Pickleball Injuries Are Rising: Achilles, Knee, Shoulder, and Balance Risks in Adult Athletes

Pickleball has become one of the most popular sports for active adults.

It is social, competitive, and easier to start than many other racquet sports. But that does not mean it is easy on the body.

At Princeton Sports and Family Medicine, we see adult athletes in Princeton, Lawrenceville, and Mercer County who start playing pickleball for fun, fitness, or community and then develop pain in the Achilles, knee, shoulder, back, hip, or elbow.

The problem is not pickleball itself.

The problem is often the sudden combination of quick starts and stops, lateral movement, reaching, lunging, twisting, and playing multiple days per week before the body is prepared for that load.

For many adult athletes, pickleball is the first sport in years that asks the body to accelerate, decelerate, rotate, and react quickly.

That is where injuries can happen.

Why Pickleball Can Lead to Injuries

Pickleball looks lower impact than tennis, basketball, or running. In some ways, it is.

But the movement demands are still very real.

Pickleball requires:

• Quick starts
• Sudden stops
• Side-to-side movement
• Backpedaling
• Lunging
• Reaching overhead
• Rotating through the trunk
• Repeated gripping
• Fast reaction time
• Balance on one leg
• Frequent changes in direction

Many adults start playing pickleball because it feels approachable. They may not realize how much stress it places on the calves, Achilles tendons, knees, shoulders, hips, and balance system.

The injury risk often rises when someone goes from little cutting or lateral movement to playing several times per week.

Why Adult Athletes Are at Risk

Adult athletes often have the motivation to play, but the body may need time to catch up.

Common risk factors include:

• Returning to sport after years away
• Playing multiple days per week right away
• Limited calf and Achilles strength
• Poor single-leg balance
• Reduced hip strength
• Knee arthritis or prior knee injury
• Shoulder stiffness
• Rotator cuff weakness
• Limited trunk rotation
• Poor sleep or recovery
• Playing long sessions without conditioning
• Worn shoes or shoes not designed for court movement
• Prior ankle sprains
• Dehydration or fatigue
• Trying to play through early pain

Many pickleball injuries are not random. They are often the result of tissue load exceeding tissue capacity.

The good news is that many of these risks can be reduced with a smarter progression plan.

Achilles Tendon Injuries in Pickleball

The Achilles tendon is one of the most common problem areas for adult pickleball players.

Pickleball asks the calf and Achilles to handle repeated push-off, quick stops, and short explosive movements.

This can irritate the tendon over time or, in more serious cases, contribute to rupture.

Achilles tendinopathy may cause:

• Stiffness in the morning
• Pain at the start of play
• Pain that warms up and returns later
• Tenderness in the tendon
• Pain with stairs or hills
• Pain after a long pickleball session
• Thickening or soreness in the tendon

An Achilles rupture may feel very different.

Warning signs of rupture include:

• A sudden pop
• A feeling of being kicked in the back of the ankle
• Sudden sharp pain
• Difficulty pushing off
• Difficulty walking normally
• Weakness with calf raise
• Swelling or bruising

A suspected Achilles rupture should be evaluated promptly.

For Achilles tendinopathy, rest alone often does not solve the problem. The tendon usually needs a progressive strengthening plan, load modification, and a careful return to court activity.

Knee Pain and Pickleball

Pickleball can also aggravate the knee.

The knee has to handle bending, lunging, pivoting, lateral movement, and quick direction changes. Adult players with prior knee injuries, weakness, arthritis, or limited hip control may notice symptoms quickly.

Common knee symptoms include:

• Pain around or behind the kneecap
• Pain on the inside or outside of the knee
• Swelling after play
• Stiffness after sitting
• Pain with stairs
• Pain during lunges or squats
• Catching, locking, or giving way
• Pain after pivoting or twisting

Not all knee pain means serious damage. But swelling, locking, catching, giving way, or pain after a twist should be evaluated.

Knee pain may come from:

• Patellofemoral pain
• Meniscus irritation
• Knee arthritis
• Tendon pain
• Ligament sprain
• Training-load overload
• Hip or ankle mechanics

For many players, knee pain improves when strength, balance, footwear, court movement, and playing volume are addressed together.

