Pickleball’s gains bring literal pains
Sprains, fractures, tears rise, especially for older players
Ron Friedman remembers the exact moment he hurt his right knee.
“It was in the middle of a pickleball rally, and I aggressively moved toward the ball and made a sort of twisting movement and I felt it right then,” Friedman said of the match in February at Palo Alto’s Mitchell Park. “It happened in an instant.”
Worried he might have reinjured his meniscus, which he’d previously torn while playing pickleball a few years prior, Friedman, 74, made an appointment to see his doctor. Luckily, the pain mostly subsided by then and he was able to resume playing after taking a few days off to rest and stretch.
Pickleball injuries like those sustained by Friedman — who has also experienced muscle strains and tennis elbow during the five years he has played the sport recreationally — are becoming more common, according to sports medicine doctors and emerging research.
It’s not that playing pickleball is more likely to cause injuries than other sports, said Friedman’s doctor, Stanford orthopedic physician Dr. Michael Fredericson. Rather, there are simply more people playing the sport now than ever before. The rise in pickleball-related injuries marks another way the increasingly popular game, which has triggered noise complaints and fights over court space, is having a ripple effect among its ardent enthusiasts and neighboring communities.
About 8.9 million people now play pickleball in the United States, according to 2023 estimates from the Sports and Fitness Industry Association, a trade group that represents sporting goods manufacturers. That represents a 158% increase from just three years ago.
Nationally, bone fractures related to pickleball have also soared from one in 2005 to 91 in 2022, with a notable surge between 2020 and 2021, according to an analysis presented last month at the annual
meeting of the American Academy of Orthopaedic Surgeons. Most injuries occurred in people age 60 and older.
“More people are playing so we’re going to see more injuries,” said Fredericson, who said he began noticing an uptick in pickleball-related injuries in his practice two or three years ago.
Most pickleball injuries are in the lower extremities, like ankle sprains, Achilles injuries, meniscus tears in the knee, and hamstring and calf strains, he said. Some people are also coming in complaining of flare-ups of chronic issues like plantar fasciitis — foot tissue inflammation — or lower back pain. Women with osteoporosis, who are more prone to breaking bones, have come in with broken wrists from falling during a pickleball match. He has also seen some eye injuries.
“The ball can come at you quickly because in pickleball you play close to the net,” Fredericson said. “That’s why I recommend people who play pickleball wear eye protection.”
It’s not the first time doctors are treating waves of injured patients from the latest fitness trend. When Crossfit surged in popularity, many patients reported injured rotator cuffs and low back and knee pain from lifting heavier weights than they could handle, Fredericson said.
When Peloton had its moment a few years ago, Stanford orthopedic physician Dr. Calvin Hwang said he noticed a lot of patients were coming in with knee injuries from the high-intensity stationary bike. Many of them involved the kneecap not tracking properly, which can cause pain.
“Peloton was similar to pickleball two years ago, where I’d see Peloton-related knee problems three to four times a day,” Hwang said. “Pickleball has taken over.”
Hwang estimates he sees at least two patients a day with pickleball-related injuries. Many are older, in their 60s and 70s, have pre-existing arthritis, and picked up pickleball because it’s a less strenuous alternative to tennis.
“I think what’s generally happening is these are people who were previously not active, or relatively inactive, may have been interested in tennis but the barrier was too high so pickleball was a more accessible activity,” he said. “They’re picking it up with a lot of older friends. People are coming in with arthritic flares, Achilles tendonitis, sprained ankles as a result of playing pickleball and not being as spry as they used to be.”
Most pickleball injuries are relatively simple to treat and improve with rest, ice, compression and elevation, or physical therapy to address underlying chronic issues. Some need anti-inflammatory medication such as a steroid or cortisone shot to help manage pain. More serious injuries like a torn Achilles, broken wrist or meniscus tear might need surgery.
Doctors stress that pickleball is safe and fun, and the prospect of injury shouldn’t deter people from trying it because it’s good exercise and a way to connect with a community.
“The overall benefit from an aerobic cardiac perspective of doing pickleball outweighs the shorter-term risk of overuse injury,” Hwang said. “I’d still encourage it.”
Friedman, who lives in Menlo Park, now sometimes wears a soft knee brace when he plays pickleball as a reminder to be careful.
“Sometimes older people, myself included, aren’t in the best shape,” he said. “You don’t remember you’re not 17 anymore.”