If knee pain is starting to interfere with your golf game, tennis match, or time on the pickleball court, it can be tempting to assume that your knees are simply “wearing out.”

That is not necessarily the case.

Knee pain becomes more common as we get older, but pain does not automatically mean that you need to stop playing the sports you enjoy. In many cases, the better question is not simply, “What is wrong with my knee?” It is, “Why is my knee having difficulty handling the demands I am placing on it?”

Golf, tennis, and pickleball place very different demands on the body, but all three require a combination of:

• Hip mobility
• Ankle mobility
• Leg strength
• Balance
• Coordination
• Rotational control
• Deceleration
• Repeated loading

When one part of that system is not doing its job effectively, the knee may be forced to absorb more stress.

This is particularly important for active adults over 50 who want to continue playing recreational sports for decades rather than simply avoiding activities that cause discomfort.

The goal should not necessarily be to do less. The goal should be to build a body that is better prepared for the activities you want to continue doing.

Why Does Knee Pain Become More Common After 50?

There is rarely one explanation for knee pain. Changes in cartilage, previous injuries, osteoarthritis, muscle weakness, reduced mobility, changes in activity level, and altered movement strategies can all influence how the knee feels and functions.

Knee osteoarthritis is especially common with increasing age, but imaging findings alone do not determine how active someone can be. Current clinical guidelines strongly recommend exercise for people with knee osteoarthritis because appropriately prescribed physical activity can improve pain and physical function.¹

A more useful way to think about many cases of knee pain is to consider the relationship between capacity of the body and demands of the activity.

If the demands of golf, tennis, or pickleball consistently exceed your body’s current capacity, symptoms may develop. Improving that capacity may involve addressing strength, mobility, balance, endurance, movement mechanics, or a combination of these factors.

The Knee Does Not Work Alone

One of the biggest mistakes people make when addressing knee pain is focusing exclusively on the knee.

The knee sits between the hip and ankle. That means what happens above and below it can significantly influence the forces passing through the joint. For example:

Limited ankle mobility

If your ankle cannot move adequately as you squat, lunge, run, or change direction, your body may compensate elsewhere.

Limited hip mobility

Golf and racquet sports require substantial movement through the hips. If the hips do not rotate or extend efficiently, additional movement may occur through the knee or spine.

Hip weakness

The muscles surrounding the hips help control the position of the thigh and knee during weight-bearing activities.

Quadriceps weakness

The quadriceps play an important role in absorbing forces and controlling the knee during walking, stairs, squatting, lunging, running, and deceleration.

Exercise programs targeting strength and neuromuscular control are well supported in the management of knee osteoarthritis and can improve pain and physical function.^1,2

This is why successful treatment frequently requires looking beyond the location of the pain.

Knee Pain While Playing Golf

Golf may not appear particularly demanding on the knees because it does not involve running or jumping. But the golf swing produces considerable rotational forces.

Research examining golf biomechanics has demonstrated that the lead knee undergoes a combination of extension and tibial rotation during the swing, particularly as the golfer moves through impact and follow-through.^3,4

For a right-handed golfer, this means the left knee commonly experiences substantial rotational demand. The trail knee also plays an important role during the backswing and transition.

A systematic review of golf-related knee injuries found reported knee injury prevalence ranging from approximately 3% to 18%, with older golfers potentially facing greater risk.⁴

Why Might Your Knee Hurt When You Golf?

Several factors can contribute.

1. Limited hip rotation

A golf swing requires rotation through the hips, pelvis, and trunk. If hip rotation is limited, the golfer may attempt to create additional rotation elsewhere. That compensation can increase stress through the knee.

2. Poor control of the lead knee

During the downswing and follow-through, the lead leg must accept load while controlling rotation. If the muscles surrounding the hip and knee cannot adequately control that movement, the knee may become irritated.

