample of hospitals up to a national figure: good for spotting fractures and falls, useless for a sprained calf that got ice and a week off. Hospital clinic reviews describe the people who booked an appointment at that particular department, which is why a foot and ankle service reports an ocean of Achilles tendons. Questionnaires handed to players catch the slow aches that never reached anyone, and they depend on people remembering a year accurately. Case series describe a handful of patients in detail.

What none of them has is a denominator. To turn a count into a risk you need to know how many people played and for how many hours, and no study of this sport has that. So a figure on this page describes the people who were counted, not the chance of it happening to you on Saturday.

Falls, and the wrist that breaks stopping one

Falling dominates the hospital data, and in older players it beats everything else by a distance. Across ten years of US emergency department records for people aged 60 and over, a slip, trip or fall lay behind 66.9% of the pickleball injuries counted (Weiss 2021). The reflex that follows is the problem: a hand goes out, the whole body weight arrives on it, and the bone at the end of the forearm gives way. Distal radius fracture was the commonest hand and wrist diagnosis in a five-year clinic review, at 60% of its 30 cases (Meng 2026).

One detail from that review is worth knowing before your next game. Half of its 30 hand and wrist injuries, 15 of them, were on the non-paddle side, against 1 of 23 at the shoulder and 1 of 8 at the elbow, a difference the authors reported at a significance level below 0.01 (Meng 2026). The hand not holding anything is the one free to reach for the ground.

Heads matter too. In the all-age pickleball sample from the same database the head was the third most frequently injured body part, at 11.9%, behind the wrist and the lower leg, and among players 60 and over the head and neck took 18.1% of injuries by region (Weiss 2021). A knock to the head on a hard court is not something to shake off, and the warning list on this page gives the signs that need an emergency department the same evening, not a night of hoping it settles.

The ankle, calf and Achilles

This is where the sport does its most dramatic damage, and it does it without any contact at all. At one hospital foot and ankle service, a records search found 198 pickleball injuries, with a mean patient age of 58.3 years, 58.6% men, 77.8% describing a single traumatic moment, and Achilles rupture the commonest diagnosis at 39.4%. The mechanisms were running or lunging forward (30.9%), planting the foot (16.5%) and turning the ankle inward (15.5%). Overall 71.2% were managed without surgery, though 62.8% of the Achilles ruptures went to the operating room (Kingston 2024).

Age is the thread running through it. A separate review of 2,684 Achilles ruptures at one center between 2013 and 2023 picked out 43 that happened at pickleball. Those patients averaged 64.5 years against 48.6 for all the other ruptures, had a lower average body mass index, and were operated on more often (67.4% against 45.4%). The authors reported the number rising every year since 2016 apart from 2020 (McCahon 2026). Two case series at two hospitals do not make an epidemic, but they point the same way, and both sets of authors said so.

A rolled ankle is the quieter version of the same story and has its own staged program on the ankle sprain page. A tendon that aches but has not torn belongs with Achilles tendinopathy, and one that has torn goes to Achilles tendon rupture, where the surgical team's timeline comes first.

The knee

Knees show up more in clinics and surveys than in emergency departments, which fits: a meniscus does not usually send anyone to hospital at midnight. In the five-year academic clinic review, the knee was the biggest single group at 52 of 164 injuries, and a medial meniscal tear was the commonest diagnosis within it at 48%, with twisting or pivoting on a planted foot named as the movement involved (Meng 2026). In the player questionnaire from a Korean tournament, where 34.2% of 232 players reported an injury in the past year, the knee also led, at 23.3% of the injuries described (Jeong 2025).

Two different knee problems get confused here. A twist that leaves a knee swollen, catching or locking is a mechanical injury and belongs with meniscus tear. A knee that aches at the front on stairs and after sitting is usually a loading problem, and the program for that is patellofemoral pain. An assessment separates them in minutes, and the programs are not interchangeable.

The shoulder

The serve is not the problem people assume it is. A legal serve in this sport is low by rule: the serving arm has to be moving in an upward arc, the ball has to be struck below waist level, and the paddle head has to stay below the highest part of the wrist. A drop serve is allowed as an alternative and waives those three (USA Pickleball).

So the standard serve is not an overhead action. The overhead load comes from the smash, the high volley and the scramble back for a lob, and that above-the-head position is the one shoulders over 50 like least. In the clinic review, 23 shoulder injuries were recorded and 70% of them were rotator cuff tears, linked by the authors to overhead motions; unlike the elbow and wrist groups, only 35% of those patients were women (Meng 2026). The Korean survey put the shoulder or upper arm third among the regions named, at 17.2% of the injuries reported (Jeong 2025).

