Bruce Berry, MD
Pickleball is the fastest growing sport in the United States, with more than 36 million players and counting in this country last year. But the game has been linked to an estimated $700 million in medical expenses annually thanks to injuries on the court, many of which could be prevented with pregame warm-up and proper physical conditioning.
Bruce Berry, MD
As an avid pickleballer who treats patients who also play the game, I’ve been watching the growth of the sport with a mix of enthusiasm and worry, particularly for older athletes who are at increased risk for court-related injuries. This column is the first in a series of articles intended to provide you with information to share with your patients to help prevent common injuries associated with playing pickleball.
Most players arrive in a rush and hurriedly establish their place in line to play. They socialize for a few minutes, and when their turn comes, out onto the court they go! They don’t prepare their bodies for the new movements associated with playing pickleball.
The most common injury associated with pickleball is lateral epicondylitis (tennis — or, in this case, pickleball — elbow). This overuse injury results from gripping and swinging the paddle for an extended period, too hard, or with bad body mechanics. The tendons of the extensor carpi radialis brevis develop microtears at its proximal insertion, producing inflammation and pain. (Future columns will address the diagnosis and treatment of this condition.)
A few minutes of stretching prior to game play can help reduce the risk for pickleball elbow. Advise your patients to begin their dynamic warm up with these forearm exercises:
To stretch the muscles and connective tissues in the forearm, hold the left arm out in front of you, palm down and gently pull back on the fingers. Hold the stretch for one minute (Figure 1). Next, extend the left arm out in front of you, palm down, then bend your wrist and point the fingers straight down, grasp the fingers with your right hand and gently pull the fingers of your left hand toward your body. Hold that