Pickleball Injuries in South Florida: What They Are, How to Treat Them, and How to Get Back on the Court

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 injury I treat in pickleball players, and they exist on a spectrum:

Rotator cuff tendinopathy: Inflammation and degeneration without tearing. Responds well to targeted strengthening.

Partial thickness tears: Require more careful loading progression but usually respond to conservative PT.

Full thickness tears: May require surgical consultation, though many patients elect conservative management successfully.

The overhead serve and "erne" shots are particularly demanding on the shoulder. Players who have had previous shoulder issues from swimming, tennis, or overhead work are at elevated risk.

What Physical Therapy Looks Like for Pickleball Injuries

I don't do cookie-cutter protocols. Here's what a typical treatment arc looks like for a pickleball injury:

Week 1–2: Assessment and load management. Identify the injury, understand your playing volume, and establish a baseline. Begin gentle loading.

Week 3–6: Progressive loading. Sport-specific exercises that match pickleball demands. Manual therapy where indicated.

Week 7–10: Return-to-sport progression. Gradual reintroduction to court time with modified intensity, then full play.

Ongoing: Maintenance program to prevent recurrence.

The difference between in-home PT and clinic PT matters here. In a clinic, you complete your program and you're done. I continue to check in, adjust programming, and catch problems early — before they become re-injuries.

How to Prevent Pickleball Injuries

This is where most guides stop at "stretch before you play." I'll give you something more useful:

Control your volume. More than 3 days per week requires deliberate recovery planning. Most recreational players don't have this.

Develop hip and core strength. The majority of upper extremity and lower back injuries in pickleball come from poor force transfer from the ground up.

Work on ankle stability. Lateral ankle sprains are largely preventable with proper balance and proprioception training.

Get your paddle grip assessed. Grip size affects elbow and wrist load significantly.

Don't train through pain. Pain is a signal. Playing through it delays healing and builds compensatory patterns.

Get Back on the Court Faster With In-Home PT

If you're dealing with a pickleball injury in Boca Raton, Delray Beach, or Pompano Beach, you don't have to wait weeks for a clinic appointment and then sit in a waiting room.

I come to you. We work in your home, at your schedule, with a program designed around your game — not a generic protocol.

Call or text: +1-954-901-7211

Email: admin@empowerfitnesspt.com

Book online: empowerfitnesspt.com/contact

Dr. Ezra Miller, PT, DPT

Doctor of Physical Therapy and NASM Certified Personal Trainer with over 10 years of clinical experience. Founder of Empower Fitness — concierge physical therapy and functional fitness serving Boca Raton, Delray Beach, and Pompano Beach, FL. 954-901-7211 · admin@empowerfitnesspt.com