Why Does My Knee, Ankle, Shoulder, or Wrist Hurt After Playing Pickleball?

Why Does My Knee, Ankle, Shoulder, or Wrist 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, ankle, shoulder, or wrist hurts. Are pickleball injuries becoming more common, and can physical therapy help me get back on the court?”

The Short Answer

Pickleball is an excellent way to stay physically active, but like any rapidly growing recreational sport, it places specific demands on the body.

Players repeatedly:

• Accelerate
• Decelerate
• Change direction
• Reach
• Lunge
• Rotate
• Swing
• Move backward
• React quickly to the ball

Those movements can challenge the knees, ankles, shoulders, wrists, hips, and spine—particularly when someone suddenly begins playing more frequently than their current physical capacity allows.

Recent research confirms that pickleball-related injuries are increasing alongside participation.

A 2026 U.S. emergency-department study found a large rise in estimated injuries between 2014 and 2023. 

Another 2026 study of 164 patients treated for pickleball injuries found the most frequently involved areas were:

• Knee — 52 cases
• Foot/ankle — 32
• Wrist/hand — 30
• Shoulder — 23
• Spine — 10
• Hip/thigh — 9
• Elbow — 8

However, pain after playing pickleball does not automatically establish a particular injury or diagnosis.

A physical therapist can evaluate movement, mobility, muscle performance, balance, functional limitations, and sport-related demands and determine whether the presentation is appropriate for physical therapy or requires additional medical evaluation.

Why Are Pickleball Injuries Getting So Much Attention?

The simplest explanation is that an extraordinary number of people are now playing.

According to SFIA's 2026 Pickleball Single Sport Report, 24.3 million Americans played pickleball during 2025. 

That is more than five times the approximately 4.2 million participants recorded in 2020.

Participation increased approximately 479% over those five years, and pickleball has been identified as the country's fastest-growing sport over the recent multi-year period. 

The player population is also changing.

Pickleball was once viewed primarily as an activity for older adults, but SFIA's newest data show that 13-to-24-year-olds now have the highest participation rate of any age segment. 

So pickleball injuries are no longer simply an “older adult” topic.

They are increasingly relevant across age groups.

What Are the Most Common Pickleball Injuries?

The answer depends partly on which population is studied.

A 2026 study from Stanford University researchers examined 164 pickleball-related injuries treated at a tertiary academic orthopedic and rehabilitation center.

The knee was the most commonly involved body region, accounting for 52 cases.

Foot and ankle injuries were next with 32 cases, followed by wrist and hand injuries with 30 cases and shoulder injuries with 23 cases. 

Another 2026 national epidemiology study analyzing U.S. emergency-department data found that injury patterns differed by age and sex. 

These studies do not mean every pickleball player is likely to become injured.

They help clinicians understand the physical demands and injury patterns that may occur as participation expands.

Why Is Knee Pain Common in Pickleball?

Pickleball involves frequent:

• Side-to-side movement
• Lunging
• Deceleration
• Direction changes
• Squatting
• Quick reactions

These movements repeatedly load the lower extremities.

Someone who normally walks or performs relatively straight-line exercise may suddenly begin performing dozens of lateral movements and rapid stops during a pickleball game.

The knee may therefore be exposed to a type and volume of loading that the player has not recently practiced.

Knee pain after pickleball can have many possible contributors, so symptoms alone should not be used to determine a diagnosis.

A physical therapist may evaluate:

• Knee mobility
• Hip muscle performance
• Knee muscle performance
• Ankle mobility
• Balance
• Squatting
• Stepping
• Lunging
• Direction-change tolerance

and other findings relevant to the individual's presentation.

Why Does My Knee Hurt When I Lunge for the Ball?

A lunge requires the lower extremity to absorb and control body weight while reaching toward the ball.

The demand increases when the player:

• Reaches farther
• Moves faster
• Stops suddenly
• Has limited strength
• Has limited mobility
• Is fatigued

This does not mean lunging is inherently harmful.

Lunging is part of the sport.

The goal of rehabilitation may therefore be to progressively improve the player's ability to tolerate lunging rather than permanently avoiding the movement.

