Article Summary: Pickleball is Canada’s fastest growing sport; with high growth also comes a sharp rise in injuries. This guide covers the most common pickleball injuries, why they happen, how they are treated, and what you can do to stay on the court longer. Written by Dr. Nicholas Cheng, the only RacquetFit Certified healthcare provider in Canada and a Level 1 Certified Pickleball Coach, this is the most specialized resource on pickleball injury management available to Canadian players.
Pickleball is booming! Courts are filling up across Markham, Richmond Hill, Scarborough, and every corner of the GTA. Players of all ages are discovering what millions already know: pickleball is fast, social, competitive, and deeply addictive.
But here is the reality that does not always make it into the highlight reel. As participation grows, so does the injury count. Pickleball places unique and repetitive demands on the body, and players who underestimate those demands are unfortunately at higher risk of succumbing to injury.
At Rally Point Health and Rehab, we treat pickleball injuries every day. Dr. Nicholas Cheng is not just a specialist in racket sport biomechanics; he is an avid pickleball player himself, a Level 1 Certified Pickleball Coach, and the only RacquetFit Certified healthcare provider in all of Canada (as of April 2026). He has treated local professional players and understands the sport both on and off the court.
This guide covers everything you need to know about pickleball injuries: what they are, why they happen, how they are treated, and what you can do right now to reduce your risk.
Why Pickleball Injuries Are on the Rise
Pickleball is experiencing a very steep increase in participation numbers. According to Sports Marketing Surveys, pickleball participation in North America has grown by over 150% in the past five years, with Canada following closely behind. While a significant portion of active players are over the age of 50, the sport’s rapid growth has also brought an influx of younger, highly competitive athletes to the court.
How does this matter clinically? Older players have reduced tissue elasticity, take longer to recover, and generally have less muscle mass due to sarcopenia. In contrast, younger players often present with acute strains and overuse injuries driven by explosive, high-intensity play and excessive weekly volume. Combined with the sport’s rapid direction changes and repetitive overhead and forearm loading, pickleball presents a highly distinct clinical challenge for players of every generation.
The Most Common Pickleball Injuries
1. Pickleball Elbow (Lateral Epicondylitis)
Pickleball elbow is the most common complaint we treat in players. Technically identical to tennis elbow, it involves the overload and micro-tearing of the tendon that attaches to the lateral epicondyle; the bony prominence on the outside of the elbow.
The mechanism in pickleball, however, is distinct from tennis. The compact swing, frequent dinking motion, and repetitive wrist extension create a specific stress pattern that differs from a full tennis stroke. Paddle weight, grip size, and core thickness and composition all contribute to how much force travels through the forearm with each shot.
Symptoms: Pain and tenderness on the outside of the elbow, functional grip loss (eg. pain with everyday tasks that involve gripping and/or twisting like turning a door knob), discomfort when lifting or extending the wrist.
Treatment: Soft-tissue therapy to reduce tendon irritation, therapeutic modalities to ease muscle tension, progressive loading exercises to rebuild tendon capacity, and equipment assessment to correct contributing mechanical factors.
2. Rotator Cuff Strains and Tendinopathy
The shoulder is the second most commonly injured region in pickleball players. There are four rotator cuff muscles that synergistically act to stabilize the shoulder. When you combine repetitive rally swings with aggressive serves and overhead smashes, that cumulative stress easily leads to injury.
Rotator cuff injuries typically develop gradually over time rather than from a single traumatic event. Players often dismiss early warning signs until the pain begins interfering with play.
Symptoms: Deep and/or dull aching sensation, pain with overhead movements, weakness with general shoulder movement, night pain (especially if lying on the affected shoulder).
Treatment: Soft-tissue therapy, joint mobilization to restore shoulder mechanics, progressive rotator cuff strengthening, and sport specific rehabilitation targeting the demands imposed on pickleball players.
3. Knee Pain and Ligament Injuries
The sudden direction changes, split-step landings, and lateral movement demands of pickleball put an incredible amount of stress on the knees. As a result, we frequently see players suffering from patellofemoral pain syndrome (runner’s knee), ligament sprains, and meniscus irritation, especially when they increase their time on the court too quickly.
Symptoms: Pain around or behind the kneecap, joint line tenderness, pain during and immediately after a session, instability or a feeling of the knee giving way.
Treatment: Assessment of contributing factors including hip strength deficits, foot mechanics, and movement patterns. Chiropractic care, therapeutic modalities, soft-tissue therapy, and targeted rehabilitation to restore stability and strength to the affected structures.
4. Ankle Sprains
Fast court movement, split steps, and the occasional misjudged lunge make ankle sprains one of the most frequent acute injuries in pickleball. Lateral ankle sprains are the most common, occurring when the foot rolls outward under load.
What most players do not realize is that an improperly rehabilitated ankle sprain significantly increases the risk of re-injury; rest alone is not a recovery strategy.
Symptoms: Pain on either side of the ankle, swelling, bruising, difficulty bearing weight.
Treatment: Active rehabilitation to restore ankle stability, proprioception, and strength. Chiropractic care to address joint restriction, and progressive return-to-court programming to ensure the ankle is ready for the demands of play.
5. Achilles Tendinopathy
The Achilles tendon absorbs an enormous amount of force during the explosive push-off and deceleration movements in pickleball. Tendinopathy develops when cumulative load exceeds the tendon’s capacity to recover and adapt; this is commonly seen in players who ramp up their playing volume too quickly after a period of reduced activity.