3. Swing mechanics

Certain swing characteristics can alter knee loading. Golf research suggests that the combination of rotational movement and substantial forces makes technique an important consideration when evaluating knee symptoms in golfers.³

4. Walking the course

Sometimes the swing is not the primary problem. Walking 18 holes can involve several miles of walking, hills, uneven terrain, and repeated transitions in and out of a golf cart.

Someone may tolerate 20 golf swings at the driving range but develop symptoms after walking an entire course. That distinction matters when developing a treatment plan.

Knee Pain While Playing Pickleball

Pickleball presents a completely different challenge. The court is smaller than a tennis court, but that does not necessarily make the sport easy on the knees.

Pickleball requires frequent:

• Short accelerations
• Sudden stops
• Lateral movements
• Lunges
• Direction changes
• Backward movements
• Reaching outside the base of support

Lower-extremity injuries are well documented among pickleball players, and sprains and strains are among the commonly reported musculoskeletal injuries.^5,6

The growing popularity of pickleball among middle-aged and older adults makes physical preparation especially important.

Why Pickleball Can Irritate the Knee

Imagine chasing a ball toward the kitchen line. You accelerate forward. Then you suddenly need to stop.

Your quadriceps, gluteal muscles, calf muscles, and other lower-extremity muscles must work together to slow your body. That ability is called deceleration.

Deceleration is frequently overlooked in recreational athletes. Many people train themselves to move forward. Far fewer train themselves to stop effectively.

If your muscles cannot absorb those forces efficiently, more stress may be transferred to the knee.

Knee Pain While Playing Tennis

Tennis adds another layer of physical demand. Compared with pickleball, players often cover greater distances and may experience higher running speeds.

Tennis involves repeated:

• Acceleration
• Deceleration
• Lateral movement
• Pivoting
• Lunging
• Split stepping
• Direction changes
• Rotational movements

The knee therefore needs both mobility and stability. A tennis player may need to sprint laterally toward a ball, plant the outside foot, decelerate, strike the ball, and immediately push back toward the center of the court. That requires substantial lower-extremity strength and neuromuscular control.

For recreational players over 50, the problem is sometimes not tennis itself. The problem is that they may be asking their body to perform movements on Saturday that they never practice during the rest of the week.

The Weekend Athlete Problem

This pattern is extremely common. Someone may:

• Sit for much of the workweek
• Walk occasionally
• Perform little strength training
• Do no lateral movement training
• Do no sprinting
• Do no deceleration training

Then play 90 minutes of competitive pickleball or tennis.

Their cardiovascular system may tolerate the activity. Their joints and muscles may not be adequately prepared for it. This creates a mismatch between activity demand and physical capacity.

Is Knee Arthritis Causing My Pain?

Possibly. But arthritis is only part of the picture.

Osteoarthritis involves structural changes within the joint and can contribute to pain, stiffness, and reduced function. However, having arthritis does not mean that movement should automatically be avoided.

In fact, major clinical guidelines strongly recommend exercise as a central component of knee osteoarthritis management.¹

Exercise interventions can improve:

• Knee extensor strength
• Walking ability
• Balance
• Mobility

Physical function and pain.²

For many people, the objective should therefore not be, “How can I avoid using my knee?” A better question may be, “How can I improve my knee’s ability to tolerate the activities that matter to me?”

Common Causes of Knee Pain in Golf, Tennis, and Pickleball Players

Several conditions can contribute to sport-related knee symptoms.

Knee Osteoarthritis

Common symptoms can include:

• Stiffness after sitting
• Pain during prolonged activity
• Difficulty with stairs
• Reduced knee motion
• Aching after activity

Patellofemoral Pain

Pain is commonly experienced around or behind the kneecap and may worsen with:

• Squatting
• Stairs
• Lunging
• Running
• Prolonged sitting

Meniscus-Related Symptoms

The meniscus helps distribute forces within the knee. Symptoms may include:

• Joint-line pain
• Swelling
• Pain with twisting
• Difficulty with deep bending

Importantly, structural meniscal changes become increasingly common with age and do not always produce symptoms.

Tendon Irritation

The quadriceps and patellar tendons can become irritated when activity volume exceeds the tissues’ current tolerance.

