Pickleball Pain? The Most Common Injuries We See and How to Stay on the Court
- Dr. Maggie Parker
- 6 days ago
- 8 min read
Pickleball has taken over, and we get it! It is social, competitive and easy to start. It does not require a lifetime of training to have fun. And in Asheville, more and more people are finding their way onto the court, whether they are playing casually with friends, joining a league, signing up for tournaments, or getting completely hooked after “just trying it once.”
But here is the thing about pickleball: Just because it feels more approachable than tennis, running, or other high-impact sports does not mean it is easy on the body. Pickleball asks a lot from you.
You start, stop, twist, lunge, reach, pivot, shuffle, backpedal, sprint forward, and react quickly; sometimes all within the same point. Add in repeated paddle swings, fast volleys, overhead shots, and the occasional “I probably should not have gone for that ball but I did anyway” moment, and it makes sense that aches and pains can show up.
At Outshine Physical Therapy & Fitness in Asheville, we love helping active adults stay in the game. That includes pickleball players who want to move better, recover faster, prevent injury, or get back on the court after pain starts limiting their play. Let’s break down the most common pickleball injuries we see, why they happen, and what you can do to keep playing.
Pickleball Injuries Are Common, But They Are Not Random
Most pickleball injuries are not just bad luck. Yes, sometimes you roll an ankle or take an awkward step. That happens, but many pickleball aches and pains build over time because your body is being asked to do something it is not fully prepared for yet.
That might mean:
Your calves are not ready for repeated quick pushes.
Your shoulder does not have enough strength or control for overhead shots.
Your elbow is taking the stress because your grip, wrist, or shoulder is not sharing the workload.
Your hips are not rotating well, so your low back is doing extra work.
Your balance or footwork is not quite keeping up with the speed of play.
Your body is playing three times a week, but strength training zero times a week.
Pickleball may look small because the court is smaller than a tennis court, but the movements are quick, reactive, and repetitive. That combination matters.
1. Pickleball Elbow
One of the most common complaints we hear from pickleball players is pain on the outside of the elbow.
People may call it:
Pickleball elbow
Tennis elbow
Lateral elbow pain
Tendonitis
Tendinopathy
“That annoying thing that hurts every time I grip the paddle”
This pain usually shows up around the outside of the elbow and can feel worse with gripping, lifting, opening jars, hitting backhands, or playing multiple games in a row.
Why it happens
Your elbow may be getting overloaded because of:
Repeated paddle swings
A tight grip on the paddle
Too much wrist movement during shots
Poor shoulder strength or control
Sudden increases in playing time
Paddle weight or grip size that does not fit you well
Lack of forearm strength and tendon capacity
The mistake many players make is assuming elbow pain is only an elbow problem.
Sometimes it is. But often, the elbow is the place where the pain shows up because the shoulder, wrist, trunk, or grip mechanics are not helping enough.
What helps
For most pickleball elbow cases, complete rest is usually not the long-term answer. It may calm things down temporarily, but if you return to the same workload without building capacity, the pain often comes right back.
Physical therapy may include:
Forearm and wrist strengthening
Grip modifications
Shoulder strengthening
Paddle and volume recommendations
Manual therapy to decrease pain and improve motion
Gradual return-to-play planning
Education on how much pain is acceptable during rehab
The goal is not just to make the elbow feel better. The goal is to make your arm more prepared for pickleball.
2. Shoulder Pain
Pickleball shoulder pain can show up with overheads, serves, volleys, reaches, or after longer playing sessions.
You might feel it:
In the front of the shoulder
On the side of the arm
Deep in the joint
Around the shoulder blade
With overhead motion
When reaching behind you
The next day after playing
Why it happens
Pickleball requires a lot of repeated shoulder motion, especially if you like to attack balls at the net or hit overheads. If the shoulder blade, rotator cuff, trunk, and upper back are not working well together, the shoulder can get irritated.
Common contributors include:
Limited upper back mobility
Poor shoulder blade control
Rotator cuff weakness
Overusing the arm instead of rotating through the body
Too much play without enough strength work
Previous shoulder injuries that never fully rebuilt capacity
The shoulder is not just a ball-and-socket joint floating by itself. It depends heavily on the shoulder blade, rib cage, neck, trunk, and even the hips to move well.
What helps
Good shoulder rehab for pickleball players should look at the whole chain.
That may include:
Rotator cuff strengthening
Shoulder blade control
Upper back mobility
Core and trunk rotation work
Overhead strength progression
Serve and overhead tolerance
Education on when to modify play versus when to keep moving
At Outshine, we want pickleball players to feel confident reaching, swinging, and reacting — not scared that every overhead is going to flare them up.
3. Achilles, Calf, and Foot Pain
Pickleball can be sneaky on the calves and Achilles.
You may not think you are running that much, but you are doing a lot of quick pushes, small hops, sudden starts, and fast stops. That loads the calf and Achilles over and over.
Pain may show up as:
Tight calves after playing
Pain at the back of the heel
Achilles stiffness in the morning
Foot arch pain
Heel pain
A sudden calf “grab” during play
Why it happens
Your calf and Achilles act like springs. In pickleball, they help you push off, change direction, and react quickly.
Problems can happen when:
You increase playing volume too quickly.
