The Pickleball Boom: Play America's Fastest-Growing Sport Without Getting Hurt
Twenty-four million Americans now play pickleball — and injuries are climbing almost as fast as participation. Here's how to enjoy the sport's remarkable health benefits while protecting your wrists, shoulders, and spine.
Walk past the courts at almost any park in New Jersey this summer and you'll hear it before you see it: the unmistakable pop-pop-pop of a pickleball rally. What began as a backyard curiosity is now a national phenomenon — and one of the best and worst things happening to American bodies, often at the same time. The difference between players who thrive and players who get sidelined usually isn't age or luck. It's preparation.
The boom, by the numbers:
• 24.3 million Americans played pickleball in 2025
• Participation has grown about 172% in just three years — the fastest-growing sport in the country four years running
• Pickleball-related fractures have risen roughly 200% over the past decade
• About 3 in 4 pickleball ER visits involve players age 60 and older
Why Your Doctor Loves Pickleball
Let's start with what the sport gets right — because it gets a lot right.
It's cardio wrapped in a game. Pickleball delivers short bursts of effort followed by brief recovery — essentially interval training without the drudgery. Players routinely log thousands of steps and an elevated heart rate for an hour straight without once looking at a clock. That matters, because the best exercise program is the one you actually keep doing, and pickleball may be the "stickiest" workout America has found in decades.
It trains exactly what aging steals. Reaction time, hand-eye coordination, lateral quickness, balance. Practiced regularly — by a body prepared for it — pickleball is fall-prevention training disguised as recreation.
It loads your skeleton. Every push-off and quick step sends gentle impact through your legs, hips, and spine — precisely the signal bone needs to stay dense as we age.
It's deeply social. This may be its most underrated benefit. A large, decades-long Danish study found that people who played racquet sports lived significantly longer than sedentary peers — tennis players nearly a decade longer — and researchers believe the built-in social connection is a big part of why. Loneliness is a genuine health risk. A standing 8 a.m. game with three friends is medicine.
The Numbers Nobody Warms Up For
Now the other side of the paddle. As participation has exploded, injuries have followed. Emergency-department visits for pickleball injuries roughly doubled between 2020 and 2022, and fracture cases have climbed about 200% over the past decade. Roughly three out of four of those ER visits involve players sixty and older. Fractures and sprains each account for about a quarter of injuries, and the wrist is the single most commonly fractured site — almost always from a fall.
None of this makes pickleball a dangerous sport. Hour for hour, it compares reasonably with other moderate activities. What the numbers really reflect is millions of new players — many returning to athletics after years or decades away — jumping into a surprisingly quick game without preparing their bodies for it. The sport isn't the problem. The preparation gap is.
Why Pickleball Catches Bodies Off Guard
It's deceptively easy to start. You can learn the rules in ten minutes, so people skip the gradual ramp-up they'd naturally give tennis or skiing. Easy to learn gets mistaken for easy on the body.
The court is small, so the game is fast. Rallies live in sudden starts, stops, lunges, and quick rotations — precisely the movements that stress calves, knees, shoulders, and the low back when tissues aren't conditioned for them.
The lob is a trap. Most serious pickleball injuries begin the same way: a ball sails overhead, the player drifts backward with eyes up, heels catch, and they fall forcefully onto an outstretched wrist — or worse, a hip or the back of the head. Backpedaling is the single most dangerous move in the sport.
Enthusiasm outruns adaptation. Your heart may be ready for pickleball weeks before your tendons, discs, and joint capsules are. Connective tissue adapts slowly. After years at a desk, three games of explosive lateral movement is a much bigger ask than it feels like in the moment.
Where It Hurts: A Quick Tour
• Wrist and forearm — the #1 fracture site, nearly always from falling onto an outstretched hand. Prevention is mostly about not falling.
• Shoulder — overheads plus thousands of dinks can irritate the rotator cuff, especially in shoulders that sit at a desk all week.
• Calf and Achilles — explosive push-offs strain calves and the Achilles tendon; the classic "sudden pop" injury in players over 40.
