How to Avoid Pickleball Injuries: Expert Advice from a Physical Therapist

Pickleball, a sport that combines elements of tennis, badminton, and ping-pong, has seen a huge surge in popularity in recent years — and its popularity doesn’t seem to be slowing down. It’s a fun, engaging, and accessible way to stay active for people of all ages.

However, like any sport, pickleball comes with its unique set of potential injuries. As a sports/orthopedic physical therapist at Limitless Physical Therapy & Performance, I’ve seen firsthand the impact these injuries can have on players. But remember, our mantra is that “Movement is the best medicine.” So with the right knowledge and preventive measures, you can enjoy pickleball while minimizing your risk of injury.

Common Pickleball Injuries and Their Causes

Pickleball, while less physically demanding than some other racquet sports like tennis, can still lead to a range of injuries. These often result from lack of strength/conditioning prior to play, overuse, improper technique, or inadequate equipment. The most common injuries we see in pickleball players include ankle sprains, shoulder injuries, and a condition known as ‘pickleball elbow,’ similar to the well-known ‘tennis elbow.’ Let’s take a closer look at each of these injuries, their causes, symptoms, and prevention strategies.


Ankle sprains are common in many sports, including pickleball. They occur when the ligaments that support the ankle stretch or tear, usually as a result of rolling, twisting, or turning the ankle in an awkward way.

Symptoms of an ankle sprain include pain, swelling, bruising, and difficulty walking. Prevention strategies include wearing appropriate footwear with good ankle support, warming up before playing, and performing exercises to improve balance and ankle strength.

Being able to control your balance starts with good ankle strength, so it is critical (and often where we see the most problems with our patients) that you are working on balance and leg strength outside of pickleball play/practice if you want to optimize your pickleball performance and prevent ankle injuries in the future.

Perhaps most important for a game involving quick efforts of stopping/starting/direction change is choosing appropriate shoewear. Speaking out of experience as someone who loves CrossFit & Running, CrossFit-style (low or no heel-to-toe drop and wide toebox) and Running shoes (typically more heel-to-toe drop angle and much more cushion) do NOT cut it for a season of pickleball. If you haven’t already considered getting real tennis or pickleball shoes, now is the time.

ASICS Men’s Gel-Game 9 Pickleball Shoes, 9, Shocking Orange/White

The shoes that we most-often recommend include Adidas, Wilson, and Asics as our favorite brands. Here are the exact shoes that we recommend (this will take you right to Amazon!). A good pickleball shoe has a more sturdy composition of shoe material than a modern minimalist running or walking shoes, a well-made rubber sole, and a bit more cushion around the ankle for optimal support. This Amazon list has the perfect pickleball shoe for anyone.

Our favorite on the list is the ASICS Gel-Game 9 (linked above). We like the color options and we LOVE the gel cushion throughout the sole.


Shoulder injuries in pickleball often result from overuse, especially from repetitive higher-speed overhead and cross-body movements like serving and smashing. These injuries can range from rotator cuff strains to more serious conditions like shoulder impingement or a torn rotator cuff.


Symptoms can include shoulder pain, weakness, and reduced range of motion. To prevent shoulder injuries, players should ensure they’re using proper technique, particularly for overhead shots. Probably most important is to make sure that your rotator cuff and surrounding shoulder muscles are strong & resilient. Again – this has to happen OFF of the court, so working with a Performance Physical Therapist or Fitness Professional near you is key to preventing that gnarly shoulder tendon pain when you’re trying to smash the ball at your opponent.


Pickleball elbow, a lot like tennis elbow, is a form of tendinopathy (a condition involving injury to a tendon). It’s caused by repetitive stress on the wrist extensor tendons that attach to the outside portion of the elbow, leading to inflammation, pain, grip strength loss, and more. This condition is particularly common in pickleball due to the frequent forearm movements required in the sport.

Symptoms of pickleball elbow include elbow pain that worsens with activity, weakened grip strength, and tenderness around the elbow. Preventive measures include using a paddle with the correct grip size, performing regular forearm strengthening exercises, and ensuring proper technique when hitting the ball.

Preventive Measures and Treatment Strategies at Limitless Physical Therapy & Performance

At Limitless, we believe in personalized treatment plans that address the root cause of your pain. Painful conditions like rotator cuff strains and pickleball elbow often are related to deficits and impairments that we have in other regions of the body, so it’s imperative to work with a Performance Physical Therapist that can help you dig out the actual root cause of the injury to begin with. For each of the injuries discussed above, we offer a range of treatment options here in Rochester Hills, Michigan.

For ankle sprains, we often recommend foot, ankle, hip, and core exercises to improve strength and balance, as well as advice on selecting footwear with appropriate ankle support.

For shoulder injuries, treatment could include upper back, shoulder blade, and rotational shoulder exercises to strengthen the rotator cuff and other supportive muscles, as well as advice on modifying your pickleball swing technique to reduce strain on the shoulder. We also see a lot of success with dry needling as a treatment for rotator cuff conditions, as a powerful way to calm down irritated shoulder tissues.

For pickleball elbow, treatment typically can include dry needling to relieve muscle tension, targeted exercises to strengthen the tendons, a biomechanical look at whether or not you’re using your shoulder blades and shoulder muscle to support your elbow, and advice on modifying your pickleball technique to prevent future injuries.

Don’t let a pickleball injury keep you off the court. Schedule a consultation/evaluation with one of our Movement Doctors at Limitless PT & Performance today. Remember, you’ll spend 1-on-1 time with your own Doctor of Physical Therapy at each visit, ensuring personalized care tailored to your needs. Don’t live in Michigan? We have remote options as well if you’re interested in connecting with us! You can get in touch with us through the button below

At Limitless Physical Therapy & Performance, we’re committed to helping you enjoy your favorite activities without the fear of injury. Remember, “Movement is the best medicine.” With the right preventive measures and treatment strategies, you can stay in the game and perform at your best.

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Seth King
We help people feel confident and strong so they can return to the activities they love without pain or fear.

Dr. Seth King

PT, DPT, Owner/Founder of Limitless

We help people feel confident and strong so they can return to the activities they love without pain or fear.

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