Pickleball and Physical Therapy – A Perfect Partnership

Pickleball – one of America’s fastest growing sports, has exploded in popularity across all age groups, offering a fun, fast-paced workout that’s easy to learn, though also physically demanding. As more players hit the courts, many are discovering that the sport’s quick lateral movements, sudden stops, varying competitive intensity, and repetitive motions can lead to an elevated injury risk, especially without proper conditioning and recovery. Whether you’re a beginner or a seasoned player, partnering with a physical therapist can not only rehabilitate injuries, but reduce their likelihood of recurring while impacting performance and physical readiness. 

INJURY RISK IN PICKLEBALL

Injury Demographics

Injury risk is a widely discussed topic in health and wellness circles. Whether this pertains to weekend warriors or professional athletes, injuries are unfortunately a part of sport and activity. As it relates to pickleball – research supports that the most common form of injuries include fractures (32%) as well as sprains/strains (31%), with fractures occurring most commonly in the wrist (associated with falls) while sprains and strains occur most commonly in the lower leg (calf/hamstring strain – ankle sprains). The wrist clinically is supported as the most injured body part (at 13% of total cases and 29% of all fractures); with the lower trunk (low back) second (12%), then the leg/head (11%).1 This elevated risk comes from varying volumes of pickleball play and depending on experience level, court accessibility, and physical readiness, the amount an individual plays pickleball can vary. 

Injury Risk – Volume

One common link between elevated injury risk is the volume of activity. With pickleball, most courts are reserved on average for 2+ hours, playing 2-4 times a week for that duration. While this might not seem like a high volume of play, pickleball on average can be perceived as moderate to hard on the rate of perceived exertion scale (anywhere from 3-6, an average rating of 4) with some players playing anywhere between 53 minutes to 530+ minutes per week of play based on intensity of play and skill level.2 (see below for RPE reference/information).

Tim Gabbett, a well known human physiologist and sports scientist, developed a formula to correlate volume of activity with injury risk – creating an injury prediction model. This model looked at training load – determined by what Gabbett describes as arbitrary minutes – which can be calculated by the amount of time the activity is performed multiplied by the perceived exertional level of the activity (RPE).3 Based on the arbitrary minutes formula, that means during a week of pickleball, players can achieve anywhere from 720 to 2,880 of arbitrary minutes while playing. Gabbett in his research (while studying mostly contact sports) found that high volume sessions consisting of anywhere between 3,000 to 5,000 arbitrary minutes were 50-80% more likely to sustain a non-contact soft tissue injury.4. While most pickleball sessions fall under 3,000 arbitrary minutes, they contribute to potentially 25-95% of arbitrary minutes performed during a week of activity, thus elevating injury risk.

Washington Post recommends playing 4.5 hours at minimum per week to meet the requirements to receive health benefits for moderate exercise. This would estimate at roughly 1,080 arbitrary minutes of training per week devoted to pickleball to reap the benefits of moderate intensity exercise. With increased volume, the risk of injury steadily rises, but is this only from volume and intensity, or are there other factors? 

Injury Risk – Acute/Chronic Workload

Another factor closely linked to injury risk is not necessarily the volume or intensity of the activity performed, but the history of physical readiness/fitness with relation to the amount of activity currently performed. This is coined as the acute to chronic workload ratio, a ratio that looks at the acute activity (in this case one pickleball session) compared to chronic activity (3 to 6 weeks of activity – multiple pickleball sessions over numerous weeks).

Research suggests that an acute to chronic workload ratio of 1 is most optimal for reducing injury likelihood, as the amount of activity performed during one session doesn’t exceed the intensity of physical demand met over the course of weeks of activity (activity history). However, a ratio greater than 1.5 indicates a 2-4x greater risk of injury over the subsequent week.4

HOW CAN A PHYSICAL THERAPIST HELP?

Post Injury Rehabilitation

As noted above, injuries are present in pickleball, based on the sport and the volume/intensity of play. While there are factors that can influence the risk of injury, injuries do happen. When present, physical therapists can aid in the recovery process by developing personalized plans based on the injury, individual, and relevant research. This includes but is not limited to exercises prescription, physical screening, injury assessment, injury education, and manual therapy/modality use. Physical therapists understand that each injury, like each individual, are diverse and varying, which can aid in improved recovery and return to sport. 

Physical Screening/Sport Specific Screening

Not injured but curious about your injury risk? A physical therapist can help you with that too! Physical therapists are not only trained in rehabilitation but also movement analysis – allowing them to identify impairments in motion, whether general or sport-specific. With this analysis, a physical therapist can pin point areas that could be addressed including limited mobility, reduced strength, and compensatory habits that can be addressed to optimize performance while reducing the likelihood of an injury. At RPI, our physical therapists are certified through various programs/institutions to evaluate and screen functional movement patterns, with a resident pickleball/tennis/racquet sport therapist on staff! How cool! 

Optimizing Performance

Want to hit more ernes, ATPs, or finally push the 4.0s around on the court? Yes, sport physical therapy can help with that as well! Post movement analysis or sports specific screen, sport physical therapists can aid in exercise prescription and training programs to improve areas such as functional strength, endurance, power, and speed. Tying in the knowledge of anatomical movement and understanding of strength training, sport physical therapy can improve physical readiness on the court. 

Interested in learning more?! Call to schedule an appointment with one of our two therapists, Dr. Carlos Reyes (Board Certified Sports Specialist) and Dr. Henry Klein (only certified Racquet-Fit therapist in Austin) to assess your injury, evaluate your functional movement, and improve your play!

 

Citations

1. Yu J, Yendluri A, Linden GS, et al. Increasing incidence of pickleball injuries presenting to us emergency departments: a 10-year epidemiologic analysis of mechanisms and trends. Orthop J Sports Med. 2025;13(1):23259671241305364.
2. Boudreaux, Benjamin D.; Schmidt, Michael D.. Physical Activity Characteristics of Recreational Doubles Pickleball: 3392 Board #80 June 1 9:30 AM – 11:00 AM. Medicine & Science in Sports & Exercise 51(6S):p 929, June 2019. | DOI: 10.1249/01.mss.0000563283.89045.f3
3. Gabbett TJ. The development and application of an injury prediction model for noncontact, soft-tissue injuries in elite collision sport athletes. J Strength Cond Res. 2010;24(10):2593-2603.
4. Gabbett TJ. The training-injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med. 2016;50(5):273-280.