It’s finally summer, and you know what that means? Pickleball! So much pickleball! The fun family sport, invented in 1965 and relatively unknown until just a few years ago, has seen a 311% increase in popularity over the past three years, with hundreds of new enthusiasts joining the party every year. Our occupational therapist, Sarah Stangota, is a fan too:

"Pickleball is my happy place,” she gushes. “It is a year-round sport, played indoors and outdoors! Just after my fourth child was born, I decided to get back into shape, so I took up running and triathlons. A concussion (NOT exercise-related) took me out of that for a while, and then life events kept me from going back. I continue to run here and there, but I’ve never been able to keep up with any consistency. It just wasn’t a passion anymore, like it had been. Then, I discovered Pickleball almost two years ago, and I quickly became hooked. The adrenaline rush and the cardio workout were one thing, but the camaraderie and the friendships developed at Flemington Pickleball have been the most rewarding part of playing pickleball."

The fun, the camaraderie, the exercise, the indoor/outdoor flexibility… It’s all there, and it keeps pickleball exciting and fun for players of all ages. Of course, with so many people of so many fitness and experience levels taking to the court, there are bound to be injuries. Here at A Life in Balance (ALIB), our goal is to help people recover from pickleball injuries quickly and to work proactively toward pickleball injury prevention, too.

The Most Common Pickleball Injuries—and Why They Happen

Although pickleball is a fun, social way to stay in shape, it puts a surprising amount of stress on the body, especially if you're not conditioned for its quick, reactive movements. One 10-year national study found that the most common injuries included fractures and sprains centered in the upper and lower trunk, and the wrists. That lines up with our observations here at ALIB, according to Sarah:

"Common pickleball injuries tend to stem from the sport’s fast pace and sudden directional changes,” Sarah says of the most common pickleball injuries she sees in her occupational therapy Hunterdon County experience. “One of the most common is a ‘FOOSH injury’—short for 'fall on an outstretched hand'—which can lead to wrist fractures or shoulder strains when a player loses balance. I also see a lot of lateral ankle sprains, usually from quick pivots or lunging for a shot. And then there’s overuse—particularly in the elbow—caused by the repetitive swinging motion, which can lead to tendon irritation or what's often referred to as 'pickleball elbow.' All of these are preventable with proper mechanics, warm-ups, and stability training."

The same study mentions that 91% of pickleball injuries occur in adults over age 50, although the median age of pickleball players has dropped to between ages 25 and 34. Our occupational and physical therapy Flemington NJ team notes that these common injuries can put people on the bench for weeks:

FOOSH injuries (Fall On Outstretched Hand): These can result in wrist fractures, shoulder dislocations, or rotator cuff tears.
Lateral ankle sprains: Caused by sudden pivots or lunging for the ball, especially on uneven outdoor surfaces.
Tendinopathies in the elbow (commonly known as “pickleball elbow”): From repeated swings without adequate rest or muscle support.
Achilles tendon strain or tear: Seen in weekend warriors or those returning after time off without conditioning.

Pickleball Injury Prevention: Why it Matters

When the inventors of pickleball were devising its rules, they cobbled together elements of ping-pong, tennis, and badminton—all of which require quick reactions, sudden stops and starts, changes of direction, agility, coordination, and overall joint control. Many people come to pickleball as weekend warriors without much preparation for these physical demands. This often leads to soft tissue injuries from repetitive motions and strain on tendons, muscles, and joints. This is especially true for our more seasoned players.

Fortunately, working on pickleball injury prevention through strength, balance, and flexibility conditioning with physical and occupational therapy can reduce the incidence of these injuries and help you recover faster if you do get them. This can keep you on the court all summer with fewer interruptions.

The Power of a Strong Core

Sarah emphasizes that a strong core is essential to pickleball success and injury prevention:

" A strong core is key to maintaining stability during dynamic movements! Lacking core stability will make it very difficult to withstand the constant need for speed, agility, sudden directional changes, and overhead movements."

The core muscles are connected to everything else your body does, so having a strong, stable, activated core on the court and in life generally creates a positive chain reaction that helps stabilize the rest of the body’s movements. Conversely, poor core conditioning can subconsciously cause players to compensate with other movements in the arms, legs, feet, and shoulders, which can put unnecessary strain on those areas, making injuries more likely.

Sarah recommends the following three exercises for bolstering functional core strength and balance for pickleball. These exercises should be challenging, but never painful. For assistance or advice on how to perform these correctly for the best outcome, make sure to contact us!

Planks

This is a classic that everyone would benefit from! It works the whole core.

