The Pickleball Boom and the Injury Wave Behind It

Pickleball has become one of the fastest-growing sports in the country, and San Diego has embraced it — courts are packed with everyone from longtime athletes to people getting back into a sport after years away. I love it. It gets people moving, it's social, and it's genuinely fun. But as a sports chiropractor, I'm also seeing some of the physical demands of the sport walking through the door — especially when playing volume ramps up faster than the body is prepared for.

Why the Injury Wave Exists

Pickleball isn't typically a high-contact sport. The physical demand comes from something different: a lot of quick, repetitive movement. Some new players are picking up a sport that demands quick lateral movement, sudden stops, reaching, and repetitive arm motion without much recent exposure to those movements. Sometimes the enthusiasm simply outruns the conditioning.

You've got a sport that asks the body to change direction fast, brake hard, reach quickly, and repeat those movements for an entire session. When that demand increases faster than someone's current capacity or exposure to those movements, symptoms can start to show up. It's not that pickleball is inherently dangerous — sometimes the workload simply gets ahead of what the body is currently prepared for.

The Injuries I See Most

A handful of patterns come up again and again with pickleball players:

— "Pickleball elbow." It's not a formal diagnosis, but it's an easy way to describe elbow complaints that can show up with repetitive gripping and forearm loading. Pain on the outside of the elbow may be consistent with lateral elbow tendinopathy — often called "tennis elbow" — although not every case of elbow pain has the same cause.

— Shoulder pain. Repeated overhead and reaching motions can add up, particularly when playing volume increases quickly or the shoulder isn't accustomed to that amount of repetitive work.

— Achilles and calf issues. Quick starts, stops, and repeated push-offs place plenty of demand on the calf and Achilles. Symptoms here can range from calf strains and Achilles tendinopathy to more significant injuries like an Achilles rupture.

— Low back pain. Pickleball asks for plenty of bending, reaching, rotation, and quick movement — sometimes for hours at a time. For someone who isn't accustomed to that workload, the low back may be one of the areas that starts speaking up.

— Knee pain. Lateral movement, deceleration, and repeated changes of direction place plenty of demand on the knees — especially when those movements are new or playing volume ramps up quickly.

Notice a theme: many of these complaints aren't coming from one dramatic moment. Repetitive loading, sudden changes in playing volume, previous injuries, strength, recovery, and overall capacity can all play a role.

Why 'Just Push Through It' Isn't Always the Move

Pickleball has a specific trap: it's fun, social, and easy to play often — which can make it easy to underestimate how quickly the workload is adding up. A little elbow twinge is easy to ignore when you're having a great time and want to play again tomorrow. But when symptoms are getting more noticeable while playing volume keeps climbing, it may be worth adjusting the workload instead of repeatedly pushing through.

If symptoms are persistent, worsening, or starting to change how you play, that's a good time to pay attention rather than continuing to pile on more volume.

What Management Can Look Like

For the pickleball injuries I see, the approach usually blends:

— Soft tissue work — cupping, IASTM, and other manual techniques may be used for symptom management or short-term changes in mobility when appropriate.

— Adjustments where indicated — joint manipulation or mobilization may be incorporated based on the exam findings and how the athlete is presenting.

— Targeted rehab — progressive strength and endurance work helps build capacity for the demands of the sport. Depending on what we find, that might mean forearm work for an elbow complaint, calf loading for an Achilles issue, or hip and trunk work when those areas are relevant.

— Movement and load guidance — sometimes that means temporarily adjusting how often or how intensely you're playing while progressively building your tolerance back up. It doesn't always mean stopping completely.

The theme, as always: hands-on care can be one piece of the plan, but building strength, endurance, and capacity matters too.

How to Better Prepare Your Body for Pickleball

If you're a San Diego pickleball player who wants to stay on the court, a few things matter more than anything I can do in the clinic. Warm up before you play — a few minutes of movement for the ankles, hips, shoulders, and calves can help prepare your body for what you're about to ask it to do. Your first game probably shouldn't be the warm-up. Build some baseline strength off the court — calf, hip, shoulder, and forearm strength and endurance work can help build capacity for the demands you're putting on them. Ramp up gradually — going from zero to five days a week is a big jump in workload. Give your body some time to adapt as you increase how often and how long you play. And respect the early twinges — if your elbow or Achilles is starting to talk and getting louder every time you play, don't just keep turning up the volume.

A Note on What This Article Is Not

This isn't a diagnosis for your specific ache, and sports chiropractic isn't a replacement for medical evaluation. Some presentations — such as a suspected Achilles rupture, significant trauma, inability to bear weight, substantial swelling, or a major loss of function — may warrant urgent medical evaluation or referral. Part of my job is recognizing when conservative care may not be the appropriate first step.

How to Get Started at ELATE

ELATE Chiropractic & Sports Medicine is a cash-based sports chiropractic practice in San Diego serving athletes, lifters, surfers, and active adults. We accept HSA and FSA payments and can provide a superbill for potential insurance reimbursement.

A first visit is a 60-minute initial appointment ($195), where I assess your symptoms, movement, strength, range of motion, and the demands of your sport before building a plan around what we find. If you're not sure whether that twinge needs attention or just a smarter warm-up, the contact form is the easiest way to ask.

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Dr. Ashley Aguero, DC, is a Doctor of Chiropractic with a Sports Medicine emphasis. She holds a B.S. in Kinesiology from CSU San Marcos and a Doctorate of Chiropractic from Southern California University of Health Sciences. A San Diego native and CrossFit athlete, she has sideline experience in high school football, rugby, and cycling.

Pickleball Player