The 7 Most Common Pickleball Injuries — and How They Heal

Why we're seeing so many pickleball injuries

A 10-year US epidemiologic analysis published in 2024 documented a steep rise in pickleball-related ER visits, from roughly 1,300 cases in 2014 to over 24,000 in 2023. A separate 2025 study found that 73% of injuries are in players aged 60–79, and that women are roughly twice as likely to sustain fractures — which is another separate issue I'll address in a different post.

Most pickleball injuries fall into two patterns:

• Overuse / chronic injuries — tendinopathies that develop from repetitive paddle swings (elbow, shoulder, wrist)
• Acute injuries — slips, falls, sudden starts and stops on the court (ankle sprain, calf tear, Achilles rupture, fracture)

We treat both at Oakville Pain Clinic. PRP therapy is most relevant to the chronic overuse injuries; acute injuries get appropriate management (immobilization, physio, sometimes surgical referral), with regenerative therapy considered for stubborn recovery cases.

1. Sore outside of your elbow — “pickleball elbow”

What it is: Pain on the outside of your elbow that gets worse with paddle swings, gripping, or twisting motions. Clinically it's identical to tennis elbow — a chronic tendinopathy of the wrist extensor tendons where they attach to the bony bump on the outside of your elbow. Different sport, same pathology.

Why pickleball causes it: The repetitive backhand and dink motions load these tendons heavily — particularly with the common “wristy” technique many newer players use.

Treatment hierarchy: First-line is rest from the aggravating activity, a counterforce brace, and physiotherapy (especially eccentric loading). For chronic cases that haven't resolved in 3+ months, PRP has strong evidence — multiple randomized trials show PRP outperforms cortisone for sustained relief of lateral epicondylitis. Read our full PRP for Tennis Elbow & Golfer's Elbow page for evidence and recovery details.

2. Sore shoulder after overhead shots

What it is: Pain in the shoulder — particularly with overhead serves, slams, or reaching to the back of the court. The rotator cuff is the group of four small tendons that stabilize the shoulder, and they take a lot of load with paddle sports.

Why it's especially common in pickleball: Many players are 50+ and may have pre-existing rotator cuff wear before they ever pick up a paddle. Pickleball's overhead motions become the trigger that turns asymptomatic wear into a painful tendinopathy. The 2024 epidemiology study found rotator cuff was the most common body-part injury (~11% of all pickleball injuries).

Treatment hierarchy: Physiotherapy first, with a focus on rotator cuff strengthening and posterior shoulder mobility. If physio plateaus, ultrasound-guided PRP for rotator cuff tendinopathy or partial-thickness tears is reasonable — especially for players trying to avoid surgery. See our PRP for Shoulder & Rotator Cuff page.

3. Pain at the back of your heel — your Achilles

What it is: The Achilles is the thick tendon at the back of your ankle. Two flavours of pickleball-related Achilles problem: chronic tendinopathy (gradual onset, stiffness in the morning, pain that warms up but comes back) and acute rupture (a sudden “pop” with severe pain and inability to push off).

Why pickleball: The sudden starts, stops, and explosive lateral movements load the Achilles heavily, particularly in players returning to a court sport after years of inactivity. Acute Achilles rupture in the 50+ pickleball player is now depressingly common — frequently in the first few weeks after starting the sport.

Treatment: Acute ruptures usually need surgical or functional bracing management — we'll refer to an orthopaedic surgeon. Chronic tendinopathy that hasn't resolved with eccentric loading physiotherapy is where PRP is considered. See our PRP for Achilles & Patellar Tendinopathy page — note that the evidence for PRP in Achilles tendinopathy specifically is mixed, and we discuss honestly.

4. Wrist pain — from a fall or from overuse

What it is: Wrist injuries break into acute (a fall on an outstretched hand, fracture, ligament sprain, TFCC injury — a tear of cartilage on the small-finger side of the wrist) and chronic (overuse tendinopathy, thumb-base osteoarthritis irritation). Women in particular are at higher fracture risk.

Why pickleball: Falls happen — players reach for balls, get tangled at the kitchen line, or back-pedal into a slip. The instinct to break the fall with an outstretched hand transmits the entire fall force into the wrist.