Why Does My Ankle Hurt After Pickleball?

The ankle plays an important role during rapid movement around the court.

Players repeatedly push off, stop, shuffle, and change direction.

Foot and ankle injuries represented 32 of 164 injuries in the 2026 academic-center study, making them the second-most frequent region in that sample. 

Ankle symptoms may become particularly noticeable when a new player rapidly increases:

• Playing frequency
• Playing duration
• Competitive intensity
• Lateral movement

A physical therapy examination can evaluate whether limitations in mobility, muscle performance, balance, or functional loading appear relevant.

What About Achilles Tendon Pain?

Pickleball requires repeated pushing off and rapid acceleration.

The calf and Achilles tendon therefore contribute substantially to court movement.

Players who suddenly transition from relatively low activity to several pickleball sessions each week may expose the calf-Achilles system to substantially more repeated loading.

That does not mean pickleball itself is damaging the tendon.

The issue may sometimes involve the relationship between current physical capacity and a rapid increase in sport demand.

When appropriate, rehabilitation may progressively address calf strength and sport-specific loading.

Why Does My Shoulder Hurt After Pickleball?

Pickleball requires repeated upper-extremity movement during:

• Serves
• Volleys
• Overhead shots
• Reaching
• Repeated paddle swings

The shoulder must coordinate movement among the rotator cuff, shoulder blade, upper arm, and trunk.

The 2026 Stanford-associated study identified 23 shoulder injuries among its 164 pickleball-related cases. 

Persistent shoulder pain should not automatically be labeled a rotator cuff tear or “pickleball shoulder.”

A physical therapist may assess:

• Shoulder mobility
• Rotator cuff muscle performance
• Scapular muscle performance
• Trunk movement
• Functional reaching
• Sport-specific movement tolerance

and determine an individualized rehabilitation approach.

Why Does My Wrist or Hand Hurt?

The wrist and hand repeatedly control the paddle and absorb forces during ball contact.

Falls can also involve the wrist and hand when someone instinctively reaches toward the ground.

The national 2026 epidemiology study found that women had higher odds of wrist/hand injuries and fractures than men among emergency-department cases studied. 

The academic-center study also found 30 wrist/hand injuries among 164 cases. 

A painful wrist after pickleball should be evaluated based on the actual mechanism and symptoms rather than assuming it is simply an overuse problem.

Are Falls a Major Pickleball Concern?

They can be, particularly among older players.

The 2026 national emergency-department study found that most injuries occurred among adults ages 60–79.

In that age group, falls were approximately 2.1 times more likely, and the odds of fractures were also higher. 

Pickleball can require rapid movement:

• Forward
• Sideways
• Backward
• Diagonally

while simultaneously tracking a ball and reacting to another player.

That combination can challenge balance and reaction ability.

This does not mean older adults should avoid pickleball.

Physical activity and recreational sport can be valuable components of healthy aging.

It does mean that balance, strength, and gradual sport preparation may be particularly relevant for some players.

Is Moving Backward Dangerous?

Backward movement can be challenging because the player has less visual information about what is behind them.

Trying to rapidly backpedal while watching an overhead ball can increase the difficulty of maintaining balance.

A useful training strategy may involve learning controlled court movement and improving the physical abilities needed to change direction.

However, no movement strategy can guarantee that a fall will never occur.

Can Strength Training Help Pickleball Players?

Strength training may be useful because pickleball requires physical capacity throughout the body.

Depending on the individual, exercise may address:

• Quadriceps
• Hamstrings
• Calves
• Hip muscles
• Trunk
• Rotator cuff
• Shoulder-blade muscles
• Forearm muscles

Strengthening should be individualized rather than assuming every player requires the same routine.

The goal is not simply to create stronger muscles.

The goal is to improve the ability to tolerate the specific physical demands of the sport.

Does Balance Training Matter?

Balance can be particularly important for players who:

• Have a history of falls
• Feel unstable during direction changes
• Have difficulty moving backward
• Are returning after an injury
• Have reduced confidence on the court

Balance exercises may progress from relatively simple tasks toward more dynamic activities involving:

• Stepping
• Reaching
• Direction changes
• Head movement
• Sport-related reactions

when clinically appropriate.

