Why Do My Knee, Achilles, Shoulder, or Elbow Hurt After Playing Pickleball? A Physical Therapist Answers

By Nova Physical Therapy | North Hollywood, CA

Patient Question

“I recently started playing pickleball and now my knee, calf, Achilles, shoulder, or elbow is bothering me. I didn't have one major injury—it gradually started hurting after playing more often. Is this common with pickleball? Should I stop playing, and can physical therapy help me get back on the court?”

The Short Answer

Pickleball can be an excellent way to stay physically active, but the sport places meaningful demands on the body.

Players repeatedly:

• Accelerate
• Stop
• Lunge
• Change direction
• Move sideways
• Reach
• Rotate
• Swing
• Backpedal
• React quickly

As participation has increased, researchers are documenting more pickleball-related injuries.

A 2026 study using U.S. emergency-department data found that estimated annual pickleball injuries increased from approximately 1,313 in 2014 to 24,461 in 2023. Adults ages 60–79 accounted for the largest share of injuries. 

But this does not mean pickleball is inherently dangerous or that people should stop playing.

The more useful question is:

Does your current physical capacity match the amount and intensity of pickleball you are playing?

Pain may occur when training demands increase faster than the body is prepared to tolerate them. Other injuries may occur suddenly during a fall, lunge, rapid direction change, or unexpected movement.

Physical therapy can help evaluate appropriate musculoskeletal and movement-related limitations, progressively rebuild capacity, and guide return to activity when the presentation is appropriate for physical therapy.

Why Is Pickleball So Physically Demanding?

Pickleball sometimes looks easier than tennis because the court is smaller.

But a smaller court does not mean the body is doing less work.

The game requires frequent short movements.

Instead of repeatedly running long distances, players perform:

start → stop → shuffle → lunge → recover → rotate → reach → repeat.

Those movements create repeated demands on the:

• Calves
• Achilles tendons
• Ankles
• Knees
• Hips
• Trunk
• Shoulders
• Elbows
• Wrists

A recreational player may perform hundreds of these movements during a playing session.

That can become especially important when someone goes from:

little regular exercise

to

pickleball three or four days per week.

Why Are Pickleball Injuries Increasing?

One major reason is simple:

far more people are playing.

The Sports & Fitness Industry Association reported in June 2026 that approximately 24.3 million Americans played pickleball during 2025.

For comparison, approximately 4.2 million participated in 2020.

That represents more than a fivefold increase in only five years. 

USA Pickleball reported that its court-location database reached 18,258 locations nationwide by the end of 2025. 

More participants and more playing opportunities naturally mean more total exposure to potential injury.

So rising injury numbers do not automatically mean the sport itself has become more dangerous.

Is Pickleball Only Popular With Older Adults?

No.

This perception is increasingly outdated.

The SFIA's 2026 Pickleball Single Sport Report found that teenagers and young adults ages 13–24 now have the highest participation rate of any age segment.

At the same time, older adults remain an important part of the pickleball community.

That creates an interesting rehabilitation challenge.

A 25-year-old competitive player and a 65-year-old recreational player may perform the same sport but have completely different:

• Training histories
• Strength levels
• Recovery needs
• Previous injuries
• Medical histories
• Goals

There should not be one generic “pickleball exercise program” for everyone.

What Are the Most Common Pickleball Injuries?

Current research shows injuries throughout both the upper and lower extremities.

A 2026 national emergency-department analysis found distinct patterns depending on age and sex.

Women had higher odds of:

• Upper-extremity injuries
• Hand and wrist injuries
• Fractures
• Fall-related injuries

Men had higher odds of:

• Lower-extremity injuries
• Trunk injuries
• Strains and sprains
• Overexertion-related injuries

Adults ages 60–79 had increased odds of wrist/hand injuries and fractures, and falls were more common in this group. 

Common pickleball-related musculoskeletal complaints may therefore involve the:

Achilles tendon

calf

ankle

knee

hip

lower back

shoulder

elbow

wrist

The exact cause of pain cannot be determined simply from the sport being played.

Why Does My Achilles Hurt After Pickleball?

Pickleball repeatedly loads the calf-Achilles complex.

Imagine standing near the kitchen line when your opponent sends the ball short.

You may suddenly:

push off → accelerate → lunge → stop → recover.

The calf muscles and Achilles tendon help produce and control these movements.

