Play pickleball? Here are 10 tips to avoid injuries (for starters, don’t run backward!)

Lois K. Solomon | South Florida Sun-Sentinel

South Floridians trying to get in shape are calling their doctors with a new complaint: They got injured playing pickleball.

Besides ankle, hamstring and lower back strains, many are suffering from arthritis flares, torn rotator cuffs and Achilles tendon ruptures. Another frequent affliction is the broken wrist — that’s what Shelly Turetzky of Delray Beach endured about three months ago.

Turetzky, who plays at least three times a week, took a few steps back to reach for an overhead ball, then lost her balance and landed on her side.

“I went to my orthopedist and he said pickleball is giving him his biggest boom ever,” said Turetzky, 66, a self-described “couch potato” before she started the game during the pandemic. “I’m now fully healed and back out there again because I get so much joy from the game.”

Many middle-aged players who say tennis is too hard on their bodies have migrated to pickleball; others have never played tennis but heard pickleball is easy to learn and super social. The game is played on a badminton-sized court, single or doubles, with a plastic ball and large ping pong-style paddles.

Although the average age of American pickleball players is 38, USA Pickleball, the sport’s governing body, says more than half the people who play regularly are 55 and older. And that’s a group with a lifetime’s worth of accumulated conditions that could get aggravated by the game’s quick turns, lunges and high swings.

A 2021 study showed heart attacks and cardiovascular events comprised 11% of pickleball injuries in players age 60 and older reported to the U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System. After removing cardio incidents, researchers found slips and falls made up about 63% of injuries; strains and sprains about a third; fractures 28% and contusions about 11%.

Physical therapists, coaches and doctors, seeing a steady stream of new players and patients, are starting to become experts in how to prevent the most common aches and breaks. Here’s their advice.

Get the right shoes.

“People wear walking or running shoes, or shoes with waffle bottoms. These are bad,” said Keith Kovach, a certified instructor from Delray Beach.

Kovach recommends tennis or basketball sneakers, or any shoe that has good lateral support. He said pickleball shoes are fine, too, although he described them as mostly “rebranded tennis shoes.”

Take it slow.

“Anything you do too aggressively, you can get hurt,” said Dr. Jason Walters, a Broward Health orthopedic surgeon and pickleball player since he was a teenager. “People get their competitive juices flowing. It’s best to play with people who are on your same skill level.”

Warm up by moving.

Before each game, loosen up with movement-based stretches that avoid prolonged holds, such as back slaps, high knees and arm circles, said Matthew Butler, physical therapist and clinical director at the Palm Beach Institute of Sports Medicine in Boca Raton.

“Static stretching does not warm up the body and has been shown to diminish performance when performed right before an activity,” he said.

Butler suggested the following exercises to strengthen the lower body: heel raises, squats, lunges and side-stepping with a band around the legs.

Learn the proper position to receive the ball.

Get to know the “ready position,” with legs shoulder-width apart and knees bent. Butler said your weight should be balanced so you can easily change directions.

Learn how to fall.

Butler recommends these “proper fall techniques” to help reduce fractures and other injuries:

• Protect your head. Don’t let it touch the ground so you avoid a concussion.
• Keep arms and legs bent. One of the most common injuries is a wrist fracture from a FOOSH (fall on outstretched hand).
• Don’t fall straight forward or backward. Try to disperse the fall onto a larger part of the body, such as your side.
• Roll with the landing instead of having all of your weight fall on a single site, such as your knee or wrist.

Drink!

Players need to guzzle not just water but electrolyte-rich beverages to prevent cramping, said Andy Rubenstein, a competitive player, instructor and tournament organizer from Plantation.

He downs at least 17 ounces two to three hours before play, at least 8 ounces before getting on the court, and 8 to 12 ounces “during and after every match.” His go-to: Jigsaw Pickleball Cocktail, an orange-flavored supplement containing lots of potassium, magnesium and chloride.

Don’t run backward.

If you must go backward, move not by facing forward but by shuffling your feet as you face sideways, said Bob Savar, a certified instructor in Delray Beach and author of “Pickleball for Beginners.”

“I often tell [new players] that if the ball is hit over their head, they should just applaud their opponent, rather than risk going backward while trying to catch up to the ball,” he said. “It’s just not worth getting injured trying to track down an overhead volley, especially at the beginner level.”

Never cross one foot in front of the other.

As you move from side to side, your legs may cross. “Once you do that, you are stuck and cannot move either way and, in that position, you can easily lose your balance,” Savar said.

Vary your exercise routine.

Pickleball is addictive, but don’t let it become your only form of exercise. Try cross-training, said Bill Kelley, a physical therapist and co-owner of Aries Physical Therapy, which has offices in Fort Lauderdale, Hollywood, Weston and Boca Raton.

Lift weights, swim and play other sports. “Too much of the same thing can lead to chronic injuries and breakdown over time,” Kelley said. “Mixing it up and adding some weight-room time to the mix can be very beneficial and protective to actually keep you on the court longer.”

Diversify off the court.

Kelley also recommends a good night’s sleep, physical therapy, massages and healthy eating. “These are all crucial elements to staying on the court and pain-free,” he said. “The best way to deal with an injury is to attempt to prevent it before it ever starts.”

Above all, said Dr. Charles Hennekens, a pickleball player and professor at Florida Atlantic University’s medical school: Don’t stop exercising.

“As you get older, you’re not the same as you used to be,” Hennekens said. “I like tennis better than pickleball, but my body does not. Whatever you take up, start slowly. Anything that increases physical activity will be a good thing.”

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