Pickleball Injuries: How to Prevent and Manage

1.    Check your health before ramping up activity

• If you have a chronic medical condition such as heart disease, high blood pressure (hypertension), diabetes, osteoporosis or previous joint problems, speak to your doctor before suddenly increasing your activity level.
• Older adults and people who have been sedentary for a long time should start gradually, with shorter sessions and lower intensity.

A medical review can pick up heart, bone or joint issues that may raise your risk of serious health complications such as fractures or cardiac events.

2.    Warm up and cool down before and after playing

Many injuries happen when players sprint or twist suddenly with “cold” muscles and joints.

• Spend 5–10 minutes walking briskly or doing light jogging on the spot.
• Add dynamic movements such as leg swings, side steps, gentle lunges and arm circles.
•  After the game, stretch major muscle groups (calves, thighs, hips, shoulders and back) and hold each stretch for 15–30 seconds.

A proper warm-up increases blood flow, improves flexibility and reduces the risk of sudden muscle strains or joint sprains. Cooling down helps your heart rate and blood pressure return to normal levels gradually while improving circulation and recovery. It also reduces muscle soreness and stiffness, improves flexibility and lowers the risks of injury.

3.    Build strength, balance and flexibility off the court

Pickleball involves repeated lunges, quick sideways steps and reaching overhead. Weak or tight muscles can struggle with these demands.

Try to include, 2–3 times a week:

• Strength-training exercises: bodyweight squats, lunges, step-ups, planks and wall push-ups.
• Balance work: single-leg stands (hold onto a chair if needed) and heel-to-toe walking.
• Flexibility exercises: regular stretching for calves, hamstrings, hips, lower back and shoulders.

You can do these exercises at home, in your neighbourhood gym or in a community centre fitness corner. Stronger muscles and better balance support your joints, help you move more confidently, while lowering the risk of falls and overuse injuries.

4.    Choose the right shoes, paddle and court surface

Equipment matters more than many players realise.

• Wear court shoes with good grip and side support, rather than running shoes that are built mainly for forward movement.
• Replace worn-out soles to reduce the chance of slipping on indoor or outdoor courts.
• Choose a paddle grip size and weight that feels comfortable. A grip that is too small or too large may strain your wrist and elbow.
• Avoid playing on wet or uneven courts. Wipe sweat or water off the floor during indoor games.

Proper footwear and a safe surface reduce slips, twists and falls. A suitable paddle can lower the strain on your wrist, elbow and shoulder.

5.    Pace yourself and do not jump in too fast

Physiotherapists in Singapore have observed that many injuries occur when people go from a sedentary lifestyle straight into frequent games, or when they play for long hours without rest.

• Beginners can start with 1–2 non-consecutive sessions of 30–45 minutes each per week and increase frequency slowly.
• Alternate pickleball with lower-impact activities such as yoga, walking, cycling or swimming to prevent overuse injuries.
• Take regular breaks between games, especially in hot weather.

Gradual progression allows your muscles, tendons and joints to adapt, reducing the risk of overloading them.

6.   Learn proper technique and movement patterns

Rapid side-to-side movement, as well as sudden forward and backward steps, are unique challenges in pickleball and can catch new players off guard.

• Consider a few coaching sessions or beginner classes to learn basics such as safe lunging, turning and stopping.
• Avoid twisting your knee while your foot is fixed on the ground; instead, pivot your whole body.
• Keep your knees slightly bent and your weight centred rather than leaning backwards.

Better technique spreads the load more evenly through your body and helps prevent knee, ankle, shoulder and back injuries.

7.   Protect your eyes when playing pickleball

Eye injuries are an emerging concern in pickleball. An analysis of US data estimated more than 3,000 pickleball-related eye injuries between 2005 and 2024, with a sharp rise in recent years and over 1,200 cases in 2024 alone⁽³⁾. Many of these involved direct hits from the ball, falls or contact with a paddle, and some resulted in serious problems such as retinal detachment and fractures around the eye socket.

• Consider wearing wrap-around protective eyewear made from polycarbonate or other impact-resistant material, especially if you already have eye conditions.
• Players aged 50 and older have been found to have a higher risk of eye injuries, so additional protection is advisable ⁽³⁾.
• Avoid standing too close behind your partner and call out loudly when going for a ball to reduce accidental paddle contact.

Protective eyewear and good court awareness can prevent painful eye injuries and safeguard your vision.

8.   Stay safe in Singapore’s heat and humidity

Outdoor courts in Singapore can be very hot and humid.

• Drink water regularly before, during and after play.
• Avoid playing at the hottest times of day where possible (late morning to mid-afternoon).
• Watch for warning signs such as dizziness, nausea, headache, chest discomfort or breathlessness.

