Naples is at the epicenter of one of the fastest growing and most fun games around: pickleball. The Southern USA pickleball and Florida State tournaments are held each year here in wonderful Naples, FL. Athletes from Southwest Florida, the surrounding states, and even other countries come to compete in a fast-paced game of singles and doubles. If you don’t know what pickleball is then think about tennis melded with ping-pong on a court. Middle aged and older adults appears to be the largest segment interested in pickleball. These age groups have unique physical characteristics and may be predisposed to serious injuries without proper training and competing. The below article our physical therapy team will dive into some key topics in training progression, injury prevention, and what to do when a pickleball injury does happen.

Pickleball Training Progression

Pickleball is like any other sport: it involves training, practice, and recovery. Most newbie pickleballers often rush into playing without awareness to the sport’s physical demands. To begin, understand that pickleball requires fast motions both in the upper and lower body. Starting and stopping motion in a forward and backward motion, pivoting and cutting, and some lunging/reaching for shots will be required for most games. As with all sports progressions, the ideal starting point for working on power-based movements means you must start with good baseline strength. To achieve this a well-balanced 8-10 exercise strength routine is an ideal program to meet such strength demands. Compound movements such as squats, lunges (forward and side), dips, and rows against moderate resistance (or simply start with bodyweight) will help build strength in several muscle groups at once. Isolated exercises including hip abduction, calf raises, bicep curls, and planks will help develop specific muscles needed to prevent injury. Movements should be done with enough weight that you can complete 10-15 repetitions, eventually progressing to a weight that challenges you to do 8-12 repetitions. The 8-10 exercise program ought to be done 2-3 times per week, between days of pickleball, with a focus on good movement quality and control vs heavy weight. After roughly 6 weeks of such a program a person can progress to more power-based movements for training.

A power-based training program includes quick and dynamic movements designed to improve speed and prevent injury. An example of such movements would include squat jumps, side-to-side jumps over a line, ball tosses/chest passes with a weighted ball, line to line sprints, side shuffles, and sport specific movements. The United States of America Pickleball Association (USAPA) has some great sport-specific drills for you to work on at their site. Click here to check out their videos for these sport-specific movements. Ideally these movements should be done with a focus on speed and control, aiming for about 40 foot contacts with jumping movements, and perform 3-5 half-court side shuffles and line sprints in a session. Slowly increase these foot contacts, shuffles, and sprints up to 10 half-court runs. Work these power days into your pickleball schedule so you can have a day off afterwards or at least a lighter day for full recovery. 

Programming for performance is important. Ideally the speed portion of your routine can be done just before the pickleball season begins. For Southwest Florida, this timing would be to peak your power training around late Sept, as tournaments ramp up in October. As such, you should begin your baseline strength work, outlined in the first paragraph, around the end of June. As you progress into your tournament season you will need to back-off on your speed workouts, focus on maintaining your strength (using the strength program), work flexibility with stretching, and mend any small aches or pains with ice, massage, or relative rest and cross training (e.g. swimming). After the season ends it is wise to take a week or two off completely to let your body recover.

Injury Prevention

Our Wells Physical Therapy team mentioned some good pointers for injury prevention above by using smart exercise progressions and recovery. One of the biggest sudden pickleball injuries we often encounter are foot, ankle, and knee injuries. Usually these injuries are due to progressing into play too quickly. The scenario usually goes something like this: 

a friend introduces another friend to pickleball; he becomes hooked and can’t stop playing the first few weeks; the newbie loves the camaraderie of the game and the fact that it’s like tennis (which he used to play 10 years ago) but he was told was not as hard on the body (not necessarily true); after 3 weeks of playing he ruptures his Achilles and has to undergo surgery; he then needs concierge home health physical therapy with our team and can’t wait to get back to playing pickleball (but will have to wait 6 months).