Someone who has not recently performed repeated acceleration and lunging may experience a substantial increase in tendon demand after beginning pickleball.

Pain around the Achilles should not automatically be labeled Achilles tendinopathy based on symptoms alone.

A physical therapist evaluates the entire clinical presentation.

Are Achilles Ruptures Really Happening in Pickleball?

Yes, and this has become an important research topic.

A 2026 study examining surgically treated Achilles ruptures found that pickleball-related ruptures occurred in substantially older patients than ruptures associated with tennis or other sports.

Median ages were approximately:

60 years — pickleball

45 years — tennis

37 years — other sports.

Approximately 82.5% of the pickleball-associated Achilles ruptures occurred in people older than 50.

Another study involving a large orthopedic practice identified 43 pickleball-associated Achilles ruptures. Patients with pickleball-related injuries averaged approximately 64.5 years old, compared with 48.6 years across other Achilles injuries. 

These studies identify an important injury pattern.

They do not prove that every older pickleball player is likely to rupture an Achilles tendon.

Why Might the Achilles Be Vulnerable During Pickleball?

The Achilles tendon transfers force between the calf muscles and heel.

Pickleball frequently requires:

• Rapid push-off
• Sudden acceleration
• Lunging
• Deceleration
• Direction changes
• Backward-to-forward transitions

A foot-and-ankle injury study found that among documented pickleball injury mechanisms, running or lunging forward was the most common mechanism, followed by ankle inversion and backward movement. 

The key message should not be:

“Don't lunge.”

Lunging is part of the sport.

A better strategy is to progressively prepare the body for the movements the sport requires.

What Does an Achilles Rupture Feel Like?

An Achilles rupture is different from ordinary post-exercise soreness.

People sometimes describe:

• A sudden pop
• Feeling as though someone kicked the back of the leg
• Sudden posterior ankle or calf pain
• Difficulty pushing off
• Difficulty walking normally
• Weakness

A suspected Achilles rupture requires prompt medical evaluation.

Do not try to “play through” a sudden pop accompanied by substantial loss of function.

Why Does My Calf Hurt After Pickleball?

The calf works repeatedly during:

• Push-off
• Running
• Lunging
• Stopping
• Jumping
• Direction changes

The foot-and-ankle injury study found gastrocnemius injuries among the more frequently identified pickleball-related injuries. 

But calf pain can have multiple causes.

Sudden severe calf pain, substantial swelling, unexplained redness or warmth, shortness of breath, or other concerning symptoms require appropriate medical evaluation rather than assuming the problem is simply exercise soreness.

Why Does My Knee Hurt After Pickleball?

Pickleball involves repeated knee loading during:

• Lunges
• Squats
• Direction changes
• Deceleration
• Low-ball retrieval
• Getting into and out of athletic positions

Knee discomfort does not automatically mean something is “wearing out.”

A physical therapy evaluation may examine:

• Knee mobility
• Hip muscle performance
• Quadriceps performance
• Calf performance
• Balance
• Single-leg control
• Squatting
• Lunging
• Stepping
• Sport-specific movement tolerance

The goal is to understand the functional limitations rather than diagnose a condition from the location of pain alone.

Does Pickleball Cause Knee Arthritis?

It would be inappropriate to tell someone that pickleball caused osteoarthritis simply because their knee hurts after playing.

Joint pain is multifactorial.

Someone may have:

• Existing osteoarthritis
• Reduced conditioning
• Recent training changes
• Strength deficits
• Mobility limitations
• Previous injuries
• Other contributing factors

For many people, appropriately dosed physical activity remains an important part of healthy aging.

The objective should be to find an activity level the person can safely tolerate rather than automatically avoiding movement.

Why Does My Shoulder Hurt From Pickleball?

Pickleball requires repeated shoulder movement during:

• Serves
• Forehand strokes
• Backhand strokes
• Volleys
• Overhead shots

Someone who plays infrequently may tolerate this well.

But suddenly playing several days per week may dramatically increase total shoulder repetitions.

A 2026 nationwide survey of 1,758 pickleball players found that 39% reported at least one upper-extremity injury, with chronic overuse conditions representing the most frequently reported injury type.

Greater weekly playing frequency was among the factors associated with injury. 

Again, this survey does not mean 39% of every pickleball population will be injured. It reflects the specific surveyed population and study design.

