Pickleball & Rotator Cuff Injuries In The Shoulder

Pickleball, a hybrid of ping-pong and tennis, has become a very popular sport for older Americans and attracts many beginners. But seniors who enjoy playing pickleball should know about potential shoulder injuries and how to avoid them.

"With just the nature of the sport, because you're in such a small space and have to do so much movement and turning, you're unfortunately at risk for injury," said Thomas Schmittdiel, MD, a Franciscan Physician Network sports medicine doctor in Michigan City, Ind. "A lot of times people like the sport because it's easy to get into, but every sport you kind of have to build your stamina and build your strength. So we'll see a lot of injury with a lot of new pickleball players who fall in love with it. They jump right into it and then they jump into our office a few weeks later."

What Are Common Pickleball Injuries?

"The most common injuries we're seeing are elbow, shoulders and ankles," said Matthew Rachwalski, DO, a Franciscan Physician Network sports medicine doctor in Michigan City. "Then you worry about the the 'weekend warrior' population. This often is the athlete who's not doing a lot of physical activity during the week. They are often working in a sedentary job and then on the weekend they go an play a sport that requires explosive movements. This can be a set up for injury."

Rotator cuff injuries in pickleball

For pickleball players, the most common injury is to the rotator cuff tendon in the shoulder.

One of the more common causes of pain with overhead activities, like pickleball, comes from irritation of the muscles of the shoulder called the rotator cuff. The “rotator cuff” is a group of four muscles that help with shoulder movements.

This can cause shoulder pain, especially with movement and use. Problems range from tendonitis and bursitis to a tear of the tendon itself. Bigger tears can create weakness. Someone might not be able to use their arm.

The "rotator cuff" is the collective name for a group of muscles and tendons that connect the upper arm bone to the shoulder blade. The rotator cuff is a vital part of the shoulder and somewhat prone to injury. If the shoulder is overworked, perhaps by repeatedly throwing a ball or lifting heavy objects, the tendons in the rotator cuff can become inflamed—a condition called tendinitis. In more extreme cases, the tendons and muscles in the rotator cuff can tear.

"The unfortunate reality of the rotator cuff is that everyday use can cause tearing and damage, especially in the older athlete," said Sean Calloway, MD, an independent sports medicine orthopedic surgeon who chooses to practice at Franciscan Health Indianapolis Orthopedic Hospital in Carmel.

Other common pickleball injuries

Other common injuries from pickleball include:

• Strains and sprains, mostly in the legs and ankles
• Fractures
• Knee injuries.

What Causes Rotator Cuff Injuries During Pickleball?

For many individuals, the onset of pain is not caused by a specific injury, but rather the result of repetitive use over time. Pain with these activities can lead to what is termed an "overuse injury."

In pickleball, reaching overhead requires a lot of force from this tendon, which can worsen rotator cuff injuries. Pickleball is an overhead activity that requires several different arm movements that stress the muscles of the rotator cuff. 

Rotator cuff tears are not preventable. But the shoulder does better when it’s flexible and strong.

What To Do For Shoulder Pain After Pickleball?

If you are experiencing lingering or worsening shoulder pain after pickleball, don't wait to see a doctor.

"If you have pain that gets progressively worse in the shoulder, or pain that persists for a long time after your activity, these may be warning signs of a torn rotator cuff tendon,” Dr. Calloway said.

How Are Rotator Cuff Tears Fixed?

The only way to repair a fully torn rotator cuff is through surgery. Living with a rotator cuff tear can be painful and limit movement, making it difficult to remain active. As the tear enlarges, it can also become more difficult to repair. Even though small tears may not cause many symptoms, they are persistent and can progress to massive.

Surgery is often minimally invasive with only a few small incisions.

Recovery after surgery is geared toward patient-specific goals. 

Can You Prevent Rotator Cuff Injuries From Pickleball?

While a rotator cuff injury isn’t necessarily completely preventable, stretching and light-to-moderate strength training may keep your shoulder healthier and more flexible when playing pickleball.

"Warming up and stretching before activity, with the appropriate post-exercise cool-down, may allow for better shoulder performance during sporting activity and easier post-exercise recovery," Dr. Calloway said.

Stretching For Pickleball

Examples of pre-exercise stretching for pickleball players include gentle shoulder rolls, shrugs, shoulder rotations and upper body stretches. Hold your arms straight out from your sides and rotate them in small circles, then gradually make bigger circles before rotating in the opposite direction. Put your arms in front of you and rotate your shoulders forward and back.

Strength Work For Pickleball

Weight training may help prevent future injuries by strengthening the muscles around the shoulder. A strong core (low back and abdominal muscles) also leads to a lower risk of shoulder injury with racket sports. In all aspects of movement within a pickleball volley, a strong abdominal core supports the torso and offers more overall control of the body.

As a general recommendation, begin each weight training session with a brief cardiovascular warmup to loosen up muscles and joints. Make sure to stretch the upper body after lifting weights to prevent tight muscles and ligaments that are vulnerable to tears and sprains.

How Can You Prevent Other Common Pickleball Injuries?

Warming up muscles and stretching before playing pickleball is essential, particularly for new pickleball players, Dr. Rachwalski said.

You can also prevent many potential pickleball injuries by selecting the right gear.

• Choose a paddle that is appropriate for your strength level. A lightweight paddle may offer less strain and fatigue in your arms.
• You may need different shoes for outdoor and indoor court surfaces.
• Have extra socks on hand to help prevent blisters and foot injuries.
• Protect yourself from the sun with sunglasses, possibly with a strap or cord that helps keep them in place, and sunscreen of SPF 50 or higher.
• In addition, getting a lesson can help you learn to play or improve your pickleball technique.