Pickleball Physiotherapy.
The physical demands of pickleball
Pickleball is the fastest-growing sport in Australia — combining elements of tennis, badminton and table tennis on a smaller court with a paddle and plastic ball. Its accessibility, social format and lower physical demands compared to tennis have made it particularly popular with older adults and those returning to sport after injury or a period of inactivity — but this demographic reality means the injury profile differs significantly from most racquet sports. Pickleball injuries disproportionately affect adults over 50, many of whom are returning to regular physical activity after years of relative inactivity, and who present with both the acute injuries of court sport and the underlying musculoskeletal conditions that a less active lifestyle has allowed to develop.
At Articulate Physiotherapy in Tarragindi, we work with pickleball players across all levels and ages — from new players in their first season through to competitive and representative performers — understanding both the sport-specific injury demands and the age-related considerations that shape pickleball injury management.
Common pickleball injuries
Lateral epicondylalgia (pickleball elbow) — lateral epicondylalgia from the wrist extensor loading of the pickleball dink and drive strokes — is the most common overuse injury in pickleball and mirrors tennis elbow in its mechanism and management. The compact swing of pickleball — particularly the dink at the non-volley zone — places repeated eccentric demand on the wrist extensor muscles at their common extensor origin. Paddle selection — weight, grip size and surface material — significantly influences the vibration transmitted to the forearm with each contact, and paddle advice is an important adjunct to physiotherapy management. The evidence-based treatment is progressive tendon loading — not rest — and many pickleball players who are told to rest their elbow return to the same problem without having addressed the underlying tendon pathology.
Achilles tendon injuries — Achilles tendinopathy from the explosive push-off demands of court movement and Achilles tendon rupture from the sudden explosive acceleration of older adults who are not conditioned for the specific demands of court sport — are among the most significant injuries in pickleball. Achilles tendon rupture risk increases significantly with age, and the pattern of a sedentary or moderately active older adult beginning regular pickleball without adequate preparation is a consistent risk factor. The sudden explosive push-off of net play and direction change produces the peak tendon loading that predisposes to rupture in unconditioned tendons.
Knee injuries — patellofemoral pain syndrome from the repeated squatting demands of the ready position and low ball retrieval, meniscal injuries from the rotational loading of direction change — often in players with pre-existing degenerative meniscal changes — and knee osteoarthritis flares from the impact and loading demands of court play are the most common knee presentations. The smaller court and lower running demands of pickleball compared to tennis reduce knee impact loading — but the repeated squatting, lunging and direction change of net play still place significant cumulative knee demand on older players.
Ankle injuries — lateral ankle sprains from the rapid direction changes and net approach movements of pickleball — are the most common acute injury. The smaller court paradoxically increases ankle injury risk for some players because the rapid, close-range direction changes of dinking and volleying at the non-volley zone demand quick footwork with little preparation time.
Shoulder injuries — rotator cuff tendinopathy from the overhead serve and smash mechanics, and shoulder impingement from the repeated overhead and lateral reaching of pickleball play — are common in regular players, particularly those with pre-existing rotator cuff degeneration that the sport's demands have made symptomatic.
Lower back pain — from the sustained forward-flexed ready position, the repeated trunk rotation of groundstrokes, and the bending and stretching demands of low ball retrieval — is common particularly in older players with pre-existing degenerative spinal conditions that pickleball's specific postures have aggravated.
Wrist injuries — De Quervain's tenosynovitis from the grip and radial deviation of the pickleball stroke and wrist sprains from falls — are common, and in older players where bone density may be reduced, wrist fractures from falls deserve specific assessment.
Falls and fractures — a specific consideration in the older pickleball population — produce wrist fractures, shoulder injuries and hip fractures at rates that reflect the age of the playing population. Falls prevention — balance training, footwear assessment and court surface awareness — is an important safety consideration alongside sports-specific physiotherapy.
How can physiotherapy help?