A change on a scan is not proof that the cuff is what hurts, and NHS advice for a painful shoulder is to keep it moving gently rather than to stop using it. The rotator cuff tendinopathy program is the staged version, and shoulder pain when lifting your arm works through the alternatives.

The elbow, the hand and the back

Elbows are a smaller group in the hospital data than the internet suggests, though they are common in surveys, where gradual problems dominate: the elbow or forearm accounted for 18.1% of the injuries reported in the Korean tournament group (Jeong 2025). In the US clinic review the elbow group was only 8 patients, 6 of them with pain on the outside of the elbow; backhand shots and a tight grip are what the authors propose as the mechanism rather than something they measured (Meng 2026).

Backs turn up quietly. The same review recorded 10 spine cases, half of them nerve-related radiating pain and half spinal stenosis, though only two of those records mentioned a mechanism at all, both pain with repeated twisting (Meng 2026); the Korean survey put the lower back at 6.0% of injuries and the upper back at 4.3% (Jeong 2025). Small numbers, but enough to say the spine takes a share of the work too.

Eyes and faces

Balls and paddles travel at head height in a doubles game, and the court is short. The surprise in the one study of this is that neither did most of the damage. Going through 14 years of emergency department eye injury records, falls with facial trauma accounted for 60.7% of pickleball cases, a paddle strike for 15.4% and a ball strike for 10.3%, with the rate of these injuries rising 37.3% between 2022 and 2023 alone (Kamboj 2026). Cuts and bruises made up most of the diagnoses and almost every patient went home the same visit. The eye signs that are not minor are in the warning list on this page.

What it adds up to

Two problems, and they need different answers. Falls need balance and leg strength, better light, dry courts and honest shoes, and they need a doctor to look at your medicines and your blood pressure if you have gone down more than once. The balance and falls prevention program builds the first part of that up week by week. Push-off injuries ask for a calf that has been trained rather than surprised, and for a body that is warm before the first point, although no trial has tested a warm-up in this sport, as the warm-up page explains.

The rest of this topic takes the sore parts one at a time. Start at the pickleball hub if you want the overview and the exercises that cover the whole picture.

When to see a physio (physical therapist)

Go once, early, instead of three times, late. A first appointment is worth it if something has not settled in two weeks, if you have changed how you play to avoid a movement, or if you cannot say whether the problem is the shoulder, the neck or both. After a fall, go even if nothing broke, because the fall itself is the finding worth acting on.

Bring the details that sort one diagnosis from another: which shot brings it on, whether it is worse the next morning, how long it has been there and what you have already tried. Anything in the warning list below is dealt with first, at the speed each line sets, and a physio is not the right first call for any of them.