Shoulder Pain in Pickleball

Pickleball can irritate the shoulder, especially with overhead shots, reaching, serving, and repetitive play.

Shoulder pain may be more likely if the athlete has limited shoulder mobility, rotator cuff weakness, poor trunk rotation, or a sudden increase in play.

Common shoulder symptoms include:

• Pain with overhead shots
• Pain reaching across the body
• Pain lying on the shoulder
• Pain lifting objects
• Weakness
• Clicking or catching
• Loss of range of motion
• Pain that lingers after play

Shoulder pain may be related to:

• Rotator cuff tendinopathy
• Shoulder impingement
• Bursitis
• Frozen shoulder
• Arthritis
• Poor scapular control
• Neck-related symptoms

The shoulder should not be treated in isolation. Trunk rotation, thoracic mobility, grip, paddle mechanics, and playing volume can all matter.

Balance and Fall Risk

Pickleball also challenges balance.

Players move quickly in multiple directions, often while reaching for the ball or reacting to an opponent’s shot. A small misstep can lead to a fall, ankle sprain, wrist fracture, shoulder injury, or knee injury.

Balance risk may be higher in adults who have:

• Prior ankle sprains
• Poor single-leg stability
• Neuropathy
• Vision changes
• Vestibular issues
• Deconditioning
• Weak hips or calves
• Medication side effects
• Fatigue
• Poor footwear
• Fear of falling

Balance is trainable.

A good injury-prevention plan for pickleball should include more than stretching. It should include strength, balance, agility, and gradual exposure to the movements the sport requires.

Elbow, Wrist, and Hand Pain

Although Achilles, knee, shoulder, and balance problems are common, the upper limb also matters.

Pickleball can contribute to:

• Tennis elbow
• Golfer’s elbow
• Wrist tendon irritation
• Hand arthritis flares
• Grip-related pain
• Forearm soreness

These symptoms may be related to paddle grip, playing frequency, wrist position, swing mechanics, or repeated impact.

If elbow or wrist pain keeps returning, the answer is not always a brace. The plan may need to address load, strength, technique, grip size, and recovery.

When It May Be Okay to Monitor Symptoms

It may be reasonable to monitor mild symptoms briefly if:

• Pain is mild
• There is no swelling
• There was no sudden injury
• You are not limping
• You can move normally
• Symptoms improve quickly after play
• Symptoms do not worsen over time
• Daily activities are normal
• There is no weakness, numbness, or instability

In that case, start with simple changes.

Try:

• Reducing the number of weekly sessions
• Shortening play time
• Taking a rest day between sessions
• Avoiding back-to-back long matches
• Warming up before play
• Using court shoes instead of running shoes
• Adding basic strength and balance work
• Avoiding play when symptoms are worsening
• Watching the 24-hour response after playing

If pain returns every time you play, the body is telling you the current plan is not working.

When to Schedule a Sports Medicine Evaluation

Schedule an evaluation if symptoms are persistent, recurrent, or affecting how you move.

Red flags include:

• Sudden pop or tearing sensation
• Inability to bear weight
• Limping
• Swelling
• Bruising
• Weakness
• Numbness or tingling
• Locking, catching, or giving way
• Pain that changes your gait or court movement
• Shoulder weakness or loss of motion
• Pain that wakes you at night
• Pain after a fall
• Pain that worsens despite rest
• Repeated injuries
• Fear of falling or balance concerns
• Symptoms that prevent normal activity

A sports medicine evaluation can help determine whether the problem is a tendon injury, joint irritation, muscle strain, nerve issue, balance problem, or something that needs imaging or more urgent care.

Why Rest Alone Often Does Not Work

Rest may calm symptoms, but it does not always prepare the body for pickleball.

If the problem developed because the body was not ready for quick stops, lateral movement, calf loading, shoulder repetition, or balance demands, symptoms may return when play resumes.

A better plan asks:

• What tissue is irritated?
• What movements trigger symptoms?
• How much pickleball is the person playing?
• Was there a sudden increase?
• Is strength adequate?
• Is balance adequate?
• Are shoes appropriate?
• Is recovery adequate?
• Does the player need physical therapy, strength training, or technique modification?
• Is there a medical issue affecting safety?

