Pickleball has grown from a backyard curiosity to the fastest-growing sport in America, and nowhere is that growth more visible than in Central Florida. Community courts fill at 7 a.m. Retirement communities have rebuilt their tennis courts into pickleball complexes. League play, tournaments, and casual drop-in games run from dawn to sunset across Orlando, Tampa, and the surrounding counties.
What has grown alongside the sport is a set of predictable injuries. The demographic playing pickleball skews older than most other sports, the movement patterns are surprisingly demanding, and most new players underestimate the physical load the game places on tissues that have not been trained for quick direction changes and overhead mechanics.
Across the six Momentum Medical locations, pickleball injuries have become a common reason for sports medicine evaluation. Six injury patterns account for the overwhelming majority of what we see.
Why Pickleball Causes Injury
Before walking through the specific injuries, it helps to understand what the sport demands biomechanically.
Pickleball combines several movement patterns that challenge tissue in specific ways. The overhead serve and the forehand smash load the rotator cuff and the shoulder joint through end-range positions. The paddle grip and repetitive wrist flexion-extension load the forearm extensors at the lateral elbow. The quick lateral movements at the non-volley zone, also called the kitchen, require rapid acceleration, deceleration, and direction changes through the ankles, calves, and knees. The rotational trunk movements during shot preparation and follow-through load the lumbar spine and the core stabilizers.
The additional factor is that most pickleball players are older than the typical recreational athlete population. A game that would produce a muscle strain in a 25-year-old is significantly more likely to produce a tendon tear in a 60-year-old. The same movement demands do not produce the same tissue outcomes across age groups.
1. Rotator Cuff Tendinopathy
The rotator cuff is a group of four muscles that stabilize the shoulder joint and generate the fine motor control of the arm during overhead movements. The serve, overhead smash, and high-velocity forehand all load the rotator cuff, particularly the supraspinatus tendon along the top of the shoulder joint.
In pickleball players, rotator cuff tendinopathy typically presents as a gradual onset of shoulder pain that worsens with overhead activity. Patients describe pain when reaching into a cupboard, sleeping on the affected side, or serving. Early in the condition, the pain is only present during and immediately after play. As the tendinopathy progresses, the pain becomes persistent.
The clinical challenge with rotator cuff injury in this population is that many patients have pre-existing rotator cuff changes on imaging. MRIs of pain-free 60-year-olds frequently show rotator cuff fraying or partial tears. The question is not whether imaging shows changes, but whether the clinical picture matches the imaging findings and whether conservative care can restore function.
Treatment typically begins with activity modification, targeted physical therapy for the rotator cuff and scapular stabilizers, and assessment of the serving mechanics that may have contributed to the injury. For patients whose symptoms persist despite conservative care, PRP injection has reasonable evidence in rotator cuff tendinopathy. Shockwave therapy is another option with growing research support in tendon conditions.
2. Tennis Elbow (Lateral Epicondylitis)
Despite the name, tennis elbow is seen more frequently in pickleball players than in tennis players in many clinical practices, because the pickleball paddle’s shorter handle and the specific grip mechanics of the sport produce repetitive strain on the forearm extensor tendons at the lateral elbow.
Patients present with pain at the bony prominence on the outside of the elbow, often radiating down the back of the forearm. The pain is reproduced by gripping, lifting, shaking hands, or hitting a backhand shot.
Tennis elbow is a degenerative tendinopathy rather than an inflammatory condition, which changes how it should be treated. Anti-inflammatory medications may reduce symptoms but do not address the underlying tissue degeneration. Cortisone injections often provide short-term relief but have shown poorer long-term outcomes compared to other treatments in several studies.
The current best evidence for tennis elbow supports structured eccentric loading exercise, grip modification, and for persistent cases, PRP injection. Platelet-rich plasma has strong comparative evidence in this specific condition, with head-to-head studies showing better one-year outcomes than cortisone injection.
3. Achilles Tendinopathy and Rupture
The Achilles tendon takes the full load of push-off in pickleball, and the quick start-stop movement pattern of the sport is particularly demanding on this tendon in older athletes.
Two distinct presentations are common. Achilles tendinopathy develops gradually, with pain and stiffness in the back of the ankle that is worst first thing in the morning and after rest. The tendon may be visibly thickened. Athletes often describe having to “walk off the stiffness” for the first several steps of the day.
Achilles rupture is more dramatic. A player lunging for a ball feels a sudden sharp pain in the back of the calf or heel, often accompanied by a pop or snap. Walking becomes difficult or impossible. The classic clinical sign is an inability to push off the affected foot. Ultrasound or MRI confirms the diagnosis.