Related exercise programs

See a doctor promptly if

  • Emergency: if chest pain, pressure or tightness does not ease quickly when you rest, spreads to your arm, neck, jaw, stomach or back, or comes with sweating, feeling sick, feeling light-headed or being short of breath, call emergency services straight away, as this can be a heart attack. If it eases quickly and none of these happen, get medical advice the same day, and do not exercise again until you have been checked.
  • Emergency: after a fall or injury to the wrist, your hand is numb, tingles or has pins and needles, the wrist has changed shape or sits at an odd angle, or you heard a crack. The same applies to a bone showing through the skin or a cut that is bleeding heavily. Go to an emergency department or call emergency services straight away, and do not drive yourself. The wrist may be broken or out of place.
  • Emergency: your arm, hand or fingers turn cold, pale, blue or gray compared with the other side. Call emergency services or go to an emergency department straight away, and do not drive yourself. The blood supply to the arm may be blocked.
  • Emergency: the shoulder feels as if it has slipped out of place, looks a different shape or suddenly locks so you cannot move the arm, or the pain is severe after a fall or an injury. Go to an emergency department straight away, without driving yourself, and do not try to put the shoulder back in yourself.
  • Emergency: the knee became very swollen very quickly, within a few hours of a twist, fall or blow, or you felt a pop or snap. Go to an emergency department straight away. Do not drive yourself: ask someone to drive you or call an ambulance. A knee that fills up that fast has usually bled inside the joint, which can come from a torn ligament, a kneecap that slipped out or a break, so it needs checking before you play again.
  • Emergency: after a ball, a paddle or a fall to the face, any change to your sight, severe pain in the eye, a headache or finding light hard to bear, feeling sick or being sick, an eye you cannot move or keep open, or blood or pus coming from the eye. The same applies if something has pierced the eye or hit it at high speed, or if a strong chemical has gone into it. Go to an emergency department or call emergency services straight away, and do not drive yourself.
  • Emergency: after a knock to the head, being very drowsy or finding it hard to keep your eyes open, confusion, a fit (seizure), new weakness or numbness anywhere in your body, new trouble understanding, speaking, walking or keeping your balance, new problems seeing or hearing, clear fluid coming from your ears or nose, bleeding from your ears or bruising behind them, a black eye when your eye was not hit, a dent in your head or a wound with something stuck in it, or a change in behavior. Call emergency services straight away. These can be signs of an injury to the brain.
  • Emergency: after a knock to the head, you were knocked out, even for a moment, you cannot remember what happened just before or after, you have had a headache ever since, or you are being sick (vomiting). The same applies, even if you feel fine, if you take medicine that thins your blood, other than aspirin on its own, have a bleeding or clotting condition, have had brain surgery in the past, or had been drinking alcohol or taking drugs when it happened. Go to an emergency department straight away, and do not drive yourself.
  • Same day: a sudden pop or snap at the back of your ankle or heel, a feeling that someone kicked you there, or sudden pain there after which you cannot push off or rise onto your toes on that leg. Stop, take the weight off that leg carefully and go to an urgent care center or emergency department the same day, even if you can still walk, as this can be a torn Achilles tendon.
  • Same day: new wrist pain after a fall, even a small one, if you are older, have low bone density (osteoporosis) or have taken steroid tablets for a long time, even if you can still move the wrist. Get medical advice the same day and ask about an X-ray. A broken wrist is not always obvious at first.
  • Same day: the knee is hot, red and swollen, or you have knee pain with a high temperature or feel hot, cold or shivery. Get medical advice the same day, and go to an emergency department if you feel very unwell. This can be a sign of infection in the joint, which needs treatment quickly.
  • Same day: a calf or thigh that is newly swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that does not fit your injury or condition, or that feels different from normal muscle soreness after exercise. This can be a sign of a blood clot (deep vein thrombosis), especially after surgery, an injury, time in a cast or boot, a long trip or a spell of being much less mobile than usual. Get medical advice the same day. If you are also short of breath or have chest pain, call emergency services.
  • Within a few days: the pain is there at night or at rest and keeps getting worse. See your doctor within a few days. If you have had cancer, now or in the past, or are losing weight without trying, see your doctor sooner, within a day or two, and mention it. This applies even if the pain is not getting worse. If you are being treated for cancer now, contact your cancer team the same day.

Common questions

What is the most common pickleball injury?

It depends which door you count people walking through, and the answer changes completely between them. In a national sample of US emergency departments from 2014 to 2023, fracture was the commonest named diagnosis at 26.4%, with strains and sprains at 24.0%, although a third of cases were filed simply as other (McMillan 2025). In a hospital foot and ankle service, Achilles rupture was the commonest diagnosis at 39.4% of 198 cases (Kingston 2024). In a questionnaire filled in by 232 tournament players in South Korea, of whom 34.2% reported an injury in the past year, the knee was the region named most often at 23.3% of those injuries, and 78% of what they described had come on gradually rather than in one moment (Jeong 2025). All three are true, and none of them is the average player.

Do women and men get different pickleball injuries?

The databases say yes, consistently. Among emergency department patients aged 60 and over, the odds of a fracture were 3.7 times higher in women than in men, and the odds of a wrist fracture 9.3 times higher, while men had 3.5 times the odds of a strain or sprain (Weiss 2021). The later analysis of the same database found women with higher odds of hand and wrist injuries and of falls, and men with higher odds of lower limb injuries and of overexertion (McMillan 2025). A clinic series found the same split from the other side: 75% of its elbow patients and 77% of its hand and wrist patients were women, against 35% of its shoulder patients, a difference it reported at a significance level below 0.01 (Meng 2026). Bone strength is the likeliest part of the explanation, and the authors of that series note that a wrist fracture in an older adult can be the first sign of thinning bone, which is worth raising with your doctor.

Do you need eye protection for pickleball?

No trial has tested eyewear in this sport, so nobody has measured what it prevents. What has been counted is the injuries: emergency department records from 2010 to 2023 held 117 pickleball eye injury cases, weighted to an estimated 6,015 visits nationally, with a mean age of 59.9 years. Falls with facial trauma caused 60.7% of them, a paddle 15.4% and the ball 10.3%, and 98.3% of patients were treated and sent home (Kamboj 2026). So most were minor, and the ball was not the main culprit: the impacts eyewear guards against were the smaller share, and going down on the court was the larger one. Eyewear is cheap and harmless if it makes you comfortable at the net, and it is no substitute for the balance and strength work that falls need.

