PICKLEBALL ISN’T THE PROBLEM

A client of mine, right-handed, competitive, and new to pickleball, tore something in her left shoulder going for a quick two-handed backhand. Nothing dramatic happened. No collision, no fall. She reacted to a fast ball, set up for the shot, and swung.

The injury happened at her shoulder, but what caught my attention started at her feet.

When she rotated into the shot, her feet were not in an optimal position. Her left foot was farther forward than her right. That position limited how far her trunk could rotate. It stopped short of the range her swing demanded, but the momentum of the backswing did not stop with it. The remaining force had to be absorbed farther up the kinetic chain, placing greater demand on the smaller muscles stabilizing her shoulder. In this case, those tissues were unable to tolerate the load.

That matters because the body does not produce or absorb force one joint at a time. When one part of the kinetic chain cannot contribute effectively, another part may have to compensate.

Better conditioning and movement training could have improved her ability to reposition her feet, rotate efficiently, and respond to the demands of the shot. The larger lesson is not the wrong foot position inevitably causes a shoulder injury. It is that the body has to be prepared for the positions and forces the sport demands.

She is not an isolated case. She represents a pattern showing up across the country, and the numbers back it up.

The Numbers Behind the “Surge”

Pickleball’s growth has been extraordinary. Participation climbed from about 4.2 million Americans in 2020 to 24.3 million in 2025, an increase of nearly 480 percent in five years.

The number of injuries showing up in emergency departments has risen sharply as well. Estimated U.S. emergency-department visits tied to pickleball increased 91 percent between 2020 and 2022, while hospital admissions associated with those injuries jumped 257 percent. Nearly three-quarters of those injuries occurred in players between 60 and 79 years old. Fractures accounted for 29 percent of injuries and strains or sprains for 21 percent. Among injured players, those 65 and older had about 2.5 times the odds of hospitalization compared with players younger than 65.

Why is this sport producing so many injuries?

In my experience, it is not one factor. It is several stacking on top of one another. Pickleball has grown extraordinarily fast, it is commonly played on hard surfaces, and it is genuinely accessible. Most people can pick up a paddle, play once or twice, and think, “I can do this.”

And they can.

That is part of the problem.

The sport is beginner-friendly enough that people can advance quickly and become competitive well before their bodies have caught up with the movement demands they are placing on them.

Most adults spend years training their bodies, unintentionally, to sit. To look at a screen. To move within a narrow, low-demand range. Then they step onto a hard court and ask those same bodies to cut, pivot, lunge, rotate, and stop on a dime.

The body was not prepared for that overnight, and eventually it lets you know.

Why Knees Take the Hit

Knee complaints are among the most common problems I see, and one movement deserves particular attention.

The stop.

There is real biomechanics behind this. Rapid deceleration creates high impact forces and loading rates. Research has found peak ground-reaction forces during maximal horizontal deceleration up to 2.7 times greater than those seen during the first steps of maximal acceleration.

Stopping short after a quick move forward is especially demanding because the body has to absorb momentum in a very short period of time. The faster you are moving, the more momentum you have to control.

The quadriceps, glutes, calves, and other structures of the lower body help absorb and control those forces, but they have to be prepared for them.

Most recreational players never deliberately train deceleration.

They train swinging a paddle and let their brakes fend for themselves.

The Same Story, Different Joint

The shoulder injury and the knee pain illustrate the same broader issue: a body reacting to demands it may not be prepared for, with force traveling through a connected kinetic chain.

Power in a forehand or backhand does not start in the arm. It begins with interaction with the ground and travels through the legs, hips, and trunk before reaching the upper body.

When that chain works efficiently, multiple joints and muscle groups share the workload.

When positioning, mobility, strength, or timing disrupts the chain, the force does not simply disappear. Other parts of the body may have to compensate.

Sometimes they can.

Until they cannot.

What to Actually Do About It

Pickleball itself is not the problem, nor is it uniquely dangerous compared with golf, tennis, or other sports that ask the body to move quickly. Any activity carries risk when the body is not prepared for its demands.

Pickleball just happens to be where a tremendous number of people are showing up right now because it is so easy to start.

That accessibility is also one of the sport’s greatest strengths.

Pickleball can be an excellent way for someone transitioning from a sedentary lifestyle to become more active. Intensity can be controlled and it is genuinely fun to play.

The best exercise is the one you actually stick with.

Better still, preparing for pickleball does not require training like a professional athlete. A proper warm-up and adequate mobility go a long way. Strength, balance, and the ability to change direction under control help prepare your body for what happens on the court.

Knowing where to start begins with understanding how your body moves.

Movement restrictions, strength deficits, and compensations do not come from nowhere. They develop from the way we use, or do not use, our bodies over time. Sitting can be part of that story, along with inactivity, repetitive movements, old injuries, and the activities we perform every day.

We trained our bodies to tolerate sitting for hours at a time.

The same principle works in reverse.

We can train them to move, cut, stop, rotate, and swing, and prepare them to keep doing those things as we get older.

Train your body to play longer.