Common Pickleball Injuries and How to Prevent Them

Pickleball is often promoted as a low-impact sport — and compared to tennis or squash, it is. The smaller court means less running, the lighter ball means less force on impact, and the underarm serve reduces shoulder stress. But low-impact does not mean injury-free.

As participation grows across Nottinghamshire and the UK, so does the number of players picking up injuries — many of which are preventable.

Pickleball Elbow (Lateral Epicondylitis)

What it is: Pain and inflammation on the outside of the elbow, caused by overuse of the forearm muscles that attach to the lateral epicondyle. The same condition as tennis elbow — just increasingly associated with pickleball due to the sport's rapid growth.

Why it happens in pickleball: The repetitive motion of dinking — hundreds of small, controlled strokes per session — puts sustained stress on the forearm tendons. Poor grip technique and a paddle that is too heavy or has too small a grip circumference make it worse.

Prevention:

• Check your grip size — a grip that is too small forces you to squeeze harder, increasing tendon stress
• Strengthen forearm and wrist muscles with resistance band exercises off court
• Do not play through pain — early intervention prevents chronic injury
• Consider a lighter paddle if you play frequently

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Shoulder Injuries

What it is: Rotator cuff strains, impingement, or general shoulder soreness. Less common in pickleball than tennis due to the underarm serve, but still seen — particularly in overhead smashes.

Why it happens: Players new to pickleball who come from tennis often try to replicate an overhead tennis smash. The mechanics are different and the attempt can put the shoulder in an awkward position. Overuse in players who play multiple sessions per week is also a factor.

Prevention:

• Learn the correct overhead smash technique — do not import your tennis overhead directly
• Warm up the shoulder joint properly before play, including rotational movements
• Build shoulder strength with rotator cuff exercises — external rotation with a resistance band is particularly effective
• Limit back-to-back high-intensity sessions when starting out

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Knee Pain and Meniscus Issues

What it is: Pain around or inside the knee joint, sometimes involving the meniscus cartilage. More common in older players or those returning to sport after a period of inactivity.

Why it happens: The quick lateral movements at the kitchen line — shuffling side to side, lunging for wide balls — put rotational stress on the knee. Hard court surfaces increase the impact load. Players who do not bend their knees properly and instead lunge with a straight leg are particularly vulnerable.

Prevention:

• Always bend your knees when moving laterally — never lunge with a straight leg
• Wear court shoes with proper lateral support — running shoes are not suitable for pickleball
• Strengthen the quadriceps and hamstrings — strong legs protect the knee joint
• If you have a history of knee problems, consider a knee brace for additional support

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Ankle Sprains

What it is: A sprain of the ligaments on the outside of the ankle, caused by the foot rolling inward during a quick direction change.

Why it happens: Pickleball involves frequent short, sharp movements — particularly at the kitchen line. Uneven court surfaces, poor footwear, or simply losing your footing mid-rally can lead to an ankle roll.

Prevention:

• Wear proper court shoes with ankle support — not running shoes or casual trainers
• Strengthen ankle stability with single-leg balance exercises
• Be aware of court surface conditions — outdoor courts at venues like Let's Dink can be uneven or slippery after rain
• If you have a history of ankle sprains, a lace-up brace adds meaningful protection

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Achilles Tendon Problems

What it is: Pain and inflammation in the Achilles tendon, the large tendon connecting the calf muscle to the heel. In serious cases, partial or full rupture — a significant injury requiring surgery.

Why it happens: Explosive push-off movements — sprinting forward to reach a drop shot, for example — put sudden high load on the Achilles. The risk is higher in players over 40, those who play infrequently but intensely, and players who skip warm-up.

Prevention:

• Always warm up — cold tendons are far more vulnerable to injury
• Eccentric calf raises (lowering slowly on one leg) are the most evidence-based exercise for Achilles tendon health
• Do not dramatically increase your playing volume week to week — the tendon adapts slowly
• If you feel any sharp or sudden pain in the Achilles, stop immediately

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Wrist Injuries

What it is: Strains, sprains, or in more serious cases fractures — typically from falling and putting a hand out to break the fall.

Why it happens: Falls in pickleball happen. The quick footwork, occasional court obstructions, and competitive instinct to reach for impossible balls all create fall risk. The natural reaction is to put a hand out, which transfers the impact to the wrist.

Prevention:

• Work on your court awareness — know where the kitchen line and boundaries are at all times
• Do not over-reach for balls that are clearly going out
• Wrist strengthening exercises reduce strain injury risk
• If you have osteoporosis or reduced bone density, be particularly cautious — a fall that a younger player walks away from can cause a fracture

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General Prevention Principles

Warm up before every session. Five minutes of light movement, dynamic stretching and gentle rallying before you play competitively significantly reduces injury risk. A cold body does not absorb impact well.

Wear the right shoes. This cannot be overstated. Court shoes designed for lateral movement — not running shoes — protect your ankles, knees, and Achilles. If you are playing on hard courts regularly, this is non-negotiable.

Do not play through pain. Pain is your body signalling that something is wrong. Playing through it converts a minor strain into a chronic injury. Rest, ice, and see a physiotherapist early — not after six weeks of hoping it gets better on its own.

Build up gradually. One of the most common injury patterns in pickleball is the enthusiastic new player who goes from nothing to five sessions a week in a fortnight. Tendons and joints adapt more slowly than cardiovascular fitness. Increase playing volume gradually.

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If you are picking up the sport for the first time in Nottinghamshire, our courts page lists clubs running beginner-friendly sessions across the county.