Published: May 13, 2026 · Last updated: May 13, 2026
- Roughly 70 percent of regular pickleball players are 60 or older, and the sport accounts for a fast-growing share of orthopedic and ER visits in that age group (Cleveland Clinic, 2026)
- The 4 most common injuries are Achilles tendon ruptures, rotator cuff and shoulder strains, wrist fractures from falls, and ankle sprains (Cleveland Clinic, 2023)
- A structured 10-minute warm-up, court-appropriate shoes, and a paddle in the right weight range reduces injury rates by an estimated 50 to 70 percent in recreational adults (Cleveland Clinic, 2024)
Pickleball is the fastest-growing sport in America, and it is being driven almost entirely by adults over 50. The combination of low cost, short rallies, and a forgiving learning curve has pulled millions onto courts. The combination of explosive lateral movements and middle-aged tendons has pulled a fast-growing share of them onto orthopedic exam tables.
The injuries are predictable. Four account for the majority of ER visits and orthopedic referrals in pickleball players over 50. Knowing what they are, why they happen, and how to prevent each one keeps most people on the court instead of in the surgical suite.
Achilles Tendon Rupture
The single most common serious pickleball injury is a sudden Achilles tendon rupture. It happens during a quick forward lunge or a backward step, often with no prior warning, and feels like being shot in the back of the calf. Most ruptures in this group happen to people who have been moderately active but not specifically training their calves or doing regular plyometric work.
According to (Cleveland Clinic, 2026), the recommended prevention is a 5-minute dynamic warm-up before every session (walking lunges, leg swings, slow-tempo calf raises) plus 2 to 3 sessions per week of eccentric calf strengthening when not playing. Skipping the warm-up doubles the risk in cohort studies.
Rotator Cuff and Shoulder Strain
The repetitive overhead serve, smash, and reach motion strains shoulder tissues that often have age-related thinning by the 50s and 60s. Tears can range from minor strains that heal in a few weeks to full-thickness rotator cuff tears that need surgical repair.
(Cleveland Clinic, 2023) recommends choosing a paddle in the 7.5 to 8.5 ounce range for most adult recreational players. Heavier paddles accelerate shoulder fatigue. Pre-session shoulder mobility drills (cross-body stretches, sleeper stretches) plus general strengthening for the rotator cuff and rear deltoid keep tissue resilient. Shoulder pain that persists more than 2 weeks warrants an evaluation rather than another tournament.
Wrist Fractures From Falls
The instinct when you lose balance is to catch yourself with an outstretched hand. The dominant fracture pattern in pickleball falls is the distal radius, the wrist bone that breaks when force travels up an extended arm. Adults with lower bone density (especially postmenopausal women not on hormone therapy) are at substantially higher risk.
Prevention is partly bone density (a topic worth checking via DEXA if you have not), partly footing (court-appropriate shoes with lateral support, not running shoes), and partly technique (do not chase shots into the no-man's-land where momentum carries you forward and trips you up). Falling skills (the "PLF" parachute landing fall, taught in martial arts and at some senior gyms) measurably reduce wrist injury when falls happen.
Ankle Sprains
Lateral ankle sprains are the most common pickleball injury overall but usually the least severe. Quick side-to-side movement on a hard court, especially when fatigued or in worn-out shoes, twists the foot inward and stretches the lateral ankle ligaments. Most are manageable with rest, ice, compression, and 1 to 2 weeks of modified activity.
(Cleveland Clinic, 2024) notes that a court-appropriate shoe with good lateral support (not a running shoe, which is built only for forward motion) is the single biggest prevention factor. Pre-wrapping previously sprained ankles with athletic tape or a brace for the first month of return-to-play after a sprain reduces re-injury significantly.
What Makes Pickleball Different From Tennis
Tennis players have a larger court and longer rally setup times, which gives the body more setup before each movement. Pickleball has a tighter court, shorter rallies, and a higher rate of explosive movements per minute, which is why injury rates per playing hour are higher in pickleball than tennis. The fix is not to play less. The fix is to prepare the body for the sport's actual demands. For more on building lower-body resilience and joint protection, see our piece on why 60 is the best age to start strength training.
To your health,
Ageless Coach
Age Strong. Live Long.
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This content is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Reading this article does not create a provider-patient relationship. Always consult your physician or qualified healthcare provider before making changes to your diet, exercise, or health routine. Ageless Coach is not liable for any actions taken based on this information.
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