Treatment: Acute fractures get standard orthopaedic care (immobilization, sometimes surgery). For chronic overuse wrist pain, TFCC injury, or thumb-base arthritis that hasn't responded to bracing and physio, ultrasound-guided PRP is considered. The wrist contains many small structures close to nerves — image guidance is essential.

5. A rolled or sprained ankle

What it is: The classic “rolled ankle” — most often an inversion sprain of the lateral ankle ligaments. Range from mild to severe (a “high-grade” sprain approaching a partial tear).

Why pickleball: Quick lateral movements, sudden direction changes, planting on a foot at full speed. The kitchen line is a particular hazard — players lunge forward and roll their ankle on landing.

Treatment: RICE protocol (rest, ice, compression, elevation) for the first 48–72 hours, then progressive weight-bearing, ankle stability physiotherapy, and gradual return to sport. Most low-grade sprains heal fully with conservative care. Recurrent ankle sprains or chronic ankle instability that hasn't responded to physio are where regenerative options are considered.

6. Calf pain — that “pulled muscle” feeling

What it is: A sudden sharp pain in the back of the calf, often with a feeling of being “hit from behind” even when no one's there. Usually a strain or partial tear of the medial gastrocnemius muscle.

Why pickleball: Same explosive push-off and lateral-movement demands that cause Achilles problems. Calf strains are particularly common in older male players. The 2024 epidemiology study found calf injuries account for ~5.6% of all pickleball injuries.

Treatment: Most calf strains heal with rest, graduated stretching and strengthening, and gradual return to activity over 4–8 weeks. Most don't need injection. Persistent muscle pain or recurrent strains may benefit from a regenerative approach.

7. Knee pain or a twist on the court

What it is: Three broad patterns. (a) Acute meniscus tear — twisting a planted leg, often with catching or locking afterwards. (b) MCL or other ligament sprain — sudden valgus stress (knee buckles inward). (c) Underlying knee osteoarthritis flaring up under the new load of court sport.

Why pickleball: The constant pivots and sudden starts/stops are mechanically tough on the knee. Players returning to a court sport often have asymptomatic mild knee osteoarthritis — pickleball is the trigger that turns it painful.

Treatment: Diagnosis matters. Meniscus tears in active patients sometimes need surgical evaluation; in older patients, degenerative meniscus tears often respond to non-surgical care equivalently to surgery. For knee OA flares, we'd typically start with physio + activity modification, and consider PRP or other regenerative options if the OA is becoming persistently symptomatic. See our PRP for Knee Osteoarthritis page.

Preventing the next one — what actually helps

Most pickleball injuries are preventable. Based on what we see in clinic and on Harvard Health's pickleball-injury guidance:

• Warm up properly — 5–10 minutes of dynamic warm-up before play, especially calf and Achilles loading
• Build up gradually — if you're returning to court sport after years off, start with two short sessions per week and add slowly. Injuries spike in the first 4–8 weeks
• Court-appropriate shoes — proper court shoes (not running shoes) have lateral support that reduces ankle sprain risk
• Strengthen rotator cuff and hip stabilizers — two sessions per week of focused strengthening protects shoulder and knee
• Don't play through arm pain — pickleball elbow goes from manageable to chronic if you keep playing through it. Treat early
• Watch the kitchen line — many ankle sprains and falls happen from lunging forward at the no-volley zone. Foot placement matters
• Hydrate and condition cardiovascularly — a lot of pickleball cardiac events occur in unconditioned players in their first weeks

What to do if you're hurt

For acute injuries with significant pain, swelling, inability to bear weight, or any suspicion of fracture — get assessed promptly, usually starting with your family doctor or an urgent-care clinic.

For chronic overuse injuries — pickleball elbow, rotator cuff tendinopathy, chronic Achilles or wrist pain that hasn't resolved with rest and physiotherapy — that's where Oakville Pain Clinic comes in. Self-refer online or call 647-910-5359 and Amanda will reach out within 24 hours to schedule a consultation. We'll examine you, identify what's actually going on, and build a treatment plan that gets you back on court.