Ligament Injury

Sudden twisting, awkward planting, or falls can occasionally produce ligament injuries, particularly in court sports.

Seven Physical Factors That Can Increase Knee Stress

For active adults who want to continue playing sports, these areas deserve particular attention.

1. Quadriceps Strength

Your quadriceps help control knee flexion and absorb force. Strong quadriceps are particularly important when going downstairs, lunging, stopping quickly, lowering into an athletic position, or walking downhill.

2. Hip Strength

Your gluteal muscles help control the pelvis, hip, and thigh. Poor hip control may alter knee mechanics during running, lunging, and direction changes.

3. Calf Strength

Your calves help propel the body forward and absorb forces during walking and running. Calf weakness can shift demands elsewhere in the kinetic chain.

4. Hip Mobility

Limited hip rotation can become particularly problematic during golf. The body still needs to rotate. If the hip does not provide enough motion, compensation may occur through the knee or lower back.

5. Ankle Mobility

Adequate ankle dorsiflexion is important for squatting, lunging, running, and decelerating.

6. Balance

Golf, tennis, and pickleball repeatedly require you to control your body over one leg. Balance training is conditionally recommended in knee osteoarthritis management and may be particularly useful when incorporated into a broader strength and movement program.¹

7. Deceleration Ability

This is especially important for tennis and pickleball. Being able to accelerate toward a ball is only half of the equation. You must also be able to stop.

Why Strength Training Becomes More Important After 50

Muscle mass and strength can decline with age if they are not deliberately maintained. That matters because muscles act as part of the body’s force-management system.

When you lunge for a pickleball, walk downhill on the golf course, or plant your foot during tennis, your muscles help absorb and redistribute forces. Building strength can therefore improve your body’s capacity to tolerate activity.

Exercise therapy is considered a fundamental non-surgical intervention for knee osteoarthritis, with evidence supporting resistance exercise, aerobic exercise, and neuromuscular training.²

For recreational athletes, strength training should not simply be viewed as something done in the gym. It is preparation for the activities you want to continue doing outside the gym.

Five Exercises Commonly Used to Build Knee Capacity

There is no single exercise program appropriate for everyone. Your program should depend on your symptoms, medical history, strength, mobility, and sport. However, several movement categories are commonly useful.

1. Sit-to-Stand or Squat

Helps develop quadriceps strength, hip strength, and functional leg strength.

2. Step-Ups

Helps prepare the body for stairs, hills, golf course terrain, and single-leg loading.

3. Split Squats

Can help develop strength needed for tennis lunges, pickleball lunges, deceleration, and athletic positioning.

4. Calf Raises

Help develop calf strength needed for walking, running, and court movement.

5. Single-Leg Balance

Helps challenge the balance and neuromuscular control required during sport.

The appropriate starting point and progression matter more than simply choosing an exercise.

Warm Up Before You Play

Going directly from your car to the first tee or pickleball court is not ideal preparation. A warm-up should gradually expose your body to the movements you are about to perform.

For golf, consider movements involving hip rotation, trunk rotation, squatting, weight shifting, and progressive practice swings.

For tennis and pickleball, consider brisk walking, side stepping, controlled lunges, calf raises, gradual direction changes, and progressive court movement.

The objective is not simply to “stretch.” It is to prepare the nervous system, muscles, and joints for the activity ahead.

Don’t Forget Your Shoes

Footwear can influence comfort, traction, and movement. Court sports require shoes designed to tolerate repeated lateral movement.

Running shoes are primarily designed for forward movement and may not provide the same lateral characteristics as court-specific footwear.

Golfers should also consider traction. Too little traction can create instability. Excessive restriction of foot rotation may potentially alter rotational forces moving up the kinetic chain.

Footwear should therefore be considered as one component of the entire movement system rather than a stand-alone solution.

Should You Wear a Knee Brace?

Sometimes.