Physiotherapy for pickleball injuries addresses the specific court movement demands and the age-related considerations of the pickleball population — the pre-existing conditions, the deconditioning that may have preceded return to court sport, and the activity modifications that allow enjoyment of the sport within realistic physical constraints.
Elbow rehabilitation for pickleball elbow follows the same progressive tendon loading approach as tennis elbow — heavy slow resistance wrist extensor exercises progressing through pickleball-specific grip and stroke demands. Paddle selection advice — lighter paddle, appropriate grip size, softer surface material — directly influences the vibration loading on the forearm and is as important as the physiotherapy. Many players find that a simple paddle change produces significant symptom relief alongside the tendon loading program.
Achilles tendon management in the pickleball population requires specific attention to the age-related changes in tendon structure and the specific sudden-load risk of court sport in older adults. Progressive calf and Achilles conditioning — building the tendon load tolerance needed for the explosive push-off demands of pickleball — is the most important injury prevention intervention for new or returning players.
Knee management addresses both the sport-specific loading of pickleball and the pre-existing conditions — osteoarthritis, meniscal degeneration — that are common in the older pickleball population. Activity modification, footwear assessment, and strengthening programs that build the quadriceps and gluteal capacity to absorb court loading are the primary interventions.
For older players managing multiple musculoskeletal conditions alongside pickleball, exercise physiology through a GP Chronic Condition Management Plan (GPCCMP) may complement physiotherapy — building the overall physical capacity that supports safe pickleball participation.
Clinical Pilates provides excellent lower limb stability, trunk control and balance work directly relevant to pickleball performance and falls prevention. Dry needling manages the forearm extensor, periscapular and paraspinal trigger points common in pickleball players. Real time ultrasound guides deep stabiliser retraining.
Our physiotherapists Mauricio Bara and Bethany Kippen both have experience in racquet sport and older adult injuries and are members of the Australian Physiotherapy Association. Exercise Physiologist Ash O'Regan brings specific expertise in chronic condition management and older adult exercise programming that is particularly relevant to the pickleball-playing population.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Pickleball is the fastest-growing sport in Australia — combining elements of tennis, badminton and table tennis on a smaller court with a paddle and plastic ball. Its accessibility, social format and lower physical demands compared to tennis have made it particularly popular with older adults and those returning to sport after injury or a period of inactivity — but this demographic reality means the injury profile differs significantly from most racquet sports. Pickleball injuries disproportionately affect adults over 50, many of whom are returning to regular physical activity after years of relative inactivity, and who present with both the acute injuries of court sport and the underlying musculoskeletal conditions that a less active lifestyle has allowed to develop.
At Articulate Physiotherapy in Tarragindi, we work with pickleball players across all levels and ages — from new players in their first season through to competitive and representative performers — understanding both the sport-specific injury demands and the age-related considerations that shape pickleball injury management.
Common pickleball injuries
Lateral epicondylalgia (pickleball elbow) — lateral epicondylalgia from the wrist extensor loading of the pickleball dink and drive strokes — is the most common overuse injury in pickleball and mirrors tennis elbow in its mechanism and management. The compact swing of pickleball — particularly the dink at the non-volley zone — places repeated eccentric demand on the wrist extensor muscles at their common extensor origin. Paddle selection — weight, grip size and surface material — significantly influences the vibration transmitted to the forearm with each contact, and paddle advice is an important adjunct to physiotherapy management. The evidence-based treatment is progressive tendon loading — not rest — and many pickleball players who are told to rest their elbow return to the same problem without having addressed the underlying tendon pathology.
Achilles tendon injuries — Achilles tendinopathy from the explosive push-off demands of court movement and Achilles tendon rupture from the sudden explosive acceleration of older adults who are not conditioned for the specific demands of court sport — are among the most significant injuries in pickleball. Achilles tendon rupture risk increases significantly with age, and the pattern of a sedentary or moderately active older adult beginning regular pickleball without adequate preparation is a consistent risk factor. The sudden explosive push-off of net play and direction change produces the peak tendon loading that predisposes to rupture in unconditioned tendons.