What Is “Pickleball Elbow”?

People sometimes use the informal term pickleball elbow to describe pain around the elbow associated with repetitive paddle use.

The symptoms may resemble problems commonly associated with other racquet sports.

But “pickleball elbow” is not enough information to establish a clinical diagnosis.

An evaluation may consider:

• Location of symptoms
• Grip
• Wrist and forearm muscle performance
• Shoulder function
• Playing frequency
• Paddle demands
• Previous injury
• Functional limitations

Treatment should address the individual's presentation rather than simply the name of the sport.

Why Does My Wrist Hurt?

The wrist helps transfer force between the arm, hand, and paddle.

Repeated gripping and hitting can increase forearm and wrist demands.

Falls are another important mechanism.

Someone who falls may instinctively extend the arm toward the ground, potentially creating substantial force through the hand and wrist.

The 2026 emergency-department study found that adults ages 60–79 had greater odds of hand/wrist injury and fracture than some younger groups. 

Significant swelling, deformity, inability to use the hand normally, or substantial pain after a fall should receive appropriate medical evaluation.

Why Does My Back Hurt After Pickleball?

Pickleball requires repeated:

• Rotation
• Forward bending
• Reaching
• Lunging
• Low positioning
• Rapid movement

Back discomfort may therefore occur in some players.

But pain does not automatically indicate structural damage.

A physical therapist may evaluate:

• Trunk movement
• Hip mobility
• Muscle performance
• Repeated movement tolerance
• Lifting
• Squatting
• Lunging
• Sport-specific activity

Treatment is individualized according to the examination.

Are Most Pickleball Injuries From Overuse or Accidents?

Both occur.

Some problems develop gradually.

For example:

one day/week → three days/week → five days/week

may substantially increase tissue and recovery demands.

Other injuries occur suddenly from:

• Falls
• Lunges
• Direction changes
• Collisions
• Trips
• Unexpected movements

The 2026 upper-extremity survey found that chronic overuse problems accounted for approximately 41% of the upper-extremity injuries reported, followed by sprains and strains. 

The emergency-department data, meanwhile, demonstrate the importance of acute injuries and falls. 

Is Playing Pickleball Every Day Too Much?

There is no universal number of safe playing days.

A highly conditioned player may tolerate frequent sessions.

Someone beginning the sport after years of limited exercise may not.

What matters includes:

• Previous activity level
• Session duration
• Intensity
• Recovery
• Sleep
• Strength
• Previous injuries
• Age
• Medical history
• Other exercise

A particularly important concept is progressive loading.

Instead of:

0 days → 5 days/week

a gradual increase gives the body time to adapt.

Should I Stop Playing Pickleball if I Have Pain?

Not necessarily.

The answer depends on:

• Severity
• Irritability
• Mechanism
• Functional limitations
• Medical history
• Examination findings

Some presentations may allow modified participation.

Others require temporary reduction or cessation.

And an acute traumatic injury may require immediate medical assessment.

The goal should not automatically be:

“Stop pickleball forever.”

When appropriate, the goal is:

modify → rehabilitate → progressively reload → return to play.

Should I Warm Up Before Pickleball?

A gradual warm-up is reasonable.

A July 2026 sports-medicine article from Scripps Health recommends approximately 5–10 minutes of light aerobic activity and dynamic movement before pickleball. 

Examples might include appropriately selected:

• Walking
• Easy jogging
• Side stepping
• Controlled lunges
• Arm movements
• Gradual practice strokes

The purpose is not to perform an exhausting workout before the game.

It is to progressively transition from resting activity to the movements required on court.

Does Stretching Prevent Pickleball Injuries?

Stretching is not a guarantee against injury.

A person can stretch every muscle and still become injured.

Injury risk is influenced by many factors.

For pickleball, overall physical preparation may be more useful than relying on one stretch.

That can include:

strength + balance + cardiovascular fitness + sport-specific movement + gradual progression.

Should I Strengthen My Calves for Pickleball?

Calf strengthening may be appropriate because the calf-Achilles complex is heavily involved in acceleration, push-off, and lunging.

But an individualized program may also include the:

• Quadriceps
• Hamstrings
• Hips
• Trunk
• Shoulders
• Forearms

depending on the player's needs.

Strength training should complement the sport rather than attempt to predict and eliminate every possible injury.