Bracing may help certain people with knee osteoarthritis. Clinical guidelines strongly recommend tibiofemoral bracing for appropriately selected individuals with tibiofemoral knee OA and conditionally recommend patellofemoral bracing for patellofemoral OA.¹

However, a brace should not automatically replace efforts to improve strength, mobility, balance, movement mechanics, and activity tolerance.

The right brace depends on the reason for the symptoms.

How Much Pain Is Too Much?

Not every sensation during exercise means damage is occurring. However, symptoms should be monitored.

A useful consideration is how your knee responds during the activity, immediately afterward, later that day, and the following morning.

If symptoms are mild and settle relatively quickly, the activity level may be appropriate. If pain progressively increases, swelling develops, your movement changes significantly, or symptoms remain substantially worse the next day, the activity may have exceeded your current capacity.

That does not necessarily mean you need to stop the sport permanently. It may mean the dose needs to change temporarily while capacity is rebuilt.

When Knee Pain Should Be Evaluated

Seek appropriate medical evaluation if knee pain follows a significant injury or if you experience symptoms such as:

• Significant swelling
• Inability to bear weight
• A knee that repeatedly gives way
• True locking of the knee
• Significant loss of motion
• Persistent worsening symptoms
• Redness, warmth, fever, or unexplained systemic symptoms
• Pain that does not improve despite reasonable activity modification

A proper evaluation can help determine whether symptoms are primarily related to joint irritation, muscle or tendon problems, movement mechanics, an acute injury, or another condition.

What a Physical Therapy Evaluation Should Look At

For an active golfer, tennis player, or pickleball player, an evaluation should involve more than simply asking where the knee hurts. A comprehensive assessment may examine:

• Knee mobility — Can the knee fully bend and straighten?
• Hip mobility — Is there enough rotation and extension for your sport?
• Ankle mobility — Can the ankle move adequately during squatting and lunging?
• Strength — How strong are the quadriceps, hamstrings, calves, and hips?
• Single-leg control — Can you control your body effectively on one leg?
• Balance — How well can you maintain stability during increasingly challenging tasks?
• Sport-specific movement — For a golfer, this might include rotation and weight transfer. For a tennis or pickleball player, this may include lunging, lateral movement, direction changes, deceleration, and returning to an athletic stance.

The objective is to identify why the knee is being overloaded, rather than simply treating where symptoms are occurring.

The Goal Is Not Just to Make the Knee Feel Better

For active adults, pain relief is only part of the goal.

Imagine that your knee feels better after several weeks. But you still cannot walk 18 holes, lunge for a pickleball, move laterally on a tennis court, play consecutive days, or climb stairs comfortably after playing.

Then the underlying problem has not been fully addressed.

Rehabilitation should ultimately restore capacity. That means progressing from pain reduction, to mobility, to strength, to balance, to power, to sport-specific movement, and finally to return to full activity.

Can You Keep Playing Golf, Tennis, or Pickleball With Knee Arthritis?

For many people, yes. The presence of knee osteoarthritis does not automatically mean recreational sports must end.

Exercise is strongly recommended for knee osteoarthritis because appropriately prescribed activity can improve pain and function.^1,2

The important issue is matching the activity to your current capacity. That may require temporarily modifying the number of holes played, walking versus using a cart, the number of pickleball games, singles versus doubles tennis, consecutive playing days, intensity, or court time.

Then activity can often be progressively increased as strength and tolerance improve.

The Active-for-Life Approach to Knee Pain

The objective should not simply be getting through today’s golf game or pickleball match.

The bigger question is: what do you want your body to be able to do five, ten, or twenty years from now?

If golf, tennis, or pickleball is important to you, your exercise program should help prepare you for those activities. That means developing mobility, strength, balance, endurance, coordination, and sport-specific capacity.

Instead of waiting until something hurts and then repeatedly resting until it feels better, a more sustainable approach is to build the physical capacity required for the activities you value.

Frequently Asked Questions About Knee Pain and Sports After 50

Is pickleball bad for your knees?

