“I was rushing from work to get to my weekly pickleball game. I made it there just in time and stepped on the court ready to complete. The first few plays went as usual … and then POP! My achilles tendon snapped and my season was over just like that.”

This was the experience of one of my patients and of many other patients over the years. Pickleball is the new national obsession, the fastest-growing sport in the U.S. The game was developed in 1965 by a former Washington State congressman, Joel Pritchard. He and a friend were looking to play badminton, but unable to find a full set of rackets, they improvised, playing with wooden ping-pong paddles and a perforated plastic ball. And in case you were wondering, the game was named after the Pritchards’ dog, Pickles.

Pickleball is a sort of mash-up of tennis, badminton and ping pong. It’s played on a badminton-size court, includes a net, uses a paddle instead of a racket, and includes a plastic ball with holes. There are currently over 37 million pickleball players estimated in the United States, according to the Association of Pickleball Professionals. (Yes, that’s a thing.) The scary part is that by the end of 2023, pickleball is expected to yield roughly 67,000 emergency department visits. And that doesn’t account for the other injuries such as shoulder strains, achilles tendonitis, ankle sprains and low back pain. All told, financial analysts have forecasted that the direct medical costs of pickleball will top $377 million this year alone.

Pickleball is different from most other sports that people have been engaged in for most of their lives. Given that people play on a smaller court than tennis, their movements are quick and require fast reaction time, which is what leads to many of those injuries.

The good news is that you can decrease your odds of injury by following a few basic exercise principles.

1. Warmup: Proper warmup before play is critical to avoid injury. Jumping right into your game without warming up properly is like trying to stretch a frozen rubber band. It’s more likely to snap or break, whereas a warm rubber band is stretchy and flexible. According to the National Academy of Sports Medicine, starting with five minutes of aerobic exercise (walking, jogging) and then five minutes of dynamic stretching (lunges, leg swings, arm swings, squats, lateral slides) can reduce your odds of injury. You want to increase blood flow to your muscles and loosen up/lubricate your joints so that your body will be prepared for demands of the upcoming game.
2. Footwear: While running and walking shoes are made for forward motion, court shoes are made for the lateral side-to-side movement that occurs very quickly in pickleball, and can help you avoid ankle sprains and limit falls.
3. Hydration: Dehydration can lead to muscle cramps and fatigue, making you more susceptible to injuries. Drink plenty of water or sports drinks before, during and after playing pickleball.
4. Soft Grip: People often hold the paddle too tight, which can lead to overuse injuries such as lateral epicondylitis, more commonly known as “tennis elbow.” Take breaks between matches or games to allow your hand/wrist muscles to recover and reduce the risk of overuse injuries.
5. Cross-Train and Strengthen: Engage in regular exercise and conditioning that complements pickleball, such as strength training, flexibility exercises and cardiovascular workouts. A well-rounded fitness routine can help prevent imbalances and reduce the risk of injuries.
6. Work on Balance Exercises at Home: One is the Star Lunge, an exercise that entails bending slightly at the hip while ensuring that the core remains still. This type of exercise works on and mimics the lateral movement that is needed to play pickleball. The goal is to train the brain to know where you are moving—forward or side to side—without using one’s eyes so that it can be achieved while the player keeps their eyes on the ball.

Pickleball is a very popular and rapidly growing sport. Given its ease of play and low-impact nature, it can be an enjoyable way to stay active and fit and help to promote a healthy lifestyle. As with all sports, there is a risk for a variety of injuries. However, taking a few steps in preparation can allow pickleball to be an enriching activity enjoyed by players of all ages.

Noah Wasserman, DPT, CSCS is a licensed doctor of physical therapy and a certified strength and conditioning specialist. He is the owner of Wasserman Orthopedic and Sports Rehab in Englewood, New Jersey, and is happy to help people get in shape, avoid injuries, as well as help them recover so that they can get back on the court.