Good hydration and heat precautions reduce the risk of heat exhaustion, heatstroke and cardiac events during play.

1.    Stop playing and assess the injury

If you feel a sudden sharp pain in your joint, a “pop”, significant swelling, or cannot move a joint normally, stop immediately.

Continuing to play through pain can worsen ligament tears, tendon injuries or fractures.

Stopping early minimises further damage and improves the chances of a full recovery.

2.    Use RICE for mild sprains and strains

For minor soft-tissue injuries where you can still bear some weight and there is no obvious deformity:

• Rest the injured area for the first 24–48 hours.
• Ice: apply a cold pack for 15–20 minutes at a time, several times a day.
• Compression: use an elastic bandage if advised, making sure it is not too tight.
• Elevation: keep the injured area raised above heart level where possible.

RICE helps reduce pain and swelling in the early phase after an injury.

3.    See a doctor early for red-flag symptoms

Seek medical attention promptly if you experience:

• Inability to walk or bear weight on the leg or ankle
• Significant swelling, bruising or visible deformity
• Severe or worsening pain in the knee, hip, shoulder, elbow or wrist
• Sudden loss of vision, eye pain, flashing lights or a dark curtain in your vision
• Chest pain, breathlessness, dizziness or fainting on the court

International data studies show that fractures, sprains and strains are the most common pickleball injuries, with a substantial number of older players affected and many injuries due to falls(4,5,6). Most patients are treated and discharged home, but some require further care or admission, especially in those with more serious fractures or trunk injuries.

Early diagnosis ensures correct treatment (for example, splinting, casting or surgery for fractures, or urgent treatment for serious eye injuries).

4.    Follow your treatment and physiotherapy plan

Most pickleball injuries can be managed without surgery.

• Your doctor may prescribe pain relief, anti-inflammatory medication and short-term activity modification.
• A physiotherapist can guide you through rehabilitation exercises to restore movement, strength and balance.
• For overuse injuries such as “pickleball elbow”, which is similar to tennis elbow or shoulder tendon inflammation injuries (tendinopathy), a structured rehabilitation and gradual loading programme is important.

Proper rehabilitation helps you regain function, improves performance and reduces the risk of the same injury recurring.

5.    Return to the court gradually

When your pain has settled and your doctor or physiotherapist agrees you can resume playing:

• Start with light drills (for example, gentle rallies without full lunges or jumps).
• Progress to simulated games before returning to competitive play.
• Use at least one rest day between sessions as you build up again.

A graded return allows your body to adapt safely and lowers the chance of re-injury.

6.    Review your playing habits to prevent repeat injuries

After an injury, it is useful to ask:

• Were you playing too often or for too long without rest?
• Were you using worn-out shoes or a paddle that does not suit you?
• Were you skipping warm-ups or playing mainly on hard surfaces?

Make adjustments based on what you and your healthcare team identify. Sometimes a small change, such as better footwear or learning safer footwork, can make a big difference.

Addressing the underlying cause helps you enjoy pickleball long-term, rather than cycling through repeated injuries.

Studies in different countries show that pickleball injuries are mostly musculoskeletal (affecting muscles, tendons, ligaments, bones and joints), and often involve both the upper and lower limbs (4,5,6).

1.    Pickleball elbow

Pickleball elbow refers to pain on the outer side of the elbow caused by irritation of the forearm tendons. It is similar to tennis elbow (lateral epicondylitis) and occurs when repeated gripping, swinging or wrist movements strain the tendon that stabilises the wrist.

While the paddle and ball are light, the repeated wrist and forearm movements involved in serving, dinking and volleys can overload the extensor tendon. This is common in beginners who grip the paddle too tightly, as well as frequent players who play multiple times a week without adequate rest.

Look out for:

• Pain or tenderness on the outer side of the elbow
• Discomfort when gripping the paddle, lifting objects or turning doorknobs
• Weakness in the forearm or difficulty holding items firmly
• Elbow stiffness, especially in the morning or after long sessions

2.    Recognise muscle strains and ligament sprains

These are among the most frequent problems (1,2,4):

• Ankle sprains from landing awkwardly or twisting while changing direction
• Knee sprains from sudden pivots or deep lunges
• Hamstring or calf strains from sprinting or stopping suddenly

Symptoms may include pain, swelling, bruising and difficulty moving the joint normally.

3.    Watch for overuse injuries in the arm, shoulder and back

Overuse injuries develop gradually over weeks or months:

• Shoulder pain from repeated overhead strokes may signal rotator cuff irritation or impingement.
• Lower back pain can result from repeated twisting and bending, especially in players with weak core muscles.