• Knee — quick pivots on a planted foot stress ligaments and meniscus. Fatigued legs pivot sloppier.
• Elbow — "pickleball elbow" is real: the same overuse tendinopathy as tennis elbow, from gripping and repetitive swings.
• Low back — hundreds of bends and twists per session. When hips and mid-back are stiff, the low back pays the tax.
Your Spine on Pickleball
Every serve, drive, and put-away is a rotation event — and here's the detail most players never learn: your low back isn't built to rotate much. The lumbar spine is designed for stability, contributing only about a dozen degrees of total rotation. The twisting power in a good swing is supposed to come from the hips and the mid-back (thoracic spine). When those areas are stiff — and after decades of sitting, they usually are — the low back gets forced to twist beyond its design, hundreds of times per session, often from a bent-forward ready position. That's the recipe for the "Monday-after" back.
The game also lives low. Every dink is a mini squat or lunge. Players who bend from the spine instead of hinging from the hips rack up hundreds of poorly loaded reps per outing.
Finally, remember that balance itself is partly a spinal skill. The joints of your spine feed constant position information to your brain — proprioception — and that system is a core part of not falling in the first place. A well-moving spine isn't just about comfort; on a pickleball court, it's protective equipment.
The Protection Plan
- Warm up like it matters — five minutes. Two minutes of brisk walking or light jogging, then ten leg swings each direction, ten hip circles, ten trunk rotations, arm circles, twenty seconds of side shuffles, and ten slow squats. Dink before you drive: make your first game a gentle one.
- Retire the backpedal — permanently. When a lob goes over your head, turn and run, or simply let it bounce. Agree with your partner in advance who takes lobs. This one habit prevents the sport's worst injuries.
- Wear court shoes, not running shoes. Running shoes are built for straight lines and can roll during side-to-side cuts. Court shoes (tennis, pickleball, volleyball) are built for lateral support.
- Strength-train twice a week off the court. Sit-to-stand squats, hip hinges, calf raises, a 30-second single-leg stand per side, and band rows. Fifteen to twenty minutes, twice a week, transforms how much play your body can absorb.
- Ramp up on purpose. New or returning after a break? Play every other day at first, and add frequency before intensity. Injuries cluster in fatigue — skipping the fifth game when your legs feel heavy is a skill.
- Play smart in the heat. Late-July courts are hot. Hydrate before and during play, rest in shade between games, and favor morning sessions. Your spinal discs are mostly water — hydration is spine care too.
- Respect the whispers. Soreness that lingers past 48 hours, sharp or pinching pain, or a joint that swells is your body asking for help. Playing through it is how one-week problems become three-month problems.
If you tweak something mid-game: stop playing — finishing the game rarely ends well. For the first day or two, favor relative rest and gentle pain-free movement rather than complete immobility. If things aren't clearly improving within a few days, or if pain radiates, numbness appears, or the same spot keeps re-tweaking, get it assessed. Early care is almost always shorter care.
When to Get Checked
• Before problems start — if you're picking up the sport after years away, a movement screen (hip rotation, mid-back mobility, single-leg balance) finds the stiff links before the court does.
• Within a week or two — pain lasting more than a week, the same spot tweaking repeatedly, or numbness or tingling into an arm or leg deserves a professional look. These patterns usually point to a mechanical cause that responds well to conservative care.
• Right away — a fall you can't shake off, inability to bear weight, visible deformity, or any chest pain, pressure, or unusual shortness of breath during play. That's emergency care, not a wait-and-see.
In our office, the goal with pickleball players is rarely just calming down the sore spot. It's finding the stiff link that made another area overwork — restoring motion to the hips and mid-back so the low back stops paying the tax, tuning up balance so the falls never happen. Treat the cause, and the sport gets to stay in your life for decades.
Play more. Hurt less. Whether you're pickleball-curious or already playing four days a week, a spine and movement check-up can keep you on the court and out of the emergency room. Schedule your visit at ahpts.com — Dr. Lavigne and the AHPTS team are here to help you build a body that loves the game back.