How chiropractic care can prevent and treat pickleball injuries

Pickleball has gained immense popularity recently, attracting players of all ages and skill levels since its invention in 1965.

The United States Pickleball Association reports more than 36.5 million pickleball players currently play the game. The Sports and Fitness Association (SFIA) named pickleball the fastest-growing sport in America for the third straight year. Along with the sport’s increase in popularity, injuries have also become more frequent, resulting in $250-500 million in medical costs this year.¹ The most common injuries include strains/sprains, fractures and contusions.²

Help patients achieve peak performance

With our holistic approach to care, doctors of chiropractic are natural leaders in treating musculoskeletal injuries. We can treat pickleball-related injuries and counsel our patients on preventive measures to lessen the sport’s injuries while helping players excel at their game.

As a fellow pickleball player, I have experienced firsthand how the fast-paced and exciting sport connects people socially and forms bonds between generations. Children, parents and grandparents frequently play the sport with their peers, family and neighbors.

The average age of a pickleball player is 38.1 years old, but the sport sees players ranging in age from six years old to those in their seventies or eighties. As people of varying ages play together, we see older players competing with younger ones with quicker reflexes and better proprioception. The disparity in age groups and skills may lead to increased injuries.

Pickleball involves a lot of movement, which elevates the heart rate, improves endurance and strength, improves cardiovascular health and aids in weight loss. Although considered a low-impact sport, pickleball requires quick movement that changes the direction of the body and hand-eye coordination, which demands flexibility and overall balance and coordination.

A person must prepare to play the sport with the right equipment and the correct strategies to play the game. DCs can play a significant role in advising patients on proper equipment, training routines and treatment for injuries should they occur. The following are recommendations to guide your patients and community groups in pickleball.

Gear and equipment

Selecting proper footwear is just as crucial as choosing the right paddle. Pickleball involves fast-paced movements, including lateral strides, pivoting and sudden changes in direction. New pickleball players are especially vulnerable to falls when lunging for a ball and should never run backward. A supportive court shoe is highly recommended for increased traction, lateral stability and support and impact absorption. In pickleball shoes, the shock absorption comes from the midsole, lessening the impact felt in the joints, including the knees, lower back and feet.

Since proprioception diminishes as we get older, a custom three-arch foot orthotic helps improve cushioning of the joints, heel stability and foot flexibility while providing stability, balance and proper alignment of the kinetic chain. Ideally, patients should pair high-quality court shoes with stabilizing orthotics engineered for the physical demands of those activities. A shoe is only as good as the custom stabilizing orthotic in it and vice versa.

In addition to proper shoes, other protective gear should include hats or visors protecting the eyes from the sun and safety goggles or glasses to protect them from ball injuries. The ball used in pickleball is similar to wiffle balls, made from smooth molded plastic. Outdoor balls are heavier, smaller and harder than indoor balls. Indoor or outdoor balls can cause severe eye and orbital injuries.

Warm-up exercises

It is commonplace for players to warm up before a baseball game, football game or running; in pickleball, players warm up by lightly “dinking” the ball, hitting a soft shot that arcs over the net and lands in the front of the court, called the kitchen. Rarely have I ever seen a person warm up their body for the game, but this step is crucial for optimal movement and to reduce the risk of injuries.

Begin with a light jog or brisk walk for five to 10 minutes to increase the heart rate and warm up the muscles. Follow this with dynamic stretches targeting the major muscle groups involved in pickleball, such as leg swings, arm circles and torso rotations. Incorporate specific movements that mimic the actions performed during the game, such as lunges, squats and shoulder rotations. The sport-specific movement will help activate the muscles and joints, improving flexibility and reducing the risk of strains or sprains.

Strengthening and conditioning

DCs can directly help their patients with strength and conditioning programs to enhance performance and prevent injuries. Incorporate exercises targeting the muscles used in pickleball, such as the legs, core, shoulders and wrists. Squats, lunges, planks, push-ups and shoulder presses are excellent tools for developing overall strength and stability.

I advise training patients by incorporating low-tech rehabilitation protocols and equipment such as tubing. You can instruct patients using office rehabilitation equipment, and they can mimic the same exercises with a home kit utilizing tubing similar to what they trained with during their visit. Teaching the patient with highly specialized equipment is fruitless if they cannot duplicate the routine at home. One primary goal of the in-office rehabilitation program is to prepare patients for a home-based exercise routine that addresses their deficiencies and needs.

Proper balance training

The feet are the foundation for functional movement and activities of daily living. In addition to addressing spinal alignment, we must consider the stability of the kinetic chain from the ground up. There are more than 7,000 nerve endings in each foot. This represents more nerve endings than any other body part, providing feedback on body positioning, movement and balance. Injuries, aging and metabolic disorders like diabetes disrupt nerve endings. It is imperative to have good proprioception in the feet because the feet provide a contact point with the ground, which is crucial for our unconscious position sense and movement. Proprioception testing can be accomplished with the Stork Test when the eyes are open and when the eyes are closed. Utilize rehabilitation protocols to enhance proprioception.

Injury prevention and treatment

Despite taking precautions, injuries can still occur in pickleball. However, several injury prevention and recovery techniques can minimize the risk and severity of injuries. Teaching your patients to avoid overexertion, take regular breaks during play to rest and hydrate can prevent injuries. Instruct your patients on cross-training activities like yoga or Pilates to improve flexibility, balance and joint stability. Most importantly, ensure proper function and healing with ongoing adjustments and regular manipulation to support the body’s recovery and performance.

Final thoughts

In conclusion, chiropractic care, pickleball training and injury prevention go hand in hand. Implementing a from-the-ground-up approach to prepare the patient for pickleball play, providing sound advice on appropriate equipment and footwear and providing strength and conditioning rehabilitation for the patient should injuries occur will position the chiropractic community to partner with players of all levels to help them get the most from their game. Pickleball promotes fun, fitness and camaraderie, and by helping your patients become more active, you can help them fully embrace the benefits this sport offers.

MARIO P. FUCINARI, DC, CPCO, CPPM, CIC, is a Certified Professional Compliance Officer, Certified Physician Practice Manager, Certified Insurance Consultant and a Medicare Carrier Advisory Committee member. As a Foot Levelers Speaker’s Bureau member, Fucinari travels throughout the year to speak to audiences nationwide, sharing his chiropractic expertise and insights about low-tech rehabilitation protocols, documentation, billing, and optimal patient care using custom three-arch orthotics. For further information, email Fucinari at Doc@Askmario.com or visit his website at Askmario.com.

References

Boss T. The year in review in pickleball part one. December 2023. Forbes Media. https://www.forbes.com/. Accessed Jan. 8, 2024.
Weiss H, et al. Non-fatal senior pickleball and tennis-related injuries treated in United States emergency departments 2010-2019. Inj Epidemiol. 2021;8(1):34. PubMed. https://pubmed.ncbi.nlm.nih.gov/33934725/. Accessed Jan. 8, 2024.