Symptoms: Morning stiffness at the back of the heel, pain that goes away during play but returns afterward, sharp tenderness and/or discomfort when applying direct pressure on the tendon.
Treatment: Load management, progressive tendon rehabilitation using evidence-based loading protocols, soft-tissue therapy, and custom orthotics if foot mechanics are contributing to additional stress placed on the Achilles tendon.
6. Lower Back Strain/Sprain
The rotational demands of pickleball, combined with the repeated forward bend/hinge position of the ready stance, place sustained stress on the lumbar spine and surrounding musculature. Lower back strains are especially prevalent in players who are sedentary during the week and active on weekends (ie. weekend warriors); a pattern that is common in both the over and under 50 demographics of this sport.
Symptoms: Localized lower back pain, stiffness after playing, muscle spasms, referred pain into the buttock or leg.
Treatment: Spinal adjustments to restore joint mobility, soft-tissue therapy, posterior chain strengthening exercise protocols, and movement screening to identify and correct contributing postural patterns.
7. Wrist and Hand Injuries
The grip demands of pickleball, combined with the frequent impact of paddle on ball, load the wrist and hand repetitively across every session. As a result, we regularly see wrist sprains, TFCC injuries (pain on the pinky side of the wrist), and de Quervain’s tenosynovitis (tendon irritation at the base of the thumb) in both competitive and recreational players.
Symptoms: Symptoms include pain when gripping or rotating the hand, sharp tenderness along the thumb side of the joint, and clicking or instability during normal wrist movement.
Treatment: Joint mobilization, soft-tissue therapy, progressive strengthening, and paddle grip assessment to reduce contributing mechanical load.
The Rally Point Approach to Pickleball Injury Treatment
Most clinics treat pickleball injuries the same way they treat any soft-tissue complaint. Assessment, modality, exercise. Repeat.
That approach misses what makes pickleball injuries unique.
At Rally Point Health and Rehab, Dr. Cheng brings a clinical perspective that goes well beyond standard chiropractic and physical therapy care. Through his RacquetFit Certification, he utilizes a specialized framework to analyze your injury based on racket sport biomechanics, equipment choice, and specific court demands. Combined with his Level 1 Pickleball Coaching credential, Dr. Cheng can break down your stroke mechanics, footwork patterns, and movement styles to build a truly customized recovery plan.
This is not just textbook knowledge. It is expertise earned directly on the court and refined every day in the clinic with our patients.
Every treatment plan at Rally Point Health and Rehab is built around three goals:
Resolve the Current Injury: We use hands-on, evidence-based care which includes chiropractic adjustments, soft-tissue therapy, acupuncture, and progressive exercise to get you out of pain and moving safely.
Fixing the Root Cause: We look at the whole picture to identify what triggered the issue in the first place, correcting things like movement habits, equipment mismatches, and training volume errors.
Building a More Resilient Player: We do not just patch you up and get you out of pain. Through sport-specific training and smart return to court protocols, we make you stronger and more resilient so you can stay at your peak for the long rally ahead.
Rally Point Health and Rehab is located inside South Unionville Health Centre in Markham. There, Dr. Cheng works closely with the centre’s medical doctors, frequently managing their musculoskeletal cases through specialized therapeutic and rehabilitative care.
How to Prevent Pickleball Injuries
Prevention is not passive. It is a strategy. Here are the most evidence-supported approaches to staying healthy on the court.
Warm Up With Intention
A five to ten minute dynamic warm up targeting the hips, shoulders, ankles, and back before playing significantly reduces acute injury risk. Static stretching alone is not sufficient.
Manage Your Load
Most overuse injuries in pickleball, like pickleball elbow or Achilles tendinitis, happen when we load our bodies too fast, forcing tendons to withstand more stress than they are able to handle. To prevent this, always build up your playing time gradually, especially if you are returning to the court after some time off.
Get Your Equipment Assessed
Paddle weight, grip circumference, and core thickness and composition all affect how much force travels through your forearm. A paddle that is wrong for your mechanics is a liability in every rally.
Address Weakness Before It Becomes Injury
Rotator cuff strength, hip stability, and ankle proprioception are three clinically relevant areas of weakness in pickleball players. Progressive strengthening in these areas is one of the highest return investments you can make to stay healthy on the court.
Do not ignore early warning signs. Pain that persists after a session, stiffness that will not go away, or a gradual increase in weakness are all clear signals that your body needs attention. Responding early typically means a faster recovery and a shorter time off the court.
Consider a Proactive Biomechanical Assessment
At Rally Point Health and Rehab, Dr. Cheng offers sport specific movement screening for players who want to identify vulnerabilities before they become injured. It is the kind of proactive care that separates players who stay on the court from those who keep coming off.
Frequently Asked Questions
Ready to Get Back on the Court?
Whether you are managing an existing injury, coming back from a flare up, or simply ready to invest in staying healthy for the long game, Rally Point Health and Rehab is your most qualified partner in Markham and the GTA.
Book a free 15-minute consultation today. Call or text (647) 780-8703. No referral required.
Dr. Nicholas Cheng is the founder of Rally Point Health and Rehab, a chiropractic and rehabilitation clinic located inside South Unionville Health Centre in Markham, ON. He is the only RacquetFit Certified healthcare provider in Canada and a Level 1 Certified Pickleball Coach.