These injuries are common in people who play frequently, have poor technique or do not cross-train to strengthen supporting muscles.

4.    Understand fractures and falls in older players

Research shows that fractures and sprains each account for about a quarter to a third of emergency department pickleball injuries, and that more than 80–90% of these injuries occur in players aged 50 and above(4,5,6,7).

• Falls often occur when players run backwards for a lob, slide on a hard surface or trip over their own or a partner’s feet.
• Common fracture sites include the wrist, forearm and upper arm when people put out a hand to break a fall.

5.    Be alert to pickleball-related eye injuries

Although serious eye injuries are less common than sprains or fractures, they can have significant consequences. As noted earlier, severe eye injuries described in recent reports include:

• Retinal detachment
• Fractures of the bones around the eye
• Rupture of the eyeball
• Bleeding inside the eye (hyphema)

Any sudden eye pain, visual disturbance or change in vision after being hit should be treated as an emergency.

Risk factors identified in studies and clinical practice include (4,5,6,7):

• Age 50 years and older
• Playing many hours per week without adequate rest
• Being new to the sport (fewer years of experience)
• Having a sedentary lifestyle, especially office workers with deconditioned muscles and joints
• Pre-existing joint problems such as osteoarthritis or previous ligament tears
• Poor strength, balance or flexibility
• Inadequate warm-up or no conditioning work off the court
• Playing on hard, slippery or uneven surfaces
• Not using protective eyewear, especially in older adults or people with existing eye disease
• Underlying heart or lung disease if exertion is suddenly increased

Knowing your risk factors allows you to be more intentional about prevention and to seek advice before problems arise.

See a doctor or visit the emergency department if:

• Pain is severe or worsening
• You cannot put weight on your leg or move a joint normally
• There is obvious deformity, a “crooked” limb or suspected fracture
• You experience sudden eye pain, vision loss, blurred vision or flashing lights
• You feel chest pain, tightness, shortness of breath, faintness or a racing heartbeat during or after play

For persistent aches that do not settle after a few days of rest and simple care, consult your family doctor or a sports medicine clinic for assessment.

Yes, pickleball is suitable for seniors who are 60 years or older as it involves a smaller court and slower ball speed compared to sports like tennis. However, older players may have a higher risk of falls, sprains, fractures and eye injuries. It is important to start gradually, warm up properly, wear

supportive footwear and consider protective eyewear. Players with chronic medical conditions such as heart disease, osteoporosis or arthritis should check with their doctor before increasing activity. Do not play and seek medical help if you feel unwell.

2.    What are the earliest signs of a pickleball injury?

Early signs include persistent joint or muscle pain, stiffness lasting more than 48 hours, swelling, difficulty gripping the paddle or discomfort when walking or lunging. Pain that increases during play or affects daily activities warrants rest and evaluation. Seeking help early can prevent a minor strain from developing into a more serious injury.

3.    Should I wear eye protection when playing pickleball?

Eye protection is recommended, especially for players aged 50 and above. Research has shown a sharp increase in pickleball-related eye injuries, including retinal detachment and fractures around the eye (3). Wrap-around polycarbonate eyewear offers good protection. If you have existing eye conditions, speak with your eye doctor about the most suitable type of protective eyewear.

4.    How long does it take to recover from a typical pickleball injury?

Recovery depends on the type and severity of the injury as well as on a case-by-case basis. In general:

• Mild sprains and muscle strains: a few days to 2–3 weeks
• Moderate sprains or overuse injuries (e.g., elbow or shoulder tendinopathy): several weeks to months with physiotherapy 
• Fractures or ligament tears: weeks to months, sometimes requiring immobilisation or specialist care

Following your treatment plan and returning to play gradually helps ensure a safe recovery.

5.    How can beginners reduce their injury risk when starting pickleball?

Beginners can reduce risk by:

• Starting with shorter sessions and building up slowly
• Joining a beginner’s class to learn proper technique and footwork
• Wearing shoes with good grip and lateral support
• Doing simple strength and balance exercises 2–3 times a week
• Taking rest days between playing sessions

These steps allow your body to adapt safely and help you enjoy the sport long-term.

Pickleball can be an enjoyable way to improve fitness, coordination and social connection at any age. Although injury numbers have risen with the sport’s popularity, the overall benefits of staying active usually outweigh the risks, especially when sensible precautions are taken.

“Rather than avoiding the court, we encourage people to prepare well, play smart and seek help early if something feels wrong. With good habits, most people can keep enjoying pickleball safely for many years,” adds Dr Fadzil Hamzah, Senior Staff Physician, Department of Sport and Exercise Medicine, Changi General Hospital and Deputy Director, Health Promotion and Disease Prevention, SingHealth Office of Regional Health.