by Annie Pierce, University of California

Avid pickleball player Carole Harland says doing dynamic warmups and stretching pre-game is a key to staying injury-free on the court. Credit: Carole Harland

America's fastest-growing sport with the silly name—pickleball—continues to lure new players onto courts in droves. But before hopping into the game, UC San Diego Health physical therapists recommend acing a pickleball pre-game routine to help keep injuries at bay.

"It's a fun and addictive sport that you can pick up easily and immediately start playing," said Aaron Cortez, DPT, physical therapist at UC San Diego Health who has seen an uptick in pickleball injuries among his patients. "Yet it's a fast-moving game with sudden starts and stops—so it's easy to get injured if you haven't run or moved that quickly in years, or maybe even decades."

"It's crucial to prepare yourself for those explosive movements before stepping foot onto the court," he said, adding that the sport is particularly popular among older adults.

Pickleball, a mash-up of ping-pong, tennis and badminton, has clinched the top spot as the fastest growing sport in the country for three years running, with 8.9 million players in the United States in 2023, according to the Sports & Fitness Industry Association, up from 4.8 million in 2022. That number is expected to surge beyond 20 million this year.

With celebrities from Tom Brady to Leonardo DiCaprio heightening the hype of the game, its unprecedented growth is also causing a steep surge in injuries. Pickleball injuries generated more than $350 million in medical costs in 2023, as reported by Bloomberg, citing research by UBS analysts.

The analysts estimated there would be more than 66,750 emergency department visits and 366,000 outpatient visits from pickleball in 2023, based on research from a Journal of Emergency Medicine study about pickleball and tennis-related injuries.

The most common types of injuries reported are sprains, strains and fractures, and patients age 50 or older account for 90% of the injuries.

During the pandemic, pickleball's popularity skyrocketed when people discovered they could escape lockdown by learning to play a fun new game while staying socially distanced outdoors. But why all the injuries?

Kenneth Vitale, MD, a physical medicine and rehabilitation physician at UC San Diego Health, said many pickleball players already have baseline arthritis due to their age.

"When you have arthritis and then further aggravate it with twisting or trauma, the arthritis can flare up. Also, 'picklers' are notorious for not warming up and for continuing to play through an injury, which can progress their arthritis and eventually require joint replacement surgery," Vitale said.

Relishing pre-game preparation

Although the growing number of injuries is causing quite a racket, pickleball addicts say they're not about to shy away from the court.

Carole Harland said it was love at first swing when a friend invited her to play pickleball seven years ago. She had been on a weight loss and exercise journey, going to the gym three days a week and walking.

"But once I discovered pickleball that was it. I dropped the gym and just started playing pickleball nonstop. It's a game where you can just jump in—the hardest part is keeping score and staying out of the 'kitchen,'" Harland said with a laugh, referring to the non-volley zone of a pickleball court.

Harland had suffered with knee arthritis for years and underwent a full knee replacement in May 2023. She teamed up with Cortez for physical therapy to help rebuild her strength and agility before returning to the court.

"Through physical therapy, my range of motion has improved, and I've gradually been able to increase how often I can play," said Harland, who also teaches pickleball introductory classes at Poway Adult School. "Doing dynamic warm-ups and stretching is really important because your body has to be prepared and ready for the quick movements."

Cortez said Harland's newfound respect for prehab exercises has been the key to both her recovery and keeping her injury free post-surgery.

To help others do the same, Cortez and Chris Rudd, DPT, physical therapist at UC San Diego Health, have served up a series of prehab exercises to help prepare both novice and seasoned players alike for the explosive movements of the sport.

An avid pickleball player himself, Cortez says there's a lot to love about the game. With a good warm-up, wearing the correct shoes (tennis, not running shoes) and refraining from straining to return a ball or running backwards, pickleball can be a great way to burn calories and lead an active life.

"It checks a lot of boxes for people of all ages and backgrounds, blending social and physical activity," Cortez said. "There's never been a sport quite like it that has such an intergenerational component where you have teens and seniors playing together. Plus, the average 150-pound person can burn 400 to 500 calories an hour, so it can be a great workout."

Warming up is a big dill

Going from the couch to the court is a recipe for disaster, said Cortez and Rudd. Yet that's what many pickleball players expect their bodies to do. Instead, begin by warming up the body with jumping jacks, jogging or another cardiovascular activity pre-game.

Next, focus on functional movements instead of static movements. Doing forward, reverse and lateral lunges can help prepare the legs and joints for the variety of movements during play. Warming up the shoulders, wrists, ankles and Achilles tendons are also key, along with doing planks for core stability and strength.

"It's also important to play smart—ideally you shouldn't be playing multiple days in a row, because that can cause overuse injuries. You want to gradually ramp up to the activity and not suddenly become obsessed, because the body just isn't used to that level of repetition," Cortez said, adding that cross training, balance and flexibility training are also recommended.

Harland said a great way to avoid injuries is to take an introductory class instead of learning the game on the fly.

"If you start with the foundation of learning the basics and learning what not to do—like running backwards—you won't develop bad habits," she said. "Pickleball is a very social, family-oriented game where there's just so much laughter and fun. I don't ever plan on giving it up!"

Journal information: Journal of Emergency Medicine 

Provided by University of California