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Sara Coello, ESPN
In perhaps the most meteoric rise of a once-niche sport that the United States has ever seen, pickleball is now one of America’s most popular adult rec sports. The plentiful courts, straightforward rules, cheap equipment and ever-more-crowded rosters of local opponents and teammates makes it unsurprising that USA Pickleball now reports over 78,000 registered members. In 2024, The Sports and Fitness Industry Association tracks over 3 million players.
The telltale paddles are especially common sights in 55+ communities and senior rec centers as adult Americans – most of them 50 and over – take to the court. But as with any sport, more players means more injuries. Emergency rooms in hospitals across the nation have reported an especially marked increase in players over 60.
Is pickleball a good sport for all ages?
In most cases, yes. The benefits of exercise – especially with others – far outweigh the risks for most people, especially those who don’t have other opportunities for exercise or social activities. The Centers for Disease Control and Prevention recommend at least 150 minutes of moderate-intensity exercise for adults of every age. Studies have shown that regular socializing in older adults can help stave off depression, loneliness, and even some memory issues.
There are of course exceptions. The intense cardio of darting back and forth across the court can be problematic for people with heart conditions. Quick movements on the hard pavement of the court is a fracture risk for those with low bone density. Playing while injured can complicate healing for existing bone and muscle injuries. Outdoor play in rain can increase fall risks, while hot summer games come with the chance of heat stroke.
In all cases, experts recommend players check with their doctors before drastically changing exercise routines, especially for those with preexisting conditions or those at high risk of injury.
What are the most common injuries?
The most common injuries come from either one-time accidents on the court (like falling or sliding in pursuit of the ball) and repetitive use injuries similar to tennis elbow or pitcher’s arm. Of the former, analyses of emergency room data in a couple studies have shown that the vast majority of injuries that prompt hospital visits happen to the lower leg and wrist. Different players are prone to different types of injury.
A study of medical data from 2000 through 2022 tracked the rate of bone fractures through pickleball’s rise in popularity. There was a high uptick in injuries, including an 11-fold increase in injuries in seniors from 2010 through 2019. The highest proportion of the 397 fractures included in the study were to women over 60 – unsurprising given that postmenopausal women tend to experience bone loss.
A whopping 92 percent of bones broken in that study came from falls, including when players intentionally slid or dived for the ball but miscalculated their landing. Most of the injuries were to the radius, humerus and ulna – the three primary arm bones. Broken legs and ankles are also possible. Five players in the study had broken ribs while a dozen reported head injuries. However, almost 80 percent of patients were discharged the same day – those who weren’t tended to be older (with a mean age of 70) with a higher proportion of torso injuries (including four of the five patients who broke ribs).
Sprains and muscle injuries are much more common than fractures, and can prove just as difficult to heal. Another study found that patients 50 and older accounted for 90.9 percent of patients hurt while playing pickleball, with strains and sprains accounting for 28.7 percent of the injuries – one percent more than fractures. Strains and sprains were more likely to happen on the leg than fractures were, and only 12 percent of patients were admitted for longer hospital stays.
Several pickleball players have found themselves in the ER with cardiac issues or heat stroke. Pickleball seems to be no riskier than other forms of exercise when it comes to dehydration and circulatory issues, but players should take care to hydrate and pay attention to any symptoms.
To what extent is age a factor?
Age restrictions are hard to pin down and different for everybody. Age itself can come with inherent barriers to taking up a new sport, but it’s just one of several factors. Taking up a cardio-heavy sport at any age can present difficulties for people who haven’t been regular exercisers beforehand. Jones recommends a doctor’s visit focused on heart health for anyone looking to suddenly increase their cardio exercise, so experts can look for any new or previously undetected heart issues. Similarly, while bone density often decreases with age – especially after menopause – younger players with osteoporosis or other bone issues should also make sure the benefits of the game outweigh fracture risk. Overall, age itself is less of an issue than the conditions that often come with it. Seniors who get regular checkups and follow doctors’ advice can consider pickleball a low-risk way to get their exercise in.
How do the injuries compare to similar sports?
It’s surprisingly difficult to compare injury rates with other sports, especially given pickleball’s meteoric rise among older people and first-time athletes. Ches Jones, an injury control researcher at the University of Arkansas, has studied sport injuries since 1990 but told ESPN he doesn’t remember another game in his career becoming so quickly popular with players over 50.
The most common comparison is tennis, which should be unsurprising to the tennis players who’ve recently had pickleball players flock to the same courts. In pickleball, the smaller court area and lower net, along with the requirement that players bounce the ball across the “kitchen” area on either side of the net, mean slower-moving balls that reduce the risk both of being injured by a flying ball or hurt while chasing after one. Additionally, tennis has been an established sport for decades, so many of the players whose ages or preexisting conditions present risks don’t have the added complication of being a newcomer to tennis’ physical demands.
Another consideration is the average age of new players. Over a third of new pickleball players are 55 and older according to one study, many of whom play at least eight times a year. The first year that senior pickleball players’ emergency room visits reached the rate of senior tennis players’ visits was 2018. Through the years, visits have remained about constant for pickleball players under 40, with a slight increase in players 40-59 and skyrocketing for those 60 and older.
In both tennis and pickleball, eye injuries were rare and generally caused by hits from the ball. Injury analysts suggested that pickleball could be safer than tennis when it comes to cardiovascular emergencies, likely due to the lesser exertion that comes from pickleball’s lighter ball, smaller court, and the relative popularity of doubles games (which require each partner to run less).
What can be done to reduce injuries?
Though a few documented injuries have come from collisions with balls and rackets, the vast majority come from trips, falls, sudden turns and other sudden movements. That’s good news for those looking to avoid them, because it means general athletic health measures can go a long way to prevent or mitigate the effects of injury.
Experts recommend stretching and conditioning, both muscular and cardiovascular. Supplementing pickleball with running, swimming, cycling or regular workouts is an easy way to build up endurance for the court. For those taking up pickleball after long periods of inactivity, Jones recommends starting with just a few games at a time and increasing the intensity of exercise gradually. Furthermore, since most injuries are to the arms and legs, braces and stabilizers can be great options for people prone to sprains or twists.
Is pickleball a good choice for getting active?
Jones thinks so. The small courts, lightweight ball and short game durations are all factors he listed that make pickleball an approachable sport for newcomers. He warned ESPN that the benefits only come if you’re actually playing, so a sidelining injury is important to factor and avoid.
For new players, he recommends comparing pickleball to the potential player’s existing exercise routine. Those who already exercise several times a week and regularly work out their entire bodies should still start slow on the court to avoid exhaustion. Those who haven’t done much exercise lately – even if they were very athletic beforehand – should always check with a doctor. Jones emphasizes the importance of cardiac check-ups for the latter group, since they account for a large percentage of health issues in older players and can often go undetected for those just recently getting active.