The goal is not to stop pickleball forever. The goal is to help the player return with a more durable plan.

How to Reduce Pickleball Injury Risk

Pickleball injury prevention should include more than stretching.

Helpful strategies include:

• Start gradually if you are new or returning after time off
• Avoid jumping from no play to multiple sessions per week
• Warm up before matches
• Use court shoes with lateral support
• Build calf and Achilles strength
• Train single-leg balance
• Strengthen hips and glutes
• Work on shoulder and rotator cuff strength
• Include trunk mobility and rotation
• Take recovery days
• Stop when pain changes movement
• Address symptoms early

For adult athletes, consistency matters more than doing too much too soon.

The Role of Physical Therapy

Physical therapy can help pickleball players identify why pain is happening and what needs to change.

PT may focus on:

• Achilles and calf strengthening
• Hip and knee control
• Balance training
• Landing and deceleration mechanics
• Shoulder mobility
• Rotator cuff and scapular strength
• Trunk rotation
• Return-to-court progression
• Footwear and movement strategies
• Safe exercise modifications

The plan should match the player.

A newer adult player with balance concerns needs a different plan than a competitive player with Achilles tendinopathy or a former tennis player with shoulder pain.

The Role of Strength and Conditioning

Pickleball players benefit from strength and conditioning even if they do not think of themselves as athletes.

A smart program may include:

• Calf raises
• Hip strengthening
• Squats or sit-to-stand progressions
• Step-ups
• Lateral lunges
• Balance drills
• Rotator cuff strengthening
• Core and trunk rotation work
• Low-level agility drills
• Gradual conditioning

The goal is to train the body for the actual demands of the sport.

If the only quick side-to-side movement you do is during pickleball, the court becomes the conditioning program. That is often too much too soon.

How PSFM Can Help

Princeton Sports and Family Medicine works with active adults, weekend warriors, racquet-sport athletes, runners, golfers, and people trying to stay active safely.

Depending on the patient, care may include:

Primary care:
https://www.princetonmedicine.com/contents/services/primary-care-services

Physical therapy:
https://www.princetonmedicine.com/contents/services/physical-therapy-services

Sports medicine evaluation:
https://www.princetonmedicine.com/contents/services/sports-medicine-services

Run Stride & Performance Evaluation:
https://www.princetonmedicine.com/contents/services/runner-stride-performance-evaluation

VO2max & Lactate Testing:
https://www.princetonmedicine.com/contents/services/vo2max-lactate-testing

Basal Metabolic Rate Testing:
https://www.princetonmedicine.com/contents/services/basal-metabolic-rate

Medical Weight Loss:
https://www.princetonmedicine.com/contents/services/medical-weight-loss

Shockwave Therapy:
https://www.princetonmedicine.com/contents/shockwave-therapy

PSFM Wellness:
https://psfmwellness.com

Fuse Sports Performance:
https://fusesportsperformance.com

For some patients, the starting point is diagnosis and imaging decisions. For others, it is physical therapy, strength training, balance work, shockwave therapy for certain chronic tendon conditions, or a safer return-to-court plan.

The goal is to keep people active while reducing the chance that the same injury keeps returning.

Related Diagnoses and PSFM A-Z Pages

Related diagnoses and PSFM A-Z pages:

Achilles tendinopathy:
https://www.princetonmedicine.com/contents/achilles-tendinopathy

Achilles rupture:
https://www.princetonmedicine.com/contents/achilles-rupture

Tendinopathy overview:
https://www.princetonmedicine.com/contents/tendinopathy

Training around tendinopathy:
https://www.princetonmedicine.com/contents/training-around-tendinopathy

Knee pain:
https://www.princetonmedicine.com/contents/knee-pain

Patellofemoral pain / runner’s knee:
https://www.princetonmedicine.com/contents/patellofemoral-pain

Meniscus tear:
https://www.princetonmedicine.com/contents/meniscus-tear

Knee arthritis:
https://www.princetonmedicine.com/contents/knee-arthritis

Torn knee ligaments:
https://www.princetonmedicine.com/contents/torn-knee-ligaments

Ankle sprain:
https://www.princetonmedicine.com/contents/ankle-sprain

Chronic ankle instability:
https://www.princetonmedicine.com/contents/chronic-ankle-instability