Does this scenario sound familiar to you? It does to us and many local surgeons would also corroborate. One of the biggest ways to prevent injury in pickleball is to not progress too quickly into the sport. As you are playing you should have weekly and monthly goals to aim for. For example, the first week of your play you may hope to get 5 out of 10 serves landing “in” on the court. Once you achieve this, stop, and focus on another area such as returning. Hitting thousands of serves in one week, in hopes to get 10 out of 10 serves “in” on the 1st week, will only wear-out your arm and destroy your chances of playing injury free over the long-term. To help guide you in goal setting and progression, our team recommends you reference this skills chart to help guide you for the long-term.

Another injury prevention tip is to treat pickleball like a sport: it involves preparation, training, and proper recovery. Schedule your week ahead by planning times for play, sport-training or practice, and resistance and cardiovascular training (weights and jogging/cycling/walking). Many pickleballers think they can simply play and skip the strength work; while such a strategy may work in the short-term, those dedicated to long-term play without injury will tell you not to skip your cardio and weights. Also, when you practice and play focus on good form. Many pickleballers and tennis players don’t utilize their whole body during powerful movements. For instance, when swinging to smash a ball a novice player will use more arm motion versus using the legs, core, and arms in concert to hit with power. Such coordination takes practice, feedback from a good coach or mentor, and time. Prepare your meals, drinks, and play/training time accordingly. Be sure to stay hydrated, especially in the south Florida heat. Avoid heavy meals about 1.5 hours before training, practice or a match. Another vital pickleball injury prevention tip is to focus on recovery. You should dedicate time to daily stretching, days off, massage, relaxation techniques, and good whole-food plant-based nutrition to speed recovery.

When a Pickleball Injury Occurs

Sprained ankles, pulled quads, torn rotator cuffs -- injuries happen in pickleball just as in any sport. The notion that pickleball is much “safer” than tennis is an ongoing myth without data to support it. Pickleball is unique in that it combines tennis-like movements with badminton, table tennis, and even racquetball-like movements. When you feel pain or think your body is being pushed to its limit it is vital you stop and assess what is happening. Once you stop you need to determine if your injury is emergent (call 911), urgent (need to stop playing), or rehab later (and keep playing).

The emergent injuries include suspected heat-related illness, sudden unconsciousness, chest pain, one sided weakness, and large bone fractures. Some of these injuries and illnesses seem obvious, but others may come on slowly or without signs. If you play at a community facility or country club, know their emergency processes, how to alert 911 or EMS, and where the AED is for cardiac arrest.

Urgent injuries can occur suddenly and force you to stop playing pickleball immediately. Being able to bear weight is a major indicator of serious harm for foot and ankle injuries during pickleball. For instance, if you roll your ankle when lunging for a ball and then cannot bear weight, then it is time to stop playing and get your ankle checked out in the next few days. A sudden “popping” noise with pain near the back of the ankle and a defect in the appearance of the calf may be a sign and symptom of an Achilles tendon rupture (another common pickleball injury). Knee injuries also happen quite frequently during pickleball. Pain and swelling around the joint can mean a possible flare in arthritis, meniscus tear, or a ligament sprain. Stop playing if your knee begins to catch, lock, give-way, or the symptoms don’t go away after proper rest and recovery. Muscle pulls in the quads can be nagging ailments with some players “working” through pain during recovery. Seeing an orthopedic physical therapist can often help with recovering from such nagging injuries. Shoulder injuries still do occur with pickleball. While the serve and many shots are below shoulder level, players still swing with a lot of force and repetitively. Shoulder injuries that prevent you from elevating your arm or that create numbness or weakness into the elbow or hand should be evaluated by a physical therapist or physician. Such signs and symptoms may be suggestive of a rotator cuff tear, biceps tendon tear, labral issue, or nerve entrapment.

In the end, pickleball is an amazing sport that can be fun but also pose serious physical injuries and needs. Training and practicing are vital to injury prevention. If you find yourself with an injury or simply desiring to prevent injury, then give our team a call. We are specialized in orthopedic physical therapy, sports medicine, and strength and conditioning: we can heal you, prepare you, and help prevent your next pickleball injury. Call or email today: 9O4-568-1156 or wellsphysicaltherapy@gmail.com


Keywords: pickleball, Naples, injuries, PT, physical therapy, ankle, knee, shoulder, pain