Pickleball has gone from a niche pastime to the fastest-growing sport in Canadian history. Roughly 1.8 million Canadians now play — up about 340% in five years — and courts across Surrey, Burnaby, Langley and the rest of the Lower Mainland are busier every summer.
The trouble is that pickleball feels gentler than it is. The court is small, the paddle is light, and the ball moves slower than a tennis ball. That combination convinces a lot of players that they don’t need to prepare their body the way they would for a run or a gym session. Then comes the lunge for a dink at the kitchen line, the backpedal for a lob, and a sudden trip to the clinic.
Here are the five injuries we see most often from pickleball, why they happen, and what actually works to prevent them.
Why Pickleball Causes More Injuries Than People Expect
Three things make pickleball deceptively demanding on the body.
The movement is short, sharp and sideways. Pickleball is built on quick lateral shuffles, split-steps and hard stops — not the steady forward motion most people train for. Ankles, knees and hips absorb a lot of load in a very small space.
Players backpedal. Chasing a lob by walking backwards is the single most dangerous habit on the court. It shifts your centre of gravity behind your feet, and if a heel catches, you fall backwards onto an outstretched hand or hip.
The demographic skews older. Pickleball’s growth has been strongest among players in their 50s, 60s and 70s. A 10-year review of national injury data found that roughly 91% of pickleball injuries occurred in players aged 50 and older, with fractures and sprains each accounting for about 27% of cases. That’s not an argument against playing — the cardiovascular, balance and social benefits are excellent. It’s an argument for warming up properly.
The 5 Most Common Pickleball Injuries
1. Ankle Sprains
The classic pickleball injury. A quick change of direction rolls the ankle inward, overstretching the ligaments on the outside. You’ll feel immediate pain, followed by swelling and bruising over the next day or two.
Most ankle sprains recover well, but the ones that cause long-term problems are the ones people rush back from. Ligaments heal, but the balance and position sense in the joint don’t return on their own — which is why a poorly rehabbed first sprain is the biggest risk factor for a second one.
2. Achilles Tendon Strain
The Achilles takes the brunt of every explosive push-off toward the net. Overuse builds a nagging stiffness at the back of the heel that’s worst first thing in the morning. Less commonly, a sudden forceful push-off can partially or completely tear the tendon — often described as feeling like being kicked in the calf, sometimes with an audible pop.
Morning heel stiffness that eases as you move around is your early warning sign. That’s the point to get it looked at, not after it becomes constant.
3. Pickleball Elbow (Lateral Epicondylitis)
Same condition as tennis elbow: irritation of the tendons on the outside of the elbow, caused by repetitive gripping and wrist extension. Pain shows up on the outside of the elbow and often travels down the forearm, and it tends to flare when you shake hands, lift a kettle or open a jar.
Grip size, paddle weight and technique all contribute. So does volume — a lot of people go from playing twice a week to five times a week without any transition period.
4. Rotator Cuff and Shoulder Pain
Overhead smashes and repeated serves load the rotator cuff, the group of four muscles that stabilize the shoulder. Pain with reaching overhead, weakness lifting the arm out to the side, or an ache that keeps you awake when lying on that shoulder all point in this direction.
Our guide to the best exercises to fix shoulder pain covers useful starting points, though persistent shoulder pain deserves a hands-on assessment.
5. Falls, Wrist Fractures and Knee Injuries
When a player falls — usually backpedalling — the instinct is to catch themselves on an outstretched hand. That’s how wrists break. Research on pickleball injuries has consistently found the wrist among the most frequently injured areas, and fractures make up a large share of the total.
Knees take damage from twisting under load, producing meniscus tears and ligament strains. If your knee swells within a few hours of an injury, locks, or gives way, that needs proper assessment — our article on when to see a physio for knee pain walks through the warning signs.
A 6-Minute Warm-Up That Actually Prevents Injuries
Static stretching before play does not prevent these injuries. A dynamic warm-up does, because it raises tissue temperature and rehearses the movements you’re about to perform. Do this before you step on the court:
- Brisk walk or easy jog, 2 minutes. Get your heart rate up and blood flowing.
- Leg swings, 10 each direction per leg. Forward-and-back, then side-to-side, holding the fence for balance.
- Lateral shuffles, 3 lengths of the court. This is the single most sport-specific thing you can do — it primes exactly the muscles pickleball demands.
- Calf raises, 15 reps. Wakes up the calf and Achilles before they’re asked to push off hard.