Shoulder impingement:
https://www.princetonmedicine.com/contents/shoulder-impingement

Rotator cuff tendinopathy:
https://www.princetonmedicine.com/contents/rotator-cuff-tendinopathy

Rotator cuff tear:
https://www.princetonmedicine.com/contents/rotator-cuff-tear

Frozen shoulder:
https://www.princetonmedicine.com/contents/frozen-shoulder

Tennis elbow:
https://www.princetonmedicine.com/contents/tennis-elbow

Golfer’s elbow:
https://www.princetonmedicine.com/contents/golfers-elbow

Wrist tendonitis:
https://www.princetonmedicine.com/contents/wrist-tendonitis

Hand arthritis:
https://www.princetonmedicine.com/contents/hand-arthritis

Low back pain:
https://www.princetonmedicine.com/contents/low-back-pain

Hip pain:
https://www.princetonmedicine.com/contents/hip-pain

Overuse injuries:
https://www.princetonmedicine.com/contents/overuse-injuries

Muscle strain:
https://www.princetonmedicine.com/contents/muscle-strain

Safe exercise progression:
https://www.princetonmedicine.com/contents/safe-exercise-progression

Exercise readiness:
https://www.princetonmedicine.com/contents/exercise-readiness

Return to sport:
https://www.princetonmedicine.com/contents/return-to-sport

Shockwave therapy:
https://www.princetonmedicine.com/contents/shockwave-therapy

Sports performance testing:
https://www.princetonmedicine.com/contents/sports-performance-testing

A-Z Conditions:
https://www.princetonmedicine.com/contents/a-z-conditions

Practical Next Steps for Pickleball Players

If you play pickleball and want to reduce injury risk, start with these steps:

1. Build up gradually.

If you are new or returning after time off, avoid jumping into long sessions or multiple days per week right away.

2. Use the right shoes.

Running shoes are made for forward motion. Pickleball usually requires lateral support. Court shoes may be a better option for many players.

3. Strengthen the calves and hips.

The Achilles, knees, and balance system all depend on calf and hip strength.

4. Train balance before you need it.

Single-leg stability, controlled stepping, and lateral movement drills can help prepare the body for court demands.

5. Do not ignore tendon pain.

Achilles, elbow, shoulder, and knee tendon pain often worsens when players keep pushing without adjusting load.

6. Take symptoms seriously if they change movement.

If pain causes limping, altered footwork, poor shoulder mechanics, or fear of falling, stop and get evaluated.

7. Recover between sessions.

Pickleball can feel fun and low impact, but the body still needs time to adapt.

The Bottom Line

Pickleball is a great way for adults to stay active, social, and competitive.

But it still places real demands on the Achilles tendons, knees, shoulders, hips, balance system, and upper limbs.

Injuries often happen when enthusiasm increases faster than tissue capacity.

A smarter plan includes gradual progression, strength training, balance work, recovery, appropriate footwear, and early evaluation when symptoms persist.

If pickleball pain is limiting your activity, Princeton Sports and Family Medicine can help identify the cause and build a plan to keep you moving.

Request an appointment:
https://www.princetonmedicine.com/contactus

Main website:
https://www.princetonmedicine.com

A-Z Conditions:
https://www.princetonmedicine.com/contents/a-z-conditions

Medical Disclaimer

This article is for educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Pickleball-related pain and injuries vary by person. If you have severe pain, sudden injury, inability to bear weight, significant swelling, bruising, weakness, numbness, chest pain, shortness of breath, fainting, head injury, symptoms after a fall, neurologic symptoms, or symptoms that are worsening or not improving, seek medical care promptly. Always consult a qualified healthcare professional before starting, stopping, or changing a treatment, medication, exercise, or return-to-sport plan.

Author

Peter Wenger, MD Peter C. Wenger, MD, is an orthopedic and non-operative sports injury specialist at Princeton Sports and Family Medicine, P.C., in Lawrenceville, New Jersey. He is board certified in both family medicine and sports medicine. Dr. Wenger brings a unique approach to sports medicine care with his comprehensive understanding of family medicine, sports medicine, and surgery. As a multisport athlete himself, he understands a patient’s desire to safely return to their sport.