Is Balance Training Important for Pickleball?

It can be.

Pickleball requires control while:

• Reaching
• Lunging
• Stepping sideways
• Moving backward
• Changing direction

Balance may be particularly relevant for players who:

• Have fallen
• Feel unstable
• Avoid backward movement
• Have difficulty changing direction
• Are returning after injury

The emergency-department data found that falls were particularly important among older pickleball players. 

What Shoes Should I Wear?

Court sports involve substantial lateral movement.

Shoes intended for court activity generally provide different lateral support characteristics than traditional running shoes, which are primarily designed for forward movement.

Scripps' July 2026 pickleball safety guidance specifically recommends supportive court footwear for lateral movement. 

Footwear cannot guarantee prevention of ankle, knee, Achilles, or fall-related injuries.

But appropriate footwear is one reasonable component of preparation.

Should I Play Through Pain?

A small amount of post-exercise muscle soreness is different from:

• Sudden sharp pain
• A pop
• Rapid swelling
• Inability to bear weight
• Significant weakness
• Progressive neurological symptoms

Pain that repeatedly worsens during or after playing also deserves attention.

“Playing through it” is not automatically evidence of toughness or good rehabilitation.

Sometimes the better strategy is modifying the load and addressing the limitation early.

Can Physical Therapy Help?

Yes, when a pickleball-related musculoskeletal or movement limitation is appropriate for physical therapy.

Physical therapy may address:

• Pain-related functional limitations
• Joint mobility
• Muscle performance
• Balance
• Walking
• Squatting
• Lunging
• Stepping
• Direction changes
• Shoulder function
• Forearm capacity
• Calf and Achilles capacity
• Progressive strengthening
• Sport-specific movement
• Return-to-play progression

A rehabilitation program should eventually consider what the player actually needs to do.

For pickleball that may mean progressing from:

basic strengthening

to

standing

to

stepping

to

lunging

to

direction changes

to

controlled court movement

to

return to play.

What Does Research Say?

Pickleball injury research is expanding quickly in 2026.

2026 National Emergency-Department Study

McMillan and colleagues examined U.S. emergency-department data from 2014 through 2023.

Estimated annual pickleball-related injuries increased from approximately:

1,313 in 2014

to

24,461 in 2023.

Adults ages 60–79 accounted for the largest proportion.

Women had higher odds of upper-extremity injury, wrist/hand injury, fractures, and falls, while men had higher odds of lower-extremity injury and strains/sprains. 

The study was published in the July/August 2026 issue of Sports Health.

2026 Upper-Extremity Study

A nationwide survey published in JOSPT Open in 2026 included 1,758 pickleball players.

Approximately:

39% reported at least one upper-extremity injury

and

16.2% reported an injury resulting in time away from play.

Chronic overuse conditions were the most frequently reported injury category.

More frequent weekly play was associated with injury. 

2026 Lower-Extremity Systematic Review

A systematic review published in May 2026 examined lower-extremity injuries among adult pickleball players.

The authors concluded that the growing popularity of pickleball has been accompanied by increasing lower-extremity injury concerns and emphasized the need for better injury surveillance and prevention research. 

2026 Achilles Research

A 2026 study examining surgically treated Achilles ruptures found that pickleball-associated ruptures occurred at a median age of approximately 60, compared with approximately 45 for tennis and 37 for other sports.

Approximately 82.5% of pickleball-associated ruptures occurred in players older than 50. 

Another 2026 publication found increasing pickleball-related Achilles injuries over the previous decade, with affected pickleball players averaging approximately 64.5 years of age. 

What Does All of This Mean?

It does not mean:

“Pickleball is dangerous.”

It means:

pickleball is now played by millions of people, the sport requires meaningful athletic movement, and players should prepare for those demands appropriately.

Research is increasingly helping clinicians understand which injuries are occurring and in which groups.

Why Is This Topic Especially Relevant in North Hollywood Right Now?

Pickleball's growth is visible directly around Nova Physical Therapy.

There are dedicated playing facilities in North Hollywood itself, including courts serving players from North Hollywood, Burbank, Studio City, Sherman Oaks, Toluca Lake, Valley Village, and the surrounding San Fernando Valley. 

Nearby Burbank also has multiple public pickleball options. 

Nationally, the latest 2026 participation report puts the number of U.S. pickleball participants at 24.3 million. 

