The Most Common Pickleball Injuries (And How to Self-Treat Them)

Pickleball is the fastest-growing sport in the U.S., with participation jumping more than 150% from 2021 to 2023 (Sports & Fitness Industry Association, 2023). With that growth has come a wave of injuries — a 2023 UBS report estimated pickleball-related medical costs in the U.S. could exceed $400 million in a single year. Most of these injuries are predictable, preventable, and very manageable when treated early.

Here are the four most common pickleball injuries we see in our Carmel office — and what you can do at home to start treating them today.

1. Lateral Epicondylitis ("Pickleball Elbow")

The same tendinopathy long known as "tennis elbow" is now the single most common pickleball-related complaint we see. It's caused by overload of the wrist extensor tendons — particularly the extensor carpi radialis brevis — where they attach on the outside of the elbow.

What it feels like: A dull ache or sharp pain on the outside of the elbow, often worse with gripping the paddle, lifting a coffee cup, or shaking hands. Many players notice it the day after a long session.

Why it happens: Late, wristy contact on the ball, an oversized grip, and high paddle weight all increase eccentric load on the wrist extensors. A 2021 systematic review (Bisset & Vicenzino, Br J Sports Med) confirms that progressive eccentric loading — not rest — is the most effective long-term treatment.

What you can do at home:

• Tyler Twist with a FlexBar (or rolled towel): 3 sets of 15 slow eccentric wrist extensions, once daily. This is the most evidence-supported home exercise for lateral epicondylitis.
• Forearm self-massage: Use a lacrosse ball or your opposite thumb to work through the meaty part of the forearm extensors (top of the forearm) for 2–3 minutes per side.
• Check your paddle: A grip that's too small forces you to squeeze harder. Measure from the middle crease of your palm to the tip of your ring finger — that's your grip size in inches.
• Warm up the wrist and forearm before play with 10 wrist circles and 10 light wrist curls each direction.

2. Calf Strain and Achilles Tendinopathy

The sudden forward lunges and quick stops of pickleball put enormous strain on the calf and Achilles. Calf strains are especially common in players over 40, where a stiff, deconditioned calf is asked to produce explosive force.

What it feels like: A sharp "pop" or sudden grab in the middle of the calf during a lunge (acute strain), or a gradual morning stiffness and tenderness along the Achilles tendon (tendinopathy).

Why it happens: Limited ankle dorsiflexion, weak calf endurance, and inadequate warm-up. A landmark study by Alfredson et al. (Am J Sports Med, 1998) established heavy, slow eccentric loading as the gold-standard treatment for Achilles tendinopathy — and that finding has held up across two decades of follow-up research.

What you can do at home:

• Eccentric heel drops: Stand on a step with the balls of your feet, rise up on both legs, then slowly lower on the involved leg for a 3-second count. 3 sets of 15, once daily. Do them with knees straight and again with knees slightly bent.
• Soleus wall stretch: Bent-knee calf stretch against the wall, 30 seconds × 3 per side, after activity (not before).
• Foam roll the calves for 1–2 minutes per side daily.
• Build up gradually: Do not jump from one session a week to four. Increase weekly playing time by no more than ~10% — the well-documented "acute-to-chronic workload" rule for injury prevention.

3. Rotator Cuff Strain and Shoulder Tendinopathy

Overhead smashes, serves, and high backhand volleys repeatedly load the rotator cuff — especially the supraspinatus and infraspinatus. Most pickleball players never train these muscles directly, so they're first to fatigue and complain.

What it feels like: A deep ache in the front or side of the shoulder, pain when reaching overhead or behind the back, and weakness on serves and overheads. Sleeping on the involved side is often uncomfortable.

Why it happens: Poor scapular control, weak external rotators, and tight pec/lat tissue create impingement-style loading at the shoulder. Evidence from Lewis (Br J Sports Med, 2018) and the latest JOSPT clinical guidelines strongly favors progressive loading and scapular control work over rest, injection, or imaging for non-traumatic shoulder pain.

What you can do at home:

• Band external rotations: Tuck a towel under your elbow, hold a light resistance band, and rotate the forearm outward. 3 sets of 15, daily.
• Scapular rows: Pull a band toward your ribs while squeezing the shoulder blades together. 3 sets of 12.
• Doorway pec stretch: Forearm on the doorframe, step through, hold 30 seconds × 3 per side.
• Cross-body posterior capsule stretch: Hold the involved arm across the chest with the opposite hand, 30 seconds × 3.

4. Low Back Pain

The repeated trunk rotation, sudden forward bending, and quick stops of pickleball expose tight hips and a weak core almost immediately. Low back pain is consistently among the top three reported pickleball injuries in epidemiology surveys (Forrester, Inj Epidemiol 2020).

What it feels like: A deep ache or stiffness across the low back, often worse the morning after playing or after prolonged sitting. Many players also notice it during the dink-and-volley reach.

Why it happens: Limited hip internal rotation and thoracic mobility force the low back to absorb the rotation that should be coming from the hips and mid-back. Clinical practice guidelines from the American College of Physicians (2017) recommend spinal manipulation, exercise, and manual therapy as first-line care for non-specific low back pain — ahead of medication or imaging.

What you can do at home:

• 90/90 hip rotations: Sit on the floor, front leg bent at 90°, back leg bent at 90°. Slowly rotate side to side for 2 minutes. This is the single best self-mobility drill for pickleball players.
• Cat-cow + open book rotations: 10 reps each, before and after play.
• Dead bugs and bird dogs: 3 sets of 10 per side, 3–4 days per week. These rebuild the deep core control that protects the spine during rotation.
• Walk after sitting: Don't go from the couch straight to a competitive match — 5–10 minutes of brisk walking primes the hips and low back.

When to See Us

Self-care works extremely well for the early stages of these injuries, but you should book an evaluation if:

• Pain has been present longer than 3 weeks despite reducing play and doing the work above
• You felt a sudden "pop" with sharp pain (especially in the calf or shoulder)
• You have weakness, numbness, or tingling into the arm or leg
• Pain is waking you up at night
• The same injury keeps coming back every time you return to play

Most pickleball injuries respond beautifully to a combination of chiropractic adjustments, Active Release Technique, dry needling, and a sport-specific rehab plan — typically in just a handful of visits. The goal is never to keep you off the court longer than necessary; it's to send you back stronger than the player who got injured in the first place.

Keep dinking. Keep moving. And if something doesn't feel right after a week or two of smart self-care — come see us.

— Dr. Owen Friest, D.C.

Indy Spine and Rehab · Carmel, IN