In a Pickle: Preventing Pickleball Sport Injuries

What do you get when you cross tennis with badminton AND table tennis? PICKLEBALL!
I’m hearing lots about it from my clients these days. Contrary to its name, Pickleball does not involve pickles of any kind. It is both a recreational and competitive sport played on a badminton-sized court, with a net set at 34 inches high in the middle, a wiffleball-like ball, and double-sized ping pong-like paddles. It can be played in singles or doubles, much like tennis, and on indoor or outdoor courts.
Originating in a Washington backyard in the mid-1960s, the sport has steadily made its way across the USA since then, growing in popularity so much that today, in the United States alone, the sport boasts an estimated 3.1 million players. As Canadian “snowbirds” visited the US and returned to Canada they brought the sport home with them. In 2017, Canada had an estimated 60,000 registered players, and that number is growing. The sport has gained popularity mainly because it is so easy to learn the skills necessary to play. There is a huge selection of YouTube videos demonstrating just that!

Pickleball, A Sport for All

Pickleball Canada’s slogan, “A Sport for All” is supported by the Sport & Fitness Industry Association statistics: 75% of those who play Pickleball eight or more times per year are 55+ years old, while it’s the 35-54 age group that plays casually (1-7 times per year), proving that it is no longer a sport played in retirement communities alone. There are now Pickleball clubs and facilities in all Canadian provinces and territories. It is played in North America, United Kingdom, India, Spain, Finland, France, Belgium, and New Zealand, so the sport enjoys healthy international competition. Players with diverse sporting backgrounds (sometimes never having been very active before) participate for a whole host of reasons, one being the social element of the game.

Potential Injuries from Pickleball

Of course, with increased participation in any sport comes an increase in the risk of injury. In my Pedorthic clinic, I see the number of Pickleball-related sport injuries on the rise. There are several internal risk factors that predispose someone to a sports-related injury. They include age, gender, body composition (% body fat), history of previous injury, muscle and joint fitness, anatomy, and skill level. Pair some of those factors with external factors such as other players, inadequate equipment, and unpredictable conditions of the playing surface, and you’ve got yourself a recipe for injury.
Like other court sports, the most common Pickleball injuries in the lower body are ankle ligament sprains from rolled ankles, Achilles tendon strains/ruptures from quick stop-starts or changes of direction, plantar fascia strains from overuse, ligament sprains at the knee due to change of direction, and pulled hamstrings from overextension. Upper body injuries like broken wrists and concussions are typically connected to falls on the court.
Despite the risks, many Pickleball-related injuries can be prevented. Here are some Pedorthic tips for preventing and recovering from Pickleball-related injuries:

Footwear

You may think that the most essential piece of equipment to be able to play Pickleball is a ball and paddle. Ask anyone who has played more than one game and they’ll tell you that it’s what is on your feet that is most important. Regular running shoes are the worst option for court sports of any kind. The soling and flared midsole (the part between the sole and upper) can catch on the surface of the court and cause forces to be applied to the foot and leg that are sometimes not well received by the small ligaments and tendons mentioned above.
Before your first Pickleball experience, get yourself a shoe designed specifically for use in court sports. Court shoes are designed specifically for the surface they are being used on, so when shopping for this type of footwear it is important to know whether you’ll be on hardwood or hardcourt. It is also crucial to get the correct size. You do not want to feel insecure in the shoe, like you’re sliding around, but you will want some space around the toes. A ¼-½” space beyond your longest toes is a good amount. To avoid disrupting circulation, tie your shoes securely but not too tight.

Before, During and After the Game

Before a game it is important to get the muscles and joints warmed up. Many Pickleball players will start with “dinking”, sort of like rallying in tennis. You can do some stretching that focuses on the back of the leg (Achilles/calf, hamstrings) and the front of the leg (quads). During the game you’ll want to use your larger muscle groups; bend at the knees and hips (like in a squat) to avoid injuring the lower back.
Sessions can be long, lasting upwards of three hours, so make sure to hydrate throughout and have a snack on hand. After the game you can do some more stretching. You can incorporate balance, stability, and strength exercises to condition for your next session.

Orthotics and Bracing

You may also benefit from using orthotics (custom or off-the-shelf) or bracing. Orthotics and bracing can help with stability, increasing the information received from the surface you’re on through your feet, and supporting the structures of the feet. Even small modifications made to the liner of your shoe can contribute in a big way towards a more comfortable, injury free, Pickleball experience.
By seeking the advice of a Canadian Certified Pedorthist, or C. Ped (C), your individual needs will be considered to determine which assistive device(s) will be the best solution. A Pedorthic assessment will include taking a detailed history, functional testing and measurements, and, if orthotics or bracing is necessary, a 3-dimensional cast or digital scan of your feet. To find a C. Ped (C) in your area, visit the Pedorthic Association of Canada’s website here.
By Jaime Nickerson, C. Ped (C), B.Sc. (Kin), Dip. Pedorthics