Knee injuries — patellofemoral pain syndrome from the repeated squatting demands of the ready position and low ball retrieval, meniscal injuries from the rotational loading of direction change — often in players with pre-existing degenerative meniscal changes — and knee osteoarthritis flares from the impact and loading demands of court play are the most common knee presentations. The smaller court and lower running demands of pickleball compared to tennis reduce knee impact loading — but the repeated squatting, lunging and direction change of net play still place significant cumulative knee demand on older players.
Ankle injuries — lateral ankle sprains from the rapid direction changes and net approach movements of pickleball — are the most common acute injury. The smaller court paradoxically increases ankle injury risk for some players because the rapid, close-range direction changes of dinking and volleying at the non-volley zone demand quick footwork with little preparation time.
Shoulder injuries — rotator cuff tendinopathy from the overhead serve and smash mechanics, and shoulder impingement from the repeated overhead and lateral reaching of pickleball play — are common in regular players, particularly those with pre-existing rotator cuff degeneration that the sport's demands have made symptomatic.
Lower back pain — from the sustained forward-flexed ready position, the repeated trunk rotation of groundstrokes, and the bending and stretching demands of low ball retrieval — is common particularly in older players with pre-existing degenerative spinal conditions that pickleball's specific postures have aggravated.
Wrist injuries — De Quervain's tenosynovitis from the grip and radial deviation of the pickleball stroke and wrist sprains from falls — are common, and in older players where bone density may be reduced, wrist fractures from falls deserve specific assessment.
Falls and fractures — a specific consideration in the older pickleball population — produce wrist fractures, shoulder injuries and hip fractures at rates that reflect the age of the playing population. Falls prevention — balance training, footwear assessment and court surface awareness — is an important safety consideration alongside sports-specific physiotherapy.
How can physiotherapy help?
Physiotherapy for pickleball injuries addresses the specific court movement demands and the age-related considerations of the pickleball population — the pre-existing conditions, the deconditioning that may have preceded return to court sport, and the activity modifications that allow enjoyment of the sport within realistic physical constraints.
Elbow rehabilitation for pickleball elbow follows the same progressive tendon loading approach as tennis elbow — heavy slow resistance wrist extensor exercises progressing through pickleball-specific grip and stroke demands. Paddle selection advice — lighter paddle, appropriate grip size, softer surface material — directly influences the vibration loading on the forearm and is as important as the physiotherapy. Many players find that a simple paddle change produces significant symptom relief alongside the tendon loading program.
Achilles tendon management in the pickleball population requires specific attention to the age-related changes in tendon structure and the specific sudden-load risk of court sport in older adults. Progressive calf and Achilles conditioning — building the tendon load tolerance needed for the explosive push-off demands of pickleball — is the most important injury prevention intervention for new or returning players.
Knee management addresses both the sport-specific loading of pickleball and the pre-existing conditions — osteoarthritis, meniscal degeneration — that are common in the older pickleball population. Activity modification, footwear assessment, and strengthening programs that build the quadriceps and gluteal capacity to absorb court loading are the primary interventions.
For older players managing multiple musculoskeletal conditions alongside pickleball, exercise physiology through a GP Chronic Condition Management Plan (GPCCMP) may complement physiotherapy — building the overall physical capacity that supports safe pickleball participation.
Clinical Pilates provides excellent lower limb stability, trunk control and balance work directly relevant to pickleball performance and falls prevention. Dry needling manages the forearm extensor, periscapular and paraspinal trigger points common in pickleball players. Real time ultrasound guides deep stabiliser retraining.
Our physiotherapists Mauricio Bara and Bethany Kippen both have experience in racquet sport and older adult injuries and are members of the Australian Physiotherapy Association. Exercise Physiologist Ash O'Regan brings specific expertise in chronic condition management and older adult exercise programming that is particularly relevant to the pickleball-playing population.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