That combination makes search questions such as:

“Why does my knee hurt after pickleball?”

“Why does my Achilles hurt after pickleball?”

“What is pickleball elbow?”

“Can physical therapy help a pickleball injury?”

“How do I return to pickleball after an injury?”

and

“Where can I get sports physical therapy near North Hollywood?”

highly relevant to the local outpatient physical therapy population.

What Happens During a Physical Therapy Evaluation?

At Nova Physical Therapy, an evaluation for a pickleball-related complaint may include, when appropriate:

• Injury and symptom history
• Mechanism of injury
• Playing frequency
• Recent changes in activity
• Previous injuries
• Relevant medical history
• Joint mobility
• Muscle performance
• Balance
• Walking
• Squatting
• Stepping
• Lunging
• Single-leg control
• Direction-change tolerance
• Shoulder and upper-extremity function when relevant
• Sport-specific movement
• Patient goals

The therapist may ask:

How many days per week are you playing?

Did your playing frequency recently increase?

Did the pain start suddenly or gradually?

Was there a pop?

Did you fall?

Does pain occur during play or afterward?

Can you walk normally?

Can you push off the affected leg?

Which pickleball movements reproduce your symptoms?

The Physical Therapy Board of California scope of practice includes physical therapy evaluation, treatment planning, instruction, rehabilitation, exercise, and promotion of physical fitness through physical therapy interventions. California law also specifies that a physical therapist license does not authorize diagnosis of disease.

If findings suggest a condition requiring evaluation or treatment beyond physical therapy scope, referral is appropriate. California's direct-access statute also specifically requires referral when a physical therapist identifies signs or symptoms requiring treatment beyond PT scope or when a directly accessed patient is not progressing toward documented goals. 

When Should You Seek Medical Attention?

Seek appropriate medical evaluation after a pickleball injury if you experience:

• A sudden pop in the Achilles or calf
• Inability to push off the foot
• Inability to bear weight
• Significant swelling
• Obvious joint or limb deformity
• Suspected fracture
• Significant head impact
• Concussion symptoms
• New neurological symptoms
• Progressive weakness or numbness
• Severe or rapidly worsening pain
• Significant calf swelling, redness, or warmth
• Chest pain or shortness of breath
• Persistent symptoms that are not improving as expected

A sudden Achilles pop with substantial weakness or inability to push off should not be treated as ordinary muscle soreness.

Scripps' July 2026 sports-medicine guidance similarly recommends prompt evaluation for severe pain or swelling, deformity, inability to bear weight, suspected fracture, head injury, or persistent symptoms. 

Why Patients Choose Nova Physical Therapy

At Nova Physical Therapy, our mission is simple:

We Care.

Pickleball is not something we automatically want patients to stop doing.

For many people, it provides:

• Exercise
• Competition
• Social interaction
• Recreation
• Cardiovascular activity
• A reason to stay active

When pain appears, our goal is not simply:

“Stop playing.”

And it is not:

“Ignore the pain and keep going.”

We want to determine:

What is limiting you, what can appropriately be improved, and how can we progressively prepare your body for the demands of the activity you enjoy?

Our rehabilitation philosophy emphasizes:

• Evidence-based care
• Individualized evaluation
• Progressive strengthening
• Mobility when indicated
• Balance
• Functional movement
• Sport-specific preparation
• Gradual return to activity
• Patient education
• Appropriate referral when needed

When appropriate, rehabilitation should help bridge the gap between:

the treatment table

and

the pickleball court.

Frequently Asked Questions

Is pickleball actually a workout?

Yes. Pickleball involves repeated acceleration, deceleration, lunging, reaching, rotation, and direction changes.

How popular is pickleball now?

SFIA reports that approximately 24.3 million Americans played in 2025, compared with 4.2 million in 2020. 

Are pickleball injuries increasing?

Emergency-department estimates increased substantially between 2014 and 2023 as participation expanded. 

What body part gets injured most in pickleball?

Injuries involve both upper and lower extremities. Patterns vary according to age, sex, playing exposure, mechanism, and the population studied.

Why does my Achilles hurt after pickleball?

Pickleball repeatedly loads the calf-Achilles complex during acceleration, lunging, and push-off. Achilles pain can have multiple causes and should not be diagnosed from symptoms alone.