Ruptures require prompt evaluation because surgical repair, when indicated, produces better outcomes within the first week after injury. Tendinopathy, in contrast, is managed with a combination of load management, eccentric calf strengthening, and in persistent cases, regenerative options including PRP and shockwave therapy.
4. Calf Strain (“Pickleball Pop”)
Sometimes called tennis leg in older literature, calf strain is one of the most common acute injuries in pickleball. A player pushes off explosively, lunges for a shot, or changes direction rapidly, and feels a sudden sharp pain in the mid-calf, often accompanied by a sensation of being kicked from behind.
The injury is typically a tear of the medial gastrocnemius muscle or, less commonly, the plantaris tendon.
- Grade one strains involve minor fiber disruption.
- Grade two strains involve partial tearing.
- Grade three strains involve complete rupture of the muscle or a major portion of it.
Most calf strains in pickleball players are grade one or grade two and respond well to conservative treatment. Early management focuses on relative rest, ice, compression, and gentle range of motion. Graduated return to activity follows a predictable timeline, usually two to six weeks depending on severity.
The important clinical consideration is distinguishing a calf strain from a deep vein thrombosis, which can present with similar symptoms and is significantly more common in older adults. Ultrasound evaluation is warranted when the presentation is not clearly consistent with muscle strain.
5. Ankle Sprains
The lateral quick-cutting movements of pickleball produce ankle sprains with regularity. The mechanism is usually an inversion injury, where the foot rolls inward while the ankle joint is bearing weight, stretching and sometimes tearing the lateral ankle ligaments. The anterior talofibular ligament is the most commonly injured.
Patients present with swelling, bruising, and pain over the outside of the ankle. Walking is difficult. The ability to bear weight, the location of tenderness on examination, and imaging when indicated help distinguish a sprain from a fracture.
Ankle sprains are often undertreated. The misconception that a sprain is “just a sprain” and will heal on its own leads many patients to skip formal evaluation and rehabilitation. The clinical reality is that chronic ankle instability, recurrent sprains, and early ankle arthritis are all meaningfully more common in patients whose initial sprain was not properly rehabilitated.
Proper rehabilitation after an ankle sprain includes restoring range of motion, rebuilding the strength of the peroneal muscles and other ankle stabilizers, and restoring proprioception, which is the ability of the ankle to sense its position. This work makes a substantial difference in preventing re-injury.
6. Lumbar Strain and Facet Joint Irritation
The rotational trunk movements and sudden lunging of pickleball load the lumbar spine in ways that many players have not prepared for. Acute lumbar strain, facet joint irritation, and occasionally more significant disc involvement are common.
The typical presentation is lower back pain that begins during or after a match. The pain may be localized to one side, often worse with rotation or extension, and may radiate into the buttock or upper thigh. Prolonged sitting makes it worse. Walking often helps.
Most cases of pickleball-related low back pain respond well to chiropractic care combined with targeted physical therapy focused on hip mobility, core strength, and postural stability. More persistent cases benefit from a broader assessment that may include imaging to rule out disc involvement or nerve root compression.
A Seventh Consideration: Falls
Not on the list of six, but worth mentioning for the older pickleball population: falls during play produce a meaningful number of serious injuries each year, including wrist fractures from breaking a fall, hip fractures from landing on the side, and head injuries in some cases.
Fall risk in pickleball is influenced by footwear (court shoes rather than running shoes), playing surface conditions, hydration, medication side effects, and balance. Players in their 60s and 70s who are new to the sport should consider formal balance assessment and a basic strength and stability program before full immersion in league play.
When to Seek Evaluation
Pickleball players should consider clinical evaluation when pain persists beyond a week of rest, when an acute injury produces immediate significant pain or functional loss, when a joint swells significantly, when walking is affected, or when symptoms suggest something more than simple muscle soreness.
The earlier evaluation occurs, the more options are available. A rotator cuff strain addressed in the first two weeks is usually a straightforward rehabilitation case. A rotator cuff strain ignored for three months often requires a more extended recovery and sometimes more aggressive intervention.
Momentum Medical offers sports medicine evaluation, chiropractic care, physical therapy, shockwave therapy, and PRP injection across our Central Florida locations. The specific treatment approach depends on the specific injury, the patient’s goals, and how soon care is initiated. For pickleball players who want to keep playing the game they love, addressing injuries early is usually the difference between a short recovery and a long one.