On a padded yoga or exercise mat on the floor, lie down on your stomach with your hands placed palm-down by your face, elbows at chest level.
Then lift your chest and belly off the floor and raise up on your toes so that your body is in a straight “plank” position.
Pull your belly button in to keep focus on your abs and maintain a straight line from your shoulders to your feet. Don't let your hips or belly sag, and don’t bow your bottom up high. Keep that straight line.
Keep your shoulders in a neutral position and don’t let them poke up to your ears. Keep your heels above the balls of your feet.
Hold your plank for 10 seconds and then release gently down to the floor without losing control.
Over time, you can work up to longer periods in the plank position, or do four or five sets of 10 seconds.

Bird Dogs

Bird dogs are wonderful for pickleballers, working the abs, lower back, glutes, and thighs.

On a padded yoga or exercise mat on the floor, start by kneeling on all fours.
Position your knees over your hips and hands directly under your shoulders while keeping your abs tight, pulling in your belly button.
Simultaneously extend one arm straight in front of you while extending the opposite leg straight behind you, making a straight line.
Keep your hips level to the ground, your back straight, and your belly pulled in tight.
Hold this position for 3-5 breaths, then slowly return to your base position.
Now switch and do the other hand and leg the same way.
Try for 10 reps or five reps on each side.

Resisted Lateral Walks

These resistance band walks are great for building strength and stability in the core, especially the glutes and hip abductors.

Step into the resistance band and place it just above each ankle, keeping the band flat for comfort.
Stand with your feet at shoulder-width, keeping the band taught, but not too tight.
Now, bend the knees just a bit so that you’re in a half-squat to get those glutes activated.
Face forward with your face and shoulders up, distributing your weight evenly between your feet.
In this position, take a sideways step with one foot, and then the other, moving each step outward for 8 to ten reps.
Make sure to keep your hips stable and level during this exercise, and don’t round your back. Keep it straight.

Keep in mind that there are variations of each of these exercises that can help players coming in at different levels, from beginners to experienced. Our physical therapists and occupational therapists can work with you individually to help you get the correct form and try variations to take you from where you are to the next level of pickleball prowess and injury prevention!

What OT Brings to the Court

Physical therapy and occupational therapy can work hand-in-hand to help you with pickleball injury prevention. Here at ALIB, we do this by treating the “kinetic chain” of the body—the integrated system of joints and muscles from your head to your toes.

"As an OT, I work with patients to improve the kinetic chain function,” says Sarah. “The kinetic chain refers to how different segments of the body (joints, muscles, bones) work together in a connected sequence to generate force and movement. In pickleball, every swing, step, or pivot involves a chain reaction—from the feet up through the core to the arm and hand. If one part of the kinetic chain weakens, it is a recipe for injury if not attended to."

By helping you gain awareness, control, and stability within your body’s kinetic chain, OT can help you improve your pickleball and life game by:

Improving joint alignment and control
Speeding functional reflexes and reaction times
Strengthening shoulder and grip strength for great paddle control

Not only do these occupational therapy techniques help prevent pickleball injuries, but they also improve your coordination and performance, giving you an edge on the court.

Real Results: Therapy in Action

So, how does the PT/OT connection work in real-life pickleball situations, you might wonder? Just one of many examples came to Sarah’s mind:

"I had a patient with an Achilles tear,” she says. “The patient would play pickleball and literally not be able to walk the next day. I suggested physical therapy and/or needling to address pain and inflammation associated with the partial Achilles tear. Dry needling has also been instrumental in his ability to return to the court without pain and keep walking the next day."

If you feel a lot of aches and pains the day after pickleball, or just have a nagging issue that keeps you from getting out on the court as much as you’d like to, now is the time to experience how physical therapy and occupational therapy can provide relief and improve your performance every day.

Occupational Therapy Advice for Pickleball Players—New or Returning

Whether you’re new to the game, haven’t played in a while, or you only get to play on the weekends, Sarah has some critical advice:

"Prioritize fundamental stability before returning to play,” she advises. “If any part of the kinetic chain weakens or is injured, you must go back to the basics. It’s like trying to drive a car with a lousy engine—you aren’t going to get far in that car. Work on core engagement, scapula stabilization, and retraining basic movement patterns like quick lateral movements, rapid starts and stops, diagonal overhead reaching, and rotational movements. When you prioritize the fundamentals and strengthen your inner kinetic chain, you will find that the actual “skill” of playing pickleball will return quickly."

How A Life In Balance Can Help: Physical Therapy Flemington NJ

The team at A Life in Balance is glad to see pickleball’s continuing popularity because it means more and more people are engaging in a very important physical activity, getting stronger, and having fun! Our comprehensive care model can help you get stronger, more flexible, and more agile. We can also help you deal with any pickleball injuries that you can’t avoid through the complementary care of PT, OT, dry needling, massage, fitness coaching, and more. Our personalized movement assessments can blueprint how your body moves, find ways in which you overcompensate, and then we can correct those issues through the occupational therapy Hunterdon County pickleballers have come to trust for injury prevention and improved performance!

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From Court to Clinic: Staying Strong for Summer Pickleball