Is pickleball elbow the same thing as tennis elbow?

The tissue is the same and the name is marketing. Pain on the bony bump on the outside of the elbow, worse when you grip or lift with the palm down, is lateral epicondylalgia whatever racket or paddle brought it on. In one clinic series it was the diagnosis in 6 of the 8 pickleball elbow cases, and the authors point to backhand shots and a tight grip, as a proposal rather than a measurement (Meng 2026). That is a small group, so treat it as a description, not a statistic. The program for it is the tennis elbow program linked from this page, and the site also has a page on elbow pain when lifting that covers how to tell it apart from the other causes.

Does playing more often make injury more likely?

You would expect so, and the one survey that asked found the opposite, which is a good reason to be careful with it. Among 232 tournament players, more weekly playing hours and a higher skill level both went with lower odds of having been injured in the past year, and both associations were small (odds ratios 0.91 per hour and 0.79 per skill level) (Jeong 2025). That is a cross-sectional survey at a single tournament, so it cannot show cause, it counts people fit enough to enter a tournament, and anyone hurt badly enough to stop playing was never there to fill it in. Someone carrying an injury also plays fewer hours a week, which on its own would produce the pattern the authors found. What is better supported is the shape of the increase, not the total: sudden jumps in how much you play, after a new court opens or a vacation week, are what clinicians see before an overuse problem arrives.

References

  1. McMillan P, Lake LP, Burkhart A, Reddy E, Hale IC, Grawe BM. The epidemiology of pickleball injuries presenting to US emergency departments. Sports Health. Published online 13 July 2025; in print 2026;18(4):749-755. https://doi.org/10.1177/19417381251350671
  2. Weiss H, Dougherty J, DiMaggio C. Non-fatal senior pickleball and tennis-related injuries treated in United States emergency departments, 2010-2019. Injury Epidemiology. 2021;8:34. https://doi.org/10.1186/s40621-021-00327-9
  3. Meng Y, Chen A, Nguyen C, Kaufman M, Li D, Pham N, Chou R, Roh E. Pickleball-related injuries treated at a tertiary academic center over five years: a cross-sectional study. Injury Epidemiology. 2026;13:39. https://doi.org/10.1186/s40621-026-00673-6
  4. Kingston K, Parker EB, Higgins A, Smith JT. Emerging patterns of foot and ankle injuries in pickleball players: a short report. Foot and Ankle International. 2024;45(11):1266-1269. https://doi.org/10.1177/10711007241271215
  5. McCahon JAS, Miller M, Riebesell S, Pedowitz DI, Parekh SG, Daniel JN. Pickleball and the rising incidence of Achilles tendon injuries in the elderly. Foot and Ankle Specialist. 2026;19(2):206-210. https://doi.org/10.1177/19386400241286591
  6. Jeong B, Lee KJ, Nam SH, Im S, Lee RS, Heo J, Kim KM. Injury risk and epidemiology of pickleball players in South Korea: a cross-sectional study. Frontiers in Public Health. 2025;13:1617291. https://doi.org/10.3389/fpubh.2025.1617291
  7. Kamboj A, Kistamgari S, Mokhtarzadeh A, Harrison AR, Smith GA. Pickleball-related eye injuries presenting to United States emergency departments, 2010-2023. Digital Journal of Ophthalmology. 2026;32(2):26-31. https://doi.org/10.5693/djo.01.2025.12.001
  8. USA Pickleball. Essential pickleball rules summary for beginners. https://usapickleball.org/rules/summary/
  9. NHS. Shoulder pain. Page last reviewed 22 May 2023. https://www.nhs.uk/symptoms/shoulder-pain/
  10. NHS. Eye injuries. Page last reviewed 12 March 2026. https://www.nhs.uk/conditions/eye-injuries/
  11. NHS. Head injury and concussion. Page last reviewed 29 May 2025. https://www.nhs.uk/conditions/head-injury-and-concussion/
  12. NHS. Chest pain. Page last reviewed 8 August 2023. https://www.nhs.uk/symptoms/chest-pain/
  13. NHS. DVT (deep vein thrombosis). Page last reviewed 30 April 2026. https://www.nhs.uk/conditions/deep-vein-thrombosis-dvt/
  14. NHS. Tendonitis. Page last reviewed 9 June 2023. https://www.nhs.uk/conditions/tendonitis/

Written and checked by the PocketPhysio editorial team. Last updated 2026-10-01.

This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.