25 Aug Getting Back to Pickleball After an Injury
Pickleball has a reputation for being gentle. The court is small, the paddle is light, the ball is plastic, and the whole thing looks a lot like a friendly game of ping-pong that grew up.
That reputation is exactly what gets people hurt.
The sport is deceptively demanding in short bursts. A single point can involve a hard split-step, a lunge toward the kitchen line, a sudden change of direction, an overhead reach, and — the big one — a backpedal to chase a lob. Those movements are explosive; they’re repeated hundreds of times per session, and they happen most often in a population that isn’t spending the rest of the week doing explosive lateral training.
Add in the fact that many players are on the court four, five, even six days a week because the game is genuinely fun and social, and you get a near-perfect setup for overuse injuries. There’s no offseason in pickleball. There’s just Tuesday.
The Injuries We See Most Often
Every player is different, but a few patterns come up again and again in our clinics:
Pickleball elbow (lateral epicondylitis). Pain on the outside of the elbow that flares with backhands, gripping, and even lifting a coffee mug. It’s usually a tendon overload problem driven by technique, grip size, or simply too much volume too quickly.
Rotator cuff irritation and shoulder tendinitis. Overheads, serves, and reaching volleys stack up. Shoulder pain that starts as “a little sore after playing” often becomes “I can’t sleep on that side.”
Achilles tendinopathy and calf strains. That first hard push off the line is a common moment of injury, especially without a real warm-up. Achilles injuries in racquet and paddle sports are well documented, and pickleball is no exception.
Ankle sprains and knee injuries. Quick lateral cuts on a small court, sometimes on a surface that’s a little damp or a little dusty, are a classic mechanism for rolled ankles and meniscal irritation.
Low back strain. Repeated bending for dinks and low volleys, combined with rotation on the serve, adds up over a long session.
Wrist and hand injuries from falls. The backpedal is the single most dangerous movement in the sport. Players run backward for a lob, lose their balance, and land on an outstretched hand — which can mean a wrist fracture, not just a sprain.
The Mistake Almost Everyone Makes
Here’s the pattern we see all the time. A player tweaks something. They take two or three weeks off. The pain fades. They feel fine walking around, fine going up stairs, fine reaching into a cabinet. So they go back to their usual Saturday round-robin — three hours, competitive games, no ramp-up.
Within a week, they’re hurting again. Often worse than the first time.
The problem is that absence of pain is not the same thing as readiness. Rest calms the irritated tissue, but it doesn’t restore the strength, tendon capacity, balance, or movement control that got compromised—either by the injury itself or by weeks of doing nothing. You feel fine at rest because rest is easy. The court is not rest.
A real return to play rebuilds capacity before you test it in a game where you’re chasing a ball and not thinking about your mechanics.
A Phased Return to the Court
Every injury and every player is different, and this is general education rather than a prescription for your specific situation. But a well-structured return usually moves through four stages, and you earn your way into each one.
Phase 1 — Calm it down. The goal is to reduce pain and protect healing tissue while keeping as much motion and activity as safely possible. This is not total shutdown. Complete rest tends to backfire, leaving you stiffer and weaker than necessary. Hands-on treatment, targeted mobility work, and modified activity belong here.
Phase 2 — Rebuild strength and control. Now we load the injured area on purpose, in a controlled way. For pickleball elbow, that means progressive grip and forearm loading. For an Achilles, that’s calf strengthening built up methodically. For a knee or ankle, it’s single-leg strength and balance work. This phase is where most self-directed recoveries fall short, because it’s the least intuitive and the least fun.
Phase 3 — Restore the movements pickleball actually demands. Straight-ahead strength isn’t enough. You need lateral shuffles, split-steps, deceleration, controlled direction changes, and — critically — safe footwork to replace the backpedal. Learning to turn and run rather than shuffle backward is one of the highest-value changes a player can make.
Phase 4 — Return to play, gradually. This means starting with dinking and controlled drills before competitive games. Shorter sessions before full ones. One session before back-to-back days. Add intensity and volume one variable at a time, so if something flares up, you know exactly what caused it.
A Simple Readiness Check
Before you step back into a competitive game, you generally want to be able to answer yes to all of these:
- Can you move through full, pain-free range of motion in the injured area?
- Does the injured side have strength comparable to the uninjured side?
- Can you perform sport-specific movements — lateral shuffles, lunges, overhead reaching — without pain during or the day after?
- Have you completed drills at game-like intensity without a flare-up?
- Do you feel confident, not tentative, moving on the court?
That last one matters more than people expect. Playing while guarding an injury changes how you move, and compensating often creates a second problem somewhere else — the classic case being a player who protects a sore shoulder and develops elbow or neck pain a month later.
Staying on the Court Once You’re Back
A few habits go a long way toward keeping you playing:
Warm up for real. Five minutes of light movement, leg swings, arm circles, and a few progressively harder shuffles. Dinking is not a warm-up — it’s the first thing you do after one.
Retire the backpedal. Turn and run for lobs, or let them go. No point is worth a wrist fracture.
Check your paddle and grip. Grip size, paddle weight, and string-free paddle balance all affect elbow and shoulder load. Small equipment changes can meaningfully reduce strain.
Wear court shoes. Running shoes are built for forward motion and provide poor lateral support. Court-specific shoes reduce ankle risk considerably.
Build in recovery days. If you’re playing five or six days a week, cross-train or take a day. Tendons need time to adapt.
Do something for strength off the court. Two short sessions a week focused on hips, calves, shoulders, and grip will do more for your longevity in this sport than any amount of extra play.
When to See a Physical Therapist
Come in sooner rather than later if you’re dealing with pain that lasts more than a week or two, pain that’s getting worse instead of better, swelling that won’t settle, a joint that feels unstable or gives way, night pain, or an injury you’ve now aggravated more than once.
That last one is worth repeating: a recurring injury signals that something in the underlying mechanics hasn’t been addressed. Rest alone won’t fix it, because rest was never the missing piece.
At All-Star Physical Therapy, we treat many pickleball players, and our approach is individualized rather than protocol-driven. Our therapists are McKenzie-trained; we work with patients one-on-one, and our focus is on getting you back to the activity you actually care about—not just clearing you to walk around without pain. Whether you’re recovering from tendinitis, a sprain, a rotator cuff repair, or a joint replacement, the goal is the same: return you to the court stronger and better prepared than you were before.
We also offer in-home physical therapy services if getting to the clinic is difficult during your recovery.
Ready to Get Back on the Court?
We have two convenient Long Island locations with early morning and evening hours, so you can fit treatment around your schedule — and your games. Request an appointment and let’s build your return-to-play plan.
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