You play multiple days in a row without recovery.
Your calves are not strong enough for repeated quick movements.
You have limited ankle mobility.
Your shoes are worn out or not supportive enough.
You skip warming up and go straight into competitive points.
This is especially important because Achilles injuries can become more serious if ignored.
What helps
For calf and Achilles issues, rehab often includes:
Calf strengthening
Soleus strengthening, which targets the deeper calf muscle
Balance and single-leg control
Gradual plyometric or hopping progressions
Ankle mobility work
Return-to-play planning
Footwear and court-surface discussion
The key is progressive loading. Stretching may feel good, but it is usually not enough by itself.
4. Knee Pain
Pickleball players often report knee pain with lunging, squatting, stairs, lateral movement, or getting low for shots.
Pain might be felt:
In the front of the knee
Around the kneecap
On the inside of the knee
With twisting
With repeated lunging
After longer games or tournaments
Why it happens
Pickleball asks your knees to handle quick changes in direction, deceleration, and low positions. Your knees are not supposed to do that alone.
They need help from your:
Hips
Glutes
Quads
Calves
Feet and ankles
Core
Balance system
If your hips are not controlling side-to-side motion well, your knee may take more stress. If your quads and glutes are undertrained, lunges and quick stops may feel rough. If your balance is limited, your knee may get caught in awkward positions.
What helps
Pickleball knee rehab may include:
Hip and glute strengthening
Quad strengthening
Step-downs and lunges
Balance training
Deceleration drills
Lateral movement mechanics
Gradual return to more intense play
The goal is not just “less knee pain.” The goal is feeling strong and stable when you move quickly.
5. Low Back Pain
Pickleball involves a lot of rotation, reaching, bending, and quick transitions.
Low back pain may show up during play, after play, or the next morning. Some players feel stiffness. Others feel sharp pain with twisting or reaching.
Why it happens
The low back often gets irritated when it is doing too much of the work.
This can happen when:
Your hips are stiff.
Your trunk rotation is limited.
Your core endurance is low.
Your warm-up does not prepare you for rotation.
You are reaching with your back instead of moving your feet.
You play longer than your body is currently conditioned for.
Pickleball rewards quick reactions, but your back may not love it when every shot becomes a last-second reach.
What helps
For low back pain, we often look at:
Hip mobility
Trunk rotation
Core control
Glute strength
Breathing mechanics
Footwork and positioning
Recovery between sessions
A stronger, better-coordinated body usually tolerates rotation and quick movement much better.
6. Falls and Balance Issues
Pickleball is fun and social, but falls can happen. Players may trip while backpedaling, lose balance while reaching, or get caught crossing their feet during a quick direction change.
Balance is not just a “senior issue.” It is a performance skill.
If you want to move quickly, react well, and stay safe, balance and footwork matter.
What helps
Balance training for pickleball may include:
Single-leg stability
Lateral stepping drills
Reaction drills
Strength training
Foot and ankle control
Practice getting low safely
Learning how to move your feet instead of overreaching
Better balance does not just reduce fall risk. It can also help you play better.
Pain Is Not a Failure - It Is Information
One of the biggest mistakes active people make is waiting too long.
They say:
“It is probably fine.”
“I will just take a few days off.”
“I thought it would go away.”
“I can still play, so it must not be that bad.”
“I only feel it after the third game.”
Pain does not mean you are broken, but it is information. The earlier you address it, the easier it usually is to manage. Waiting until pain has been around for months often means it takes longer to calm down and rebuild.
When Should You See a Physical Therapist?
You should consider getting assessed if:
Pain lasts more than 1–2 weeks.
Pain keeps coming back every time you play.
You are changing how you move because of pain.
You are avoiding certain shots.
You feel unstable, weak, or unsure on the court.
You have swelling, limping, or sharp pain.
You are worried about making it worse.
You have a tournament coming up and want a plan.
Physical therapy can help you understand what is going on, what to modify, what to strengthen, and how to keep moving safely.
How Outshine Helps Pickleball Players
At Outshine Physical Therapy & Fitness in Asheville, we work with active adults who want more than a quick “stop playing and rest” answer.
We look at the full picture:
How you move
Where you are strong
Where you are compensating
How your joints tolerate load
How your balance and footwork look
How often you play
What your goals are
What you need to keep doing, not just what hurts
Your plan may include:
Hands-on treatment
Strength training
Mobility work
Balance and footwork drills
Sport-specific movement progressions
Dry needling when appropriate
Return-to-play planning
Warm-up and recovery strategies
Education so you know what to do outside of the clinic
Our goal is simple: help you move better, feel stronger, and stay on the court.
The Bottom Line
Pickleball is fun, but it is still a sport. Your body needs strength, mobility, balance, coordination, and recovery to keep up with the demands of the game.
If you are dealing with elbow pain, shoulder pain, knee pain, Achilles pain, low back pain, or that mysterious “I only feel it after I play” issue, do not ignore it.
You deserve to keep playing (and to feel good doing it!).
Want help staying healthy on the pickleball court? Outshine Physical Therapy & Fitness in Asheville offers one-on-one rehab, injury screens, and programming/strength training for active adults and athletes. Whether you are brand new to pickleball or playing tournaments every month, we can help you build a body that is ready for the game.
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