Should I Stretch Before Pickleball?

A warm-up can prepare the body for upcoming physical activity.

Rather than relying exclusively on prolonged static stretching, players may consider gradually introducing movements resembling the sport, such as:

• Walking
• Controlled side stepping
• Gentle direction changes
• Progressive arm movement
• Gradual practice swings

The exact warm-up does not need to be identical for every player.

The objective is to transition progressively from rest into the demands of the activity.

Is Pickleball Safe for Older Adults?

No sport is completely risk-free.

But the existence of injury statistics does not mean older adults should automatically stop playing.

Pickleball provides opportunities for:

• Physical activity
• Recreation
• Social interaction
• Coordination
• Movement

The 2026 injury data should be used to improve awareness and preparation—not to create fear around participation.

An older adult returning to sport after a long period of inactivity may benefit from gradually increasing playing duration and frequency rather than immediately playing several long sessions each week.

Should I Stop Playing If Something Hurts?

Not automatically.

The answer depends on:

• Symptom severity
• Mechanism
• Functional limitations
• Whether symptoms are improving or worsening
• Examination findings

Some players may temporarily reduce:

• Playing frequency
• Game duration
• Competitive intensity
• Repeated overhead activity

while rehabilitating the involved region.

Others may need a temporary break from the sport.

Significant trauma or concerning symptoms may require medical evaluation before returning.

Can Physical Therapy Help?

Yes, when the player's symptoms and functional limitations are appropriate for physical therapy.

Rehabilitation may include:

• Mobility exercise
• Progressive strengthening
• Balance training
• Functional movement
• Lunging progression
• Direction-change training
• Shoulder strengthening
• Calf strengthening
• Trunk exercise
• Gradual return-to-sport loading
• Patient education
• Home exercise

The physical therapist may also help the player determine whether they can:

continue playing with modifications, progressively return to play, or require additional medical evaluation.

California law includes physical therapy evaluation, treatment planning, instruction, active exercise, passive exercise, resistive exercise, and physical rehabilitation within physical therapy practice. 

Can Physical Therapy Prevent Pickleball Injuries?

No physical therapy or exercise program can guarantee injury prevention.

That distinction matters.

Physical therapy may help improve modifiable physical factors such as:

• Strength
• Mobility
• Balance
• Functional movement
• Sport-specific capacity

but injuries can still occur.

A better goal is to prepare the body progressively for the demands of pickleball and address identifiable limitations, rather than promising that an exercise program will make someone injury-proof.

What Does Research Say?

The newest epidemiological evidence provides a much clearer picture of pickleball injuries.

A 2026 study published in Sports Health analyzed 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. 

Most injuries occurred among players ages 60–79.

The study also identified differences in injury patterns:

Women had higher odds of:

• Upper-extremity injury
• Wrist/hand injury
• Fracture
• Fall-related injury

Men had higher odds of:

• Lower-extremity injury
• Trunk injury
• Strain or sprain
• Overexertion-related injury

A second study published in Injury Epidemiology in April 2026 examined 164 pickleball injuries treated at a tertiary academic orthopedic and physical medicine/rehabilitation center.

The knee was the most frequently involved region, followed by the foot/ankle and wrist/hand. 

These injury findings are particularly relevant because participation continues to expand.

SFIA's June 2026 report documented 24.3 million U.S. participants, representing more than fivefold growth since 2020. 

Taken together, the evidence suggests:

The rise in pickleball injuries should be viewed in the context of an extraordinary rise in participation—not as evidence that pickleball itself is inherently unsafe.

Why Is This Topic Especially Relevant Right Now?

Pickleball remains one of the most important recreational-sport trends in the United States.

SFIA reported on June 4, 2026 that participation had reached 24.3 million Americans. 

The player population is also broadening, with teens and young adults now posting the highest participation rate, while large numbers of older adults continue playing. 

At the same time, two substantial injury studies were published in 2026, giving patients and rehabilitation professionals newer evidence about which body regions and populations are appearing in healthcare settings with pickleball-related injuries. 

