Pickleball has become the defining sport of South Florida — and if you play regularly in Boca Raton, Delray Beach, or Pompano Beach, you've either dealt with an injury yourself or watched a playing partner limp off the court.
The sport's rapid growth has brought a parallel surge in pickleball-related injuries showing up in physical therapy practices. I'm Dr. Ezra Miller, DPT, and I treat pickleball players throughout South Florida. This guide covers the most common injuries, how they happen, what treatment looks like, and what you can do to stay on the court longer.
Why Pickleball Injuries Are So Common
Pickleball is deceptively demanding. The stop-start nature of the game, the explosive lateral movements, and the repetitive overhead and dink motions put significant load on multiple joints simultaneously — particularly in players who are:
- Coming to the sport after years of inactivity
- Playing 3–5 days per week without adequate recovery
- Transitioning from tennis with different mechanics
- Over 50, where tissue healing is slower and flexibility may be reduced
The sport's accessibility is also a risk factor. People start playing without any athletic conditioning base and quickly ramp up volume. The body simply isn't prepared for that load.
The Most Common Pickleball Injuries I Treat
Pickleball Elbow (Lateral Epicondylitis)
Repetitive wrist extension and gripping overloads the tendons on the outer elbow. Pain worsens with dinking, backhand strokes, and gripping the paddle. The single most common pickleball injury I see.
Shoulder Rotator Cuff Injuries
Overhead serving, smashes, and shoulder-level drives stress the rotator cuff. Ranges from mild tendinopathy to partial or full-thickness tears — especially in players 55+.
Knee Pain (Patellar Tendinopathy)
The "kitchen" requires constant squatting, lunging, and quick direction changes. Patellar tendon overload, IT band syndrome, and meniscus irritation are all common knee presentations.
Ankle Sprains
Lateral ankle sprains from quick pivots and court surface irregularities. Underreated sprains become chronic instability — a common cycle in active players who "walk it off."
Achilles Tendinopathy
The explosive push-off in pickleball is hard on the Achilles. Tendinopathy starts as morning stiffness and progresses to pain with activity. Ignored long enough, it becomes a rupture risk.
Lower Back Strain
Rotational loads from forehand and overhead shots, combined with the forward-flexed "ready position," create predictable lumbar strain patterns — especially without hip and core strength to absorb load.
Pickleball Elbow: The Deep Dive
Because it's so prevalent, I want to go deeper on lateral epicondylitis — what players call "pickleball elbow." It's the same mechanism as tennis elbow, but the double-sided paddle and dinking motion create a slightly different load pattern.
What's actually happening
The extensor carpi radialis brevis (ECRB) tendon — which attaches to the lateral epicondyle at the outer elbow — is being loaded beyond its capacity. Over time, the tendon undergoes degenerative change (tendinosis) rather than true inflammation, which is why anti-inflammatory medications often provide minimal relief.
What works
The evidence is strong for eccentric and heavy slow resistance (HSR) loading protocols — specifically designed exercises that load the tendon under controlled stress to stimulate remodeling. Combined with manual therapy, grip assessment, and paddle evaluation, most patients see significant improvement within 6–12 weeks.
What doesn't work (or works temporarily)
- Rest alone: The tendon doesn't remodel without load. Complete rest just delays the process.
- Cortisone injections: Provide short-term pain relief but are associated with worse long-term outcomes in tendinopathy.
- Ice/NSAIDS alone: Address symptoms without addressing the underlying tendon degeneration.
The goal isn't to get out of pain so you can play through it. It's to rehabilitate the tendon so it can actually handle the demands of the sport — and stop the cycle of re-injury.
Shoulder Injuries in Pickleball
Shoulder complaints are the second most common issue I see in pickleball players. The rotator cuff is a group of four muscles that stabilize the shoulder joint — and they're under load on virtually every shot in pickleball.
The most important thing to understand: most rotator cuff problems — even partial tears — respond well to physical therapy. Surgery is rarely the first answer. The shoulder is a heavily rehabilitated joint, and strength and mobility work can restore full function in the majority of patients.
What I look for in my evaluation:
- Which specific part of the rotator cuff is involved (supraspinatus vs. infraspinatus vs. subscapularis)
- Scapular stability and movement quality
- Thoracic mobility (restriction here forces the shoulder to compensate)
- Overhead mechanics — how the player serves and smashes
Knee Pain: The "Kitchen" Problem
The non-volley zone (the kitchen) demands repeated squatting, quick direction changes, and prolonged semi-squat positioning. This is enormously stressful on the knee, particularly for players without adequate quad strength and hip stability.
I often find that knee pain in pickleball players is actually a hip strength problem. Weak glutes and hip external rotators force the knee into valgus (caving inward) on every squat and landing, accelerating wear on the joint structures. Strengthening the hip resolves the knee pain without ever directly treating the knee.
The Return-to-Sport Framework I Use
My goal is never just to get you out of pain. It's to get you back to pickleball — playing at full intensity, with confidence, without worrying about re-injury. That means we work through three clear stages:
- Pain reduction and tissue healing: Manual therapy, load management, and targeted early-stage exercise
- Strength and capacity building: Progressive loading of the injured tissue and surrounding structures — making you stronger than before the injury
- Sport-specific return: Drills that mimic the demands of pickleball, confirming you're ready before you step back on the court
Prevention: How to Stay on the Court
For the pickleball players I work with who haven't been injured yet (or want to prevent recurrence), here are the highest-yield prevention strategies:
- Two days off per week minimum. Tendons and joints need recovery time. Playing 7 days a week is how most overuse injuries develop.
- Warm up before play. 5–10 minutes of dynamic movement — leg swings, arm circles, lateral shuffles — reduces injury risk significantly.
- Strength train off the court. Hip hinge patterns, shoulder external rotation work, single-leg stability, and wrist extensors are your injury-prevention toolkit.
- Don't play through pain. Discomfort that persists into the next day is a warning signal. Get it evaluated early — when it's a small problem — instead of waiting until it forces you off the court.
- Have your mechanics evaluated. Inefficient movement patterns are often the root cause of overuse injuries. A brief session with a PT to assess your paddle grip, serve mechanics, and court movement can prevent months of treatment.
Getting Evaluated in South Florida
If you're dealing with a pickleball injury in Boca Raton, Delray Beach, or Pompano Beach, I'd love to talk. I do free consultations, and I can usually give you a clear picture of what's happening and what it will take to get you back on the court in that first conversation.
Florida is a direct access state — no referral needed to start PT. Call or message me directly, and we can often schedule within the week.