Orthopedic surgeon offers tips for avoiding pickleball injuries


More than 36.5 million Americans played pickleball from August 2021 to August 2022, according to new data released by the Association of Pickleball Professionals, making it the fastest growing sport in the America for the third year in a row. Not surprisingly, the increase in popularity has led to a rise in pickleball injuries.

“Pickleball is keeping me in business,” joked Dr. Marc F. Matarazzo, an orthopedic surgeon with the Center for Bone and Joint Surgery in Port St. Lucie. “I am seeing injuries every day from the game, particularly in the middle to older age groups. It’ becoming a social sensation that’s fun and not necessarily real strenuous but if proper precautions aren’t taken prior to playing it can result in some serious injuries.”

“Sprains, strains and fractures are the most common injuries,” Dr. Matarazzo said. “My practice is predominantly knees and shoulders so I’m seeing a lot of injuries like rotator cuff strains, bicep tendonitis, tennis elbow, aggravation of knee arthritis, meniscus tears, MCL strains, wrist, ankle, hamstring and Achilles’ strains.

“A lot of has to do with the age factor as the game is very popular with the senior population,” Dr. Matarazzo continued. “The problem is that they go from their couch to the court viewing it as more of a social occasion than a workout routine. I don’t think they realize that they can potentially get injured.”

Pickleball is described as a blend of tennis, badminton and ping pong. It’s played on what looks like a smaller tennis court with a lot of stopping, starting and quick movements. The abrupt movements can put hips, legs, ankles and feet at risk because the player plants and turns. Sometimes those movements are forceful on the joints and that force strains the calf or Achilles, causing the ankle to roll and ultimately causing back and leg injury.

A report in the Journal of Emergency Medicine estimates that there are about 19,000 pickleball injuries per year with 90 percent of them affecting people 50 or older.

While pickleball is easier on the body than most other sports, the USA Pickleball Association offers these guidelines to help reduce the risk of injury:

  • Be aware of your playing area and its obstacles.
  • Avoid backpedaling on the pickleball court.
  • Stretch and warm up your body before you play.
  • Wear proper court shoes, eye protection and use appropriate equipment.
  • Improve your balance and learn how to fall without injury.
  • Wear sunscreen and a hat when playing outdoors.
  • Avoid wet pickleball courts.
  • Hydrate.
  • Work with a professional to improve your fundamentals.
  • Know your body and give it some rest.
  • Communication with your partner to avoid confusion.
  • Have a plan in case of an emergency on the court.

“Getting the heart rate elevated before the game is so important,” said Dr. Matarazzo.

“Take a jog or do jumping jacks for five minutes to break a sweat. The warmup will increase your ability to perform the stretching exercises. You need to do a whole-body warmup and not just focus on the legs and arms.

“That being said, flexibility and stretching is imperative. For upper extremities, rotator cuff strengthening and shoulder stabilization programs are very helpful. Forearm and wrist exercising can also help minimize injury.

“In the lower extremity you would want do core stretching for lower back and abdominals.

You should strengthen your hip and groin adductors and stretch the quadriceps, hamstrings and calf muscles. A good routine would be to start with the ankle stretch and work upward toward the shoulder and neck area. Focus on each muscle group and feel the stretch, then hold it for 10-15 seconds and repeat that 5 times.

“Hydrate with water containing electrolytes which contain minerals essential to human health,” Dr. Matarazzo continued. “This is especially important in our hot climate.”

Electrolytes are responsible for directing water and nutrients to the areas of the body where it’s needed most and maintaining optimal fluid balance inside the cells. They also help your muscles to contract and relax and assist in the transmission of nerve impulses from your nervous system to different parts of the body.

Dr. Matarazzo stresses the importance of wearing eyewear and sunscreen to protect your eyes and skin from the sun’s harmful UV rays, wearing the correct shoes and having the right equipment.

According to the USA Pickleball Association, comfortable court shoes are a must. Typical sneakers and running shoes do not supply the right kind of support for the side-to-side movement of the sport. The key to finding a good court shoe is the sole. Pickleball players need a shoe that supports the foot during side-to-side shifts in weight while providing stability on the inside and outside of the foot. It’s advisable to purchase athletic shoes from a specialty store where a staff member can help fit you properly.

“The proper paddle is every bit as important as the right shoes,” Dr. Matarazzo explained.

“People should go with a lighter paddle as heavier paddles can lead to tennis elbow.

Having a looser, wider grip on the paddle is better for your joints. You can also consider taping your wrist and ankles or wearing a compression brace for more support on the wrist and ankles.

“If pain occurs during play, stop playing and ice the area of pain. Continuing to play will only aggravate the problem. If it worsens with activity, if it persists for more than 24 hours, or if it’s altering your gait or the way you would swing your racquet, then seek medical attention.”

“Fortunately, the majority of injuries can be treated without surgery,” Dr. Matarazzo said.

“Most injuries can be treated with RICE (rest, ice, compression, elevation). Most people will respond to a short period of rest and maybe some physical therapy. Others may need to wear a brace of some sort or an anti-inflammatory injection. If it’s not getting better then we’ll do an MRI scan and potentially surgery.”

Dr. Matarazzo earned his medical degree from the Lewis Katz School of Medicine at Temple University and completed his general surgery internship and orthopedic surgery residency at the Medical College of Pennsylvania and Hahnemann University, now known as Drexel University College of Medicine in Philadelphia. He completed his sports medicine and arthroscopy fellowship at Lenox Hill Hospital in New York City, where he served as the assistant team physician for the New York Jets, the New York Islanders, and the Hofstra University and Hunter College athletic departments. He is accepting new patients at the Center for Bone and Joint Surgery in Port St. Lucie, 582 NW University Blvd. Suite 100, Port St. Lucie, 561-798-6600.

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