For active patients throughout North Hollywood, Burbank, Studio City, Toluca Lake, Valley Village, Van Nuys, and the greater Los Angeles area, questions such as:

“Why does my knee hurt after pickleball?”

“Can physical therapy help me return to pickleball?”

and

“How can I prepare my body for pickleball?”

are increasingly relevant.

What Happens During a Physical Therapy Evaluation?

At Nova Physical Therapy, an evaluation for a pickleball-related musculoskeletal problem may include:

• Medical history review
• Injury mechanism
• Symptom history
• Playing frequency
• Recent changes in activity
• Joint mobility
• Muscle-performance testing
• Balance
• Walking
• Squatting
• Stepping
• Lunging
• Functional movement
• Shoulder or upper-extremity assessment when relevant
• Lower-extremity assessment when relevant
• Sport-related movement assessment when appropriate
• Patient goals

The examination depends on the injured region and individual presentation.

A knee complaint requires a different evaluation from shoulder or wrist symptoms.

California Business and Professions Code §2620 specifically states that physical therapy includes evaluation, treatment planning, instruction, consultative services, and active, passive, and resistive exercise while also clarifying that a physical therapist license does not authorize diagnosis of disease. 

If the physical therapist identifies signs or symptoms requiring care outside the physical therapy scope, California direct-access law requires appropriate referral. 

When Should You Seek Medical Attention?

Seek appropriate medical evaluation for pickleball-related symptoms such as:

• Significant trauma
• Inability to bear weight
• Obvious deformity
• Significant rapidly developing swelling
• Suspected fracture
• Inability to move an injured joint following trauma
• New significant numbness
• Progressive weakness
• Loss of consciousness
• Significant head injury
• Chest pain
• Severe shortness of breath
• Other severe or rapidly worsening symptoms

A player who falls and develops significant wrist, hip, shoulder, or other pain should not assume that the injury is simply a strain.

Likewise, symptoms that are not progressing as expected should be reassessed rather than repeatedly pushed through.

Why Patients Choose Nova Physical Therapy

At Nova Physical Therapy, our mission is simple:

We Care.

For many patients, pickleball is more than exercise.

It may be:

• Their favorite recreational activity
• Their primary form of exercise
• A social activity
• A competitive hobby
• An important part of staying active

Our goal is not simply to tell an injured player:

“Stop playing pickleball.”

When clinically appropriate, we want to understand what is limiting the player and help progressively restore the physical abilities needed for the court.

Our treatment philosophy emphasizes:

• Evidence-based care
• Individualized rehabilitation
• Patient education
• Progressive strengthening
• Mobility when indicated
• Balance
• Functional movement
• Activity modification when appropriate
• Gradual return to sport
• Long-term physical capacity

The goal is not to make patients afraid of movement.

It is to help them return to the activities they value as appropriately and confidently as possible.

Frequently Asked Questions

Why does my knee hurt after pickleball?

Pickleball involves repeated lunging, stopping, and direction changes that place physical demands on the lower extremities. Knee pain can have multiple causes, so symptoms should be evaluated individually.

What is the most common pickleball injury?

It depends on the population studied. In a 2026 academic-center study of 164 cases, the knee was the most frequently involved body region, followed by the foot/ankle and wrist/hand. 

Are pickleball injuries increasing?

Yes, the number of injuries presenting to U.S. emergency departments has risen substantially as participation has increased. Estimated annual injuries increased from about 1,313 in 2014 to 24,461 in 2023 in one national analysis. 

Is pickleball dangerous?

The increasing number of injuries should be interpreted alongside the enormous growth in participation. Injury data do not establish that pickleball is inherently unsafe.

Why does my ankle hurt after pickleball?

Rapid stopping, pushing off, lateral movement, and changes in playing volume can increase physical demands on the foot and ankle.

Why does my shoulder hurt after pickleball?

Repeated serves, volleys, reaching, and overhead movements require coordinated shoulder and trunk function. Persistent symptoms should be evaluated rather than automatically attributed to one structure.

Are older adults more likely to get injured playing pickleball?

