Pickleball looks like a lower body sport.
The movement, the footwork, the lunges, the scrambling. That is where players assume the wear and tear accumulates.
The emergency department data says otherwise.
A study examining pickleball related upper extremity injuries presenting to US emergency departments between 2015 and 2024 found that these injuries have risen sharply over the past decade, with wrist fractures comprising the majority of cases.
And those injuries were concentrated in a specific group. They were more common among females, at 68.5 percent, and among patients aged 60 or older, at 84.5 percent.
A separate fracture analysis found upper extremity fractures outnumbered lower extremity fractures by 66 percent to 19 percent.
So the arm matters considerably more than most players assume, and it gets injured in two completely different ways.
Two Different Problems
The sudden ones come from falls. Wrist fractures, shoulder injuries from landing awkwardly, and elbow injuries from impact. These dominate the emergency department figures and they are covered in our companion article on falls.
The gradual ones come from the sport itself. Shoulder pain from serving and overheads, elbow pain from repeated impact at the paddle, and wrist irritation from grip and paddle control.
These second ones rarely reach an emergency room, which means they are underrepresented in the statistics and overrepresented in actual life. They are the ones that quietly ruin a season.
This article is mostly about those.
The Shoulder
What goes wrong: the serve and the overhead are the demanding movements, and both ask the shoulder to work at the end of its range, at speed, repeatedly.
Why pickleball players specifically: many players come to this sport in their sixties, having not done anything overhead with intent for decades. The shoulder is asked for a pattern it has not performed in years, several hundred times a session, three times a week.
What it feels like: pain in a specific arc of movement rather than throughout. Difficulty with overhead shots specifically. Pain that worsens through a session. And frequently, pain lying on that side at night, which is one of the more reliable indicators that the shoulder needs attention.
The reassuring context: scan findings in this age group are frequently alarming and frequently not the explanation. Studies of people with no shoulder symptoms at all have found rotator cuff tears in 31 percent of those in their seventies and over half of those over 80. A tear on a scan in an older player is close to a normal finding, and it does not automatically explain the pain or require repair.
What helps: progressive strengthening of the rotator cuff and the muscles controlling the shoulder blade, restoring movement where it has been lost, and managing how much overhead volume you do while capacity rebuilds.
The Elbow
What goes wrong: repeated impact and vibration transmitted through the paddle into the forearm muscles and their attachment at the elbow.
Where it hurts: most commonly on the outside of the elbow, tender to touch, worse with gripping, lifting and backhand shots.
The thing people get wrong: the name suggests inflammation, and in persistent cases the tissue change is degenerative rather than primarily inflammatory. Which matters enormously, because it means rest does not fix it.
Rest reduces symptoms by removing load. It also reduces the tendon’s capacity further, so returning to play produces the same problem faster than before. That cycle is why elbow pain in racket and paddle sports has such a stubborn reputation.
What actually helps: progressive loading of the forearm. Slow, controlled wrist and forearm work with gradually increasing weight, plus grip strengthening. This takes months rather than weeks, and symptoms typically improve well before capacity has rebuilt, which is where most people stop too early.
Equipment contributors worth checking:
Grip size. A grip too small for your hand forces you to squeeze harder, which increases forearm muscle activity on every shot. This is a common and easily corrected contributor.
Paddle weight and balance. Heavier and head heavy paddles transmit more load.
And grip pressure. Most players hold on considerably harder than necessary, particularly under pressure. Four or five out of ten is usually plenty.
The Wrist
What goes wrong, acutely: falls, as above, which is why wrist fractures dominate the emergency statistics.
What goes wrong, gradually: the wrist works hard in this sport. Paddle control, dinks, flicks and the stabilizing work of holding the paddle through impact all load it repeatedly.
What it feels like: aching on the thumb side or little finger side, pain with gripping or twisting, sometimes clicking.
What helps: grip and forearm strengthening, reviewing grip size and technique, and managing volume.
And a specific note for anyone with numbness or tingling in the hand, as opposed to aching. That points toward nerve involvement rather than a tendon problem, and it needs distinguishing properly, since it may come from the wrist, the elbow or the neck. Different problems, different treatment.
The Pattern Behind All Three
Look at these together and the common thread is clear.
Pickleball asks the upper limb for repeated loading that most new players have not prepared for, in a population that frequently arrives having done very little upper body strength work.
And almost nobody trains for it. Players work on their dinks and their third shot drop. Very few do any strengthening for the shoulder, forearm or grip.
Which makes the solution reasonably obvious. Two short strength sessions a week covering the shoulder, shoulder blade, forearm and grip is enough to change the picture for most players, and it is the thing almost no recreational player is doing.
Practical Adjustments Worth Making
Warm the arm up specifically. Arm circles, gentle rotations, and a few progressively harder practice serves before you start playing points. Your first full effort overhead should not be in the first game.
Build volume gradually. Almost every overuse case traces to a change in the preceding few weeks. More sessions, a new group, a tournament, or a jump from twice a week to five times.
Check your equipment. Grip size, paddle weight, and whether your grip is worn.
Soften your grip.
And use the next day as your guide. After playing, check in 24 hours later. Back to your usual baseline means the load was appropriate. Clearly worse means reduce and rebuild.
When to Get It Assessed
Seek prompt medical assessment for any suspected fracture or inability to use the arm after a fall, obvious deformity, significant swelling, true weakness as opposed to pain limited movement, numbness or tingling spreading down the arm, severe unrelenting night pain, or any arm pain with fever, unexplained weight loss or a history of cancer.
And seek emergency care for shoulder or arm pain accompanied by chest discomfort or pressure, breathlessness, sweating, nausea, or pain spreading to the jaw. Cardiac pain can present in the shoulder and arm, and that is not worth waiting on.
Keep Playing, Properly Prepared
Most upper limb problems in this sport are predictable, and predictable problems are preventable.
Kriz Physical Therapy offers a free discovery visit at no cost and no obligation. You will get a thorough assessment of your shoulder, elbow, wrist and grip, an honest explanation of what is driving your symptoms, and a program that fits around your playing schedule rather than replacing it.
If something needs imaging or a physician’s opinion, we will tell you plainly and help you get there.
