Pickleball Injuries: What the Data Shows and What It Cannot Tell You

The short answer. Pickleball injuries are real, they cluster in recognisable patterns, and the widely quoted numbers describe emergency department visits rather than your risk in a given game. The patterns worth knowing are that older players show more falls, wrist and hand injuries and fractures, that middle-aged players show more lower limb injuries, and that Achilles problems show up more than the sport's gentle reputation suggests. Building general readiness for those movements is what one-to-one training at Aeon is for. It is not a validated injury prevention program, and this article does not diagnose or treat anything.

What the data actually counts

Most pickleball injury statistics come from the National Electronic Injury Surveillance System, a sample of United States emergency department visits. A review of ten years of that data identified 1,722 pickleball cases, corresponding to a national estimate of roughly 100,700 injuries between 2014 and 2023, with annual estimates rising from about 1,300 in 2014 to about 24,500 in 2023 (ten-year national injury surveillance review, 2025).

That growth curve is striking, and it is also not a risk rate. The authors state that the study relies solely on emergency department visits and therefore underrepresents the true injury landscape, since less severe injuries managed in clinics or at home are not captured. They also note sampling bias, and that pickleball has no unique product code in the system, so cases had to be identified from free-text narratives and some were likely missed (ten-year national injury surveillance review, 2025).

There is no denominator of games played, hours on court or number of participants inside these figures. Participation was also climbing steeply over the same period, with one review citing 48.3 million United States adults playing at least once in 2022 and an 85.7% increase in players since 2017 (critical analysis review of pickleball injuries, 2024). More players produce more injuries even at constant risk.

The patterns that hold up

Within those limits, the age and region patterns are consistent enough to be useful.

By age, players aged 60 to 79 accounted for about 73.8% of cases, with 15.1% in the 40 to 59 group and 5.6% aged 80 or older (ten-year national injury surveillance review, 2025). An earlier analysis of 2001 to 2017 data found 90.9% of patients were aged 50 or older (Forrester, Journal of Emergency Medicine, 2020).

By mechanism and body region, the ten-year review found that players aged 60 to 79 had higher odds of wrist and hand injuries and of fractures, and were about twice as likely to have been injured in a fall, while players aged 40 to 59 had roughly twice the odds of a lower extremity injury (ten-year national injury surveillance review, 2025). The earlier analysis reported strains and sprains and fractures as the two leading diagnoses, with 88% of patients treated and released (Forrester, 2020).

Clinic-based series show a different mix again, which is a clue about the data rather than a contradiction. A critical analysis review noted that studies disagree on whether upper or lower extremity injuries predominate, attributing the difference to methodology and study period, and summarised one single-practice upper extremity series led by wrist fractures and epicondylitis alongside a lower extremity series led by ankle sprains and strains, Achilles ruptures, Achilles tendinopathy and plantar fasciitis (critical analysis review of pickleball injuries, 2024).

Achilles injuries deserve their own paragraph

Pickleball's low-impact reputation does not extend to the Achilles tendon. In a series of 1,035 acute Achilles ruptures treated over five years, pickleball accounted for 40 cases, a similar share to tennis, with a median patient age of 60 compared with 44.5 for tennis and 37 for other causes, and 82.5% of pickleball cases occurring in people over 50 (Achilles rupture series, 2025).

A video analysis of professional play found significantly more at-risk Achilles movements in pickleball than in tennis, while making the honest point that the fraction of Achilles tendons which rupture during those movements is exceedingly small (video analysis of at-risk Achilles movements, 2024). Both things are true: the movement exposure is there, and most exposures are uneventful.

Elbow and shoulder complaints are a different problem

Elbow and forearm complaints follow overuse logic rather than accident logic. Lateral elbow tendinopathy, the condition usually meant by pickleball elbow, shows up in the clinical series (critical analysis review of pickleball injuries, 2024).

The management evidence is modest. A systematic review of 30 randomized trials with 2,123 participants found exercise superior to passive interventions for lateral elbow tendinopathy, but reported that the effect is small, the certainty of evidence low to very low, and the descriptions of exercise in the trials substantially heterogeneous (systematic review of exercise for lateral elbow tendinopathy, British Journal of Sports Medicine, 2021). That is a reason to get an actual assessment rather than to copy a protocol.

What general readiness might contribute

No trial has tested injury prevention in pickleball. What exists is broader evidence that we treat as suggestive rather than transferable in detail.

Strength training. A meta-analysis of 25 randomized controlled trials covering 26,610 participants reported strength training associated with a relative risk of sports injury of 0.315, and overuse injury specifically at 0.527, while stretching alone showed no benefit (Lauersen and colleagues, British Journal of Sports Medicine, 2014). The pooled estimate was heterogeneous, so the direction is more trustworthy than the figure (Lauersen and colleagues, 2014).

Falls. Given how much of the older-player burden is fall-related, the Cochrane review matters here. Across 108 trials and 23,407 community-dwelling adults aged 60 and over, exercise reduced the rate of falls by 23% and the number of people experiencing a fall by 15%, with balance and functional exercise and resistance training among the effective types, though most trials were at unclear or high risk of bias (Sherrington and colleagues, Cochrane Database of Systematic Reviews, 2019).

Balance and deceleration. The same Cochrane review identified balance and functional exercise as effective categories, which is relevant because the fall mechanism dominates the older-player data rather than paddle contact or collision (Sherrington and colleagues, Cochrane Database of Systematic Reviews, 2019).

Put together, the qualities that look most relevant to the reported patterns are lower limb strength and calf capacity, deceleration and change of direction control, single-leg balance, and shoulder and forearm tolerance for repeated volume. That is a reasonable training focus. It is not a promise.

The limits, stated plainly

Emergency department data cannot tell you your risk per hour of play, because it has no denominator and captures only injuries severe enough to reach an emergency department (ten-year national injury surveillance review, 2025). Clinic series reflect the specialty of the clinic, which is why an upper extremity practice and a foot and ankle practice can publish very different pictures of the same sport (critical analysis review of pickleball injuries, 2024). The video analysis used a small sample of professionals, whose movement patterns are not those of recreational players (video analysis of at-risk Achilles movements, 2024).

And none of the prevention evidence was generated in pickleball. Anyone claiming a proven pickleball injury prevention program is extrapolating (Lauersen and colleagues, 2014).

What this means at Aeon

We train the movement qualities the reported patterns point to, and we ask about playing volume early, because court hours are usually the biggest variable in the room. Where something hurts, that becomes an assessment question rather than a programming one, and we would rather send you for a proper look than build a workaround around pain, and our on-site physical therapy exists for exactly that handoff.

If you play several times a week and want your body to keep up with your schedule, start with an assessment and personal training built around your court volume and history.