Chronic Injuries
Chronic injuries that can affect Pickleball players will typically result from overuse or repetitive pounding on the hard playing surface. In the foot, these can include plantar fasciitis and heel contusions. Plantar fasciitis typically results from irritation of the fascia that originates at the calcaneus and extends along the medial arch of the foot. This is typically treated with activity modification, stretching, intrinsic foot exercises, and potentially shoe orthotics or heel cups. Heel contusions, or bruises of the calcaneus, are treated with relative rest and localized padding or footwear modification. Blistering of the foot can also be an issue, particularly with prolonged use of improper footwear. To limit the potential for foot injuries, a player should make sure they have proper fitting shoes.
As previously mentioned, strains of the gastrocnemius, hamstring, quadriceps, or groin can be acute, but also can occur over time, presenting as gradually worsening muscle pain with prolonged use of the affected area. If a player is having persistent soreness in these muscle groups, focus should be placed on stretching the affected area and avoidance of offending activity until symptoms improve.
Lumbar muscle strains are a common injury,9 often associated with forward bending and repetitive trunk rotation while striking the ball. Initial management of lumbar strains is similar to strains of other muscles with RICE treatment. Preventive conditioning strategies to limit low back muscle injuries include core stability lower extremity flexibility training.9 This is another injury for which physical therapy can help an athlete return to their level of play. Low back injuries that do not respond to the above conservative measures may warrant MRI or other imaging to assess for more significant injury such as disk or vertebral injury.
In the upper extremity, flexor and extensor tendon strain at the wrist can develop, as well as epicondylitis injuries at the elbow. These are overuse injuries associated with repeated ball striking, and can be limited by proper ball striking form. Once present, these injuries often respond to rest, focused stretching and gentle resistance exercise targeting the injured area. Bracing of the wrist or elbow can also potentially provide increased comfort and stability while healing.
Chronic shoulder injuries would be expected to occur less frequently in Pickleball given the predominantly underhand play, but strains of the rotator cuff could occur with overhand volleys or repetitive stretching to reach for the ball. As with other muscle strains, these injuries will often improve with relative rest. Stabilization and range of motion exercises for the shoulder can be used to facilitate recovery and a return to normal function. If a patient’s progress plateaus with a shoulder or the other mentioned areas, treatment with a skilled physical therapist can help restore proper strength, balance and motion to allow a player to resume pain-free activity.