- Arm circles and torso rotations, 30 seconds each. Prepares the shoulder and thoracic spine for overhead shots.
- Half-speed practice rally, 1 minute. Ease into full pace rather than starting at match intensity.
Off-Court Strength That Keeps You Playing
Warming up handles the acute risk. Building capacity handles the chronic risk. Two or three short sessions a week make a meaningful difference:
- Eccentric heel raises. Stand with the balls of your feet on a step, heels hanging off. Rise up on both feet, then slowly lower over 3 seconds. Build toward 3 sets of 12. This is one of the best-evidenced approaches for Achilles tendon health.
- Lateral band walks. Resistance band around the ankles, small steps sideways in a quarter-squat. Strengthens the hip stabilizers that control your knee during direction changes.
- Single-leg balance. 30 seconds per leg, progressing to eyes closed. Directly retrains the position sense that ankle sprains damage.
- Grip and forearm work. Slow wrist extensions with a light dumbbell to build the tendon capacity that prevents pickleball elbow.
- Sit-to-stands or squats. General leg strength underwrites everything else and protects the knees.
Four Habits That Cut Your Risk Immediately
Wear court shoes, not runners. Running shoes are built for forward motion and have soft, tall midsoles that roll under lateral load. Court shoes have a wider, flatter base and reinforced sides. This is the highest-value equipment change most players can make.
Never backpedal. Turn and shuffle sideways to chase a lob, or let it go. A lost point is cheaper than a fractured wrist.
Increase your playing volume gradually. Going from two sessions a week to five is a 150% jump in load. Tendons adapt slowly — add roughly one session or 20% more court time at a time.
Check the court before you play. Wet patches, loose balls and cracked surfaces cause a meaningful share of falls.
When to See a Physiotherapist
Minor soreness that settles within a couple of days is normal. Book an assessment if you notice any of the following:
- Pain that persists beyond 7–10 days, or that’s getting worse rather than better
- Inability to put weight on a limb, or a joint that gives way
- Swelling that appears within a few hours of the injury
- Numbness, tingling or weakness
- A joint that locks or catches
- Any injury where you heard or felt a pop
Sudden, severe calf pain with difficulty pushing off, or an obvious deformity after a fall, should be assessed the same day.
How Synergy Rehab Can Help
Our clinics across the Lower Mainland treat pickleball injuries regularly, and treatment is matched to what’s actually driving your problem:
- Physiotherapy — assessment, manual therapy and progressive loading for sprains, tendon problems and shoulder pain
- Active rehabilitation — supervised strength and balance work to get you back on court and keep you there
- Shockwave therapy — an option for stubborn tendon conditions like chronic Achilles pain and pickleball elbow
- Kinesiology — movement retraining and conditioning programs built around your sport
- Chiropractic care — for related back, neck and joint complaints
Most extended health plans cover physiotherapy, and you don’t need a doctor’s referral to book with us in British Columbia.
Frequently Asked Questions
Is pickleball bad for your knees?
No. For most people the benefits outweigh the risks, and regular play supports joint health, balance and cardiovascular fitness. The risk comes from playing on unprepared legs — sudden twisting and stopping without adequate strength or warm-up. Conditioning, court shoes and sensible volume increases address most of it.
How long does a pickleball ankle sprain take to heal?
A mild sprain typically settles in 2–4 weeks, a moderate one in 4–8 weeks. Returning to court before balance and strength are restored is the most common reason people sprain the same ankle repeatedly, so timelines depend more on rehab quality than on the calendar.
What shoes should I wear for pickleball?
Court shoes designed for tennis, pickleball or indoor court sports. They have flatter, wider soles and lateral reinforcement that running shoes lack. Running shoes are a genuine injury risk on court because their soft midsoles roll under sideways load.
Can I keep playing with pickleball elbow?
Often yes, with modifications — reducing volume, checking your grip size and paddle weight, and adding forearm strengthening. Playing through worsening pain tends to prolong recovery considerably, so it’s worth getting assessed early rather than waiting for it to become constant.
Do I need a doctor’s referral to see a physiotherapist in BC?
No. You can book directly. Some extended health plans request a referral for reimbursement, so it’s worth checking your specific plan.
Book an Assessment
If pickleball has left you with a nagging ankle, elbow or shoulder, don’t wait for it to resolve on its own. Book an appointment at your nearest Synergy Rehab clinic and we’ll build you a plan to get back on the court.
This article is general information, not medical advice. For guidance specific to your situation, please consult a qualified healthcare professional.
