Pickleball Injuries are Getting Out of Hand for Some Adults

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Terry Landers’ pickleball injuries include two concussions, a broken wrist, a shoulder injury, a torn thumb and a black eye. None of those disasters kept her from the court. In fact, she had both knees replaced so she could keep playing.

The 69-year-old from Bridgeton, Maine, has always been athletic, playing tennis, soccer and softball. She was drawn to pickleball about a decade ago because it was a sport she could play year-round in Maine, and the community she found on the courts kept her coming back.

She blames her shoes for two hospital visits, saying they caught on the surface of the court, which tends to be asphalt or concrete compared to tennis’ clay or grass. At one point, Landers literally taped her fractured wrist to her pickleball paddle to go to the emergency room.

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“The first time I went into the wall — thankfully, the walls are padded — and hit my head pretty hard,” she says. “But then the second time, when I broke my wrist, I was side-stepping to get a low backhand, and I caught my foot, and I was down before I even knew I was falling. I broke it pretty good. I've got a plate and screws and all kinds of stuff going on in there.”

Landers has a lot of company. Pickleball, a combination of tennis and ping-pong, has been the fastest growing sport in the country for three years in a row, according to the Sports & Fitness Industry Association. Although the highest number of players fall in the 25-34 age bracket, it’s the older players running into walls and problems.

Taking a toll on the over-50 crowd

A 2024 study in Health analyzed nearly 17,000 pickleball-related injuries and found that 87% of emergency room visits involved people over 50. Orthopedic injuries were the most common, such as fractures, sprains and muscle tears, but cardiac incidents also stood out.

Ches Jones, an injury researcher at the University of Arkansas and lead author of the study, says the smaller court makes pickleball seem approachable, but too often players don’t realize they need to prepare physically.

"People think, 'Oh, I can do this without getting proper doctor's clearance,'" says Jones. "There's a perception that pickleball is a less strenuous activity than other sports. But in actuality, pickleball can be very strenuous, especially on the cardiovascular system."

‘Job security’ for surgeons

Frederick Azar is an orthopedic surgeon and director of the sports medicine fellowship at the University of Tennessee Campbell Clinic. There were so many referrals to orthopedic surgeons from pickleball injuries that it became a joke that they invented the sport for job security, he says.

He says he started noticing that his patients who had pickleball injuries fell into certain patterns and wanted more information to help with injury prevention. In a 2024 review in the Journal of the American Academy of Orthopedic Surgeons, he analyzed emergency room data from pickleball injuries from 2001 to 2017 and also surveyed clinic patients. Like the Arkansas study, he found that wrist fractures and ankle sprains were common, along with soft-tissue injuries like meniscal tears and tendinitis.

Azar’s study also found that there were differences between genders — women were more likely to suffer fractures, often tied to bone health issues like osteoporosis, while men tended to sustain sprains and strains. Many issues stem from loss of balance as players move quickly front-to-back and side-to-side, he says.

Both studies highlighted another danger: the heart. In the Arkansas analysis of older players, one out of five injuries resulted in hospital admissions, with most admissions for cardiac arrest and 25% for fractures.

Azar says the cardiac numbers highlighted the need for a good check-up before hitting the court, particularly for sedentary people who planned to play. In addition to a cardiac check-up, new players should ask about bone health, balance issues and medication side effects, like dizziness, that might result in injury, he says.

“It’s a new sport, so we’re trying to raise awareness and encourage people to take precautions because people can get hurt here,” he says.

There’s never enough

Carl Cogdill, 62, from Fort Worth, Texas, turned to wheelchair pickleball three years ago after 34 years of tennis because the smaller courts were easier on his chair and his body. Cogdill loved the inclusive nature of the sport, competing in the National Wheelchair Pickleball Championships, winning three silvers.

But then his love of the sport became an obsession. Where he could only play tennis for 20 minutes before his arms started hurting, he could play pickleball for hours without pain. At one point he was playing 70 hours a week, and once played 13 hours straight.

“Then I ended up with tendonitis and started straining my ligaments,” he says, adding that he finally went to the doctor “when I couldn’t use my arm.” That became a real issue when he needed to transfer from his wheelchair to his bed, the couch or the car.

Cogdill ended up getting several steroid injections, doing the physical therapy exercises he’d learned in the past, and knocking back his hours. Somewhat. He still plays five days a week, but only for three or four hours a day.

Jon Herting, owner of Precision Performance Physical Therapy in Philadelphia, holds a doctorate in physical therapy. He says many of the injuries he sees come from people jumping from a sedentary lifestyle onto the pickleball court without a lot of preparation.

One particular challenge with pickleball, Herting says, is that, like tennis, pickleball has a lot of sudden power-based movements, a skill that deteriorates as people age. Leaping suddenly for a ball or pushing off to run puts a lot of stress on the Achilles tendon, potentially causing tears.

“Obviously, we recommend that people maintain their strength to be able to play pickleball and maintain tissue elasticity,” he says. “But on top of that, think about introducing power-based exercise. It doesn't have to be these big-box jumps that you see NFL players doing, but like simply jumping rope, which is a great activity. That's a low barrier of entry.”

Start simply, and build up, even if it’s starting with 10 reps, he says. People can start by holding onto a wall and practicing an explosive calf raise where the toes don’t leave the ground, building up to maintain balance.

Nevertheless, pickleball definitely has an addictive side to it. Says Herting: “I don’t think we’ve had anyone that hasn’t ended up going back to play in some capacity.”

Balancing joy and risk

Jason Fruen, a 51-year-old real estate agent in Minnesota, has an entire social scene at the pickleball court, where a regular group of four or eight comes to play and then goes out for a drink or checks out a concert. In his two years on the court, he has seen some terrible injuries, including someone who was hit in the eye and another man who tripped and hit his head.

On Aug. 6, Fruen posted a photo of his foot in a boot on Facebook after suffering a calf tear, announcing: “Well I went and did it this time… Tore my calf muscle driving to the net, felt it pop & down I went.”

Fruen, who says he mostly lifted weights before starting pickleball, says by the time he reached a local orthopedic urgent care, he couldn’t walk. But he considers the calf tear “one of the luckiest of injuries you can get,” because surgery wasn’t needed.

Even so, he made sure to elevate, ice and rest. Three weeks later, he was back on the court — reducing his playing time from four or five times a week to two. Now he makes sure to stretch in the hot tub, strength train and give himself permission to rest when he’s hurting instead of forcing himself on the court.

For Terry Landers in Maine, though, the risks are worth it. After concussions, surgeries, and a wrist held together by metal, she has changed nothing about the way she plays — except she’s traded her volleyball shoes for pickleball ones.

“No, no, I'm an idiot,” she says. “I play as aggressively as I always have.”

Note: This item first appeared in Kiplinger Retirement Report, our popular monthly periodical that covers key concerns of affluent older Americans who are retired or preparing for retirement. Subscribe for retirement advice that’s right on the money.

Dawn Fallik is a Philadelphia-based reporter who specializes in data analysis. She was a reporter for The Philadelphia Inquirer, The Wall Street Journal and The Associated Press. She has served on the Pulitzer jury and is a tenured professor at the University of Delaware.