Not inherently. Pickleball requires repeated lunging, stopping, lateral movement, and direction changes. Problems can develop when those demands exceed an individual’s current strength, mobility, balance, or conditioning.^5,6

Is golf hard on your knees?

Golf places rotational forces through the knees, particularly the lead knee during the downswing and follow-through.^3,4 Walking the course can also add considerable cumulative loading.

Can I play tennis if I have knee arthritis?

Many people with knee osteoarthritis remain physically active. Exercise is strongly recommended as part of knee OA management.¹ The appropriate amount and intensity of tennis should be individualized according to symptoms and physical capacity.

Should I stop exercising if my knee hurts?

Not automatically. Complete avoidance of activity can contribute to loss of strength and conditioning. In many situations, modifying the activity while addressing strength, mobility, and movement capacity is more useful than simply stopping exercise.

What muscles should I strengthen to protect my knees?

A comprehensive program commonly addresses the quadriceps, hamstrings, gluteal muscles, calf muscles, and trunk. The goal is to improve the ability of the entire lower extremity to produce, control, and absorb force.

Why does my knee hurt after pickleball but not while walking?

Walking primarily involves predictable forward movement. Pickleball adds rapid acceleration, stopping, lunging, lateral movement, and direction changes. Your knee may tolerate normal walking while lacking the capacity required for higher-demand court movement.

Why does my knee hurt during my golf swing?

Possible contributors include limited hip rotation, knee osteoarthritis, previous injury, reduced lower-extremity strength, or swing mechanics that increase rotational demand through the knee. The lead knee is exposed to substantial rotational and extension demands during the golf swing.^3,4

Keep Playing the Sports You Love

Knee pain after 50 does not automatically mean your days of golf, tennis, or pickleball are numbered. It may simply be telling you that something in the system needs attention.

Perhaps you need more hip mobility. Perhaps your quadriceps need to become stronger. Perhaps you need better balance. Perhaps your ankle mobility is limited. Perhaps your body is not prepared to decelerate effectively. Or perhaps your current playing schedule simply exceeds your current conditioning.

Instead of asking, “What activity do I need to stop?” consider asking, “What does my body need so I can continue doing this activity?” That shift in thinking can make an enormous difference.

At Kriz Mobility and Vitality, our goal is not simply to help active adults reduce knee pain. We want to help people build the mobility, strength, balance, and physical capacity they need to continue golfing, playing tennis, playing pickleball, traveling, exercising, and staying Active for Life.

If knee pain is beginning to change how you play—or making you wonder whether you should stop playing altogether—a comprehensive movement assessment can help identify what may be limiting you and what you can do about it.

Move better. Live better. Stay Active for Life.

References

1. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2020;72(2):149–162. doi:10.1002/acr.24131.

2. Liu H, Qin L, Liu Y, Meng X, Li C, He M. Knee osteoarthritis rehabilitation: an integrated framework of exercise, nutrition, biomechanics, and physical therapist guidance—a narrative review. Eur J Med Res. 2025;30(1):826. doi:10.1186/s40001-025-03083-4.

3. Marshall RN, McNair PJ. Biomechanical risk factors and mechanisms of knee injury in golfers. Sports Biomech. 2013;12(3):221–230. doi:10.1080/14763141.2013.767371.

4. Baker ML, Epari DR, Lorenzetti S, Sayers M, Boutellier U, Taylor WR. Risk factors for knee injury in golf: a systematic review. Sports Med. 2017;47(12):2621–2639. doi:10.1007/s40279-017-0780-5.

5. Opara OA, Brush PL, Pohl N, Fras S, et al. Pickleball- and paddleball-related injuries in the lower extremity: description, treatment options, and return to play. Cureus. 2024;16(2):e53954. doi:10.7759/cureus.53954.

6. Touhey DC, Bozorgmehr CK, Tartibi DS, Smith MV, Knapik DM. Pickleball injuries in the aging athlete: a critical analysis review. Cureus. 2024;16(9):e69950. doi:10.7759/cureus.69950.