The 2026 emergency-department study found that most injuries occurred among adults ages 60–79, and falls and fractures were more common in this group. 

Can physical therapy help pickleball knee pain?

Yes, when the presentation is appropriate for physical therapy. Rehabilitation may address mobility, muscle performance, balance, movement, activity tolerance, and progressive return to sport.

Can physical therapy help me return to pickleball?

Potentially. Return-to-sport rehabilitation may progressively address the movements required for pickleball, including stepping, lunging, direction changes, reaching, and other sport-specific demands.

Should I stop playing pickleball if my knee hurts?

Not automatically. Activity decisions depend on symptom severity, injury mechanism, functional limitations, and examination findings.

Does strengthening prevent pickleball injuries?

Strengthening can improve physical capacity, but no exercise program can guarantee injury prevention.

Should I warm up before pickleball?

A gradual warm-up can help transition the body from rest to sport activity. It may include walking and progressively more pickleball-specific movement.

Can balance exercises help older pickleball players?

Balance training may be appropriate for players with identified balance limitations or difficulty with court movement, particularly when returning after injury.

Why do pickleball players fall?

The sport requires rapid reactions, changes in direction, reaching, and sometimes backward movement while tracking the ball. Several factors may contribute to a fall.

How long before I can return to pickleball after an injury?

There is no universal timeline. Return depends on the type and severity of injury, functional progress, sport demands, medical considerations, and individual response to rehabilitation.

Schedule an Evaluation

If knee, ankle, foot, shoulder, wrist, elbow, hip, or back pain is keeping you off the pickleball court—or making it difficult to move comfortably while playing—Nova Physical Therapy can help determine whether physical therapy is appropriate.

Our licensed physical therapists provide individualized evaluations and rehabilitation programs focused on mobility, muscle performance, balance, functional movement, physical capacity, and progressive return to activity.

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

Disclaimer

The information provided in this article is intended for educational and informational purposes only and should not be considered medical advice, diagnosis, injury-prevention advice, or individualized treatment. Reading this article does not establish a physical therapist-patient relationship with Nova Physical Therapy or any of its providers.

Pain or injury associated with pickleball can have multiple causes. Knee, ankle, shoulder, wrist, hip, elbow, or back pain occurring during or after pickleball does not by itself establish a specific diagnosis.

Physical therapists evaluate and treat movement and functional impairments within their professional scope. California Business and Professions Code §2620 states that physical therapy includes physical therapy evaluation, treatment planning, instruction, consultative services, and active, passive, and resistive exercise, while a physical therapist license does not authorize diagnosis of disease. 

Exercise, strengthening, balance training, mobility exercise, warm-up strategies, activity modification, and return-to-sport programs cannot guarantee that an injury will be prevented or will not recur.

Seek appropriate medical care following significant trauma, suspected fracture, inability to bear weight, major swelling or deformity, significant head injury, progressive neurological symptoms, chest pain, severe shortness of breath, or other concerning symptoms.

Individual results may vary. Nova Physical Therapy does not guarantee pain elimination, injury prevention, specific recovery times, or return-to-sport outcomes from physical therapy or any intervention discussed in this article.

References

1. McMillan P, Lake LP, Burkhart A, et al. The Epidemiology of Pickleball Injuries Presenting to US Emergency Departments. Sports Health. 2026;18(4). 
2. Meng Y, Chen A, Nguyen C, et al. Pickleball-Related Injuries Treated at a Tertiary Academic Center Over Five Years: A Cross-Sectional Study. Injury Epidemiology. 2026;13:39. Published April 14, 2026. 
3. Sports & Fitness Industry Association. 2026 Pickleball Single Sport Report. June 4, 2026. 
4. California Business and Professions Code §2620. Physical Therapy Scope of Practice.
5. California Business and Professions Code §2620.1. Direct Physical Therapy Treatment Services.

Current resources: 2026 national pickleball injury epidemiology study · April 2026 academic-center pickleball injury study · SFIA 2026 Pickleball Participation Report · SFIA U.S. Pickleball Participation Statistics · California Physical Therapy Scope of Practice §2620