Are Achilles ruptures common in older pickleball players?

Recent research has identified a notable pattern of pickleball-associated Achilles ruptures among players over 50, but these studies do not establish an individual player's probability of rupture. 

Why does my knee hurt after pickleball?

Lunging, stopping, squatting, and direction changes repeatedly load the knee. An evaluation can help identify relevant functional limitations.

What is pickleball elbow?

It is an informal term used for elbow pain associated with repetitive pickleball activity. The actual clinical presentation should be evaluated rather than diagnosed from the nickname.

Can pickleball cause shoulder pain?

Repeated paddle strokes and overhead activity can increase shoulder demand. A 2026 nationwide survey found upper-extremity injuries were common among surveyed players. 

Should I stop pickleball if something hurts?

Not automatically. The appropriate response depends on symptom severity, mechanism, functional limitations, and examination findings.

Can I play pickleball every day?

There is no universally safe frequency. Playing tolerance depends on conditioning, intensity, duration, recovery, previous activity, and individual factors.

Should I warm up?

A gradual dynamic warm-up before playing is reasonable. Current sports-medicine guidance commonly recommends approximately 5–10 minutes. 

Is stretching enough to prevent injury?

No. Stretching cannot guarantee injury prevention. Strength, balance, conditioning, recovery, sport-specific preparation, and gradual progression may all be relevant.

Should pickleball players strength train?

Strength training may help prepare the body for the demands of sport when appropriately prescribed.

Is balance training useful?

It can be, particularly for players with instability, previous falls, or difficulty controlling lunging and direction changes.

Should I wear running shoes for pickleball?

Court shoes are designed differently from traditional forward-running footwear and may provide better lateral support for court movement. 

How do I return to pickleball after an injury?

Return should generally be progressive. Depending on the injury, rehabilitation may progress from strength and mobility to stepping, lunging, direction changes, court drills, and gradual return to games.

Can physical therapy help pickleball injuries?

Yes, when the musculoskeletal or movement-related presentation is appropriate for physical therapy. Treatment may address strength, mobility, balance, movement tolerance, sport-specific activity, and return to play.

Do I need an MRI before physical therapy?

Not every musculoskeletal complaint requires imaging before physical therapy. Imaging or medical evaluation may be appropriate depending on the history, trauma, examination findings, and clinical presentation.

Where can I get physical therapy for a pickleball injury in North Hollywood?

Nova Physical Therapy provides individualized musculoskeletal and sports rehabilitation in North Hollywood for appropriate physical therapy presentations.

Schedule an Evaluation

If knee, Achilles, calf, ankle, hip, back, shoulder, elbow, or wrist symptoms are making it difficult to play pickleball, exercise, walk, work, or participate comfortably in everyday activities, Nova Physical Therapy can help determine whether physical therapy is appropriate.

Our licensed physical therapists provide individualized evaluations and rehabilitation focused on:

• Muscle performance
• Mobility
• Balance
• Functional movement
• Progressive strengthening
• Sport-specific preparation
• Activity tolerance
• Return to recreation

Contact Nova Physical Therapy today to schedule a comprehensive physical therapy evaluation in North Hollywood.

Disclaimer

This article is intended for educational and informational purposes only and does not constitute medical advice, medical diagnosis, injury-prevention clearance, return-to-sport clearance, or individualized physical therapy treatment.

Knee, Achilles, calf, ankle, hip, back, shoulder, elbow, wrist, and other symptoms can have many causes. The location of pain and participation in pickleball do not establish a specific musculoskeletal or medical diagnosis.

Physical therapists evaluate and treat movement and functional impairments within their regulated professional scope. California Business and Professions Code §2620 includes physical therapy evaluation, treatment planning, instruction, rehabilitation, exercise, and related interventions within physical therapy practice and specifies that a physical therapist license does not authorize diagnosis of disease. 

Strengthening, stretching, balance exercise, warm-ups, footwear, activity modification, and physical therapy cannot guarantee prevention of injury or a particular outcome.

Research discussed in this article describes population-level findings and should not be interpreted as an estimate of an individual player's injury risk.

Seek appropriate medical care for significant trauma, suspected fracture, severe or rapidly worsening pain, substantial swelling, inability to bear weight, a sudden Achilles or calf pop with functional loss, significant head injury, neurological symptoms, or other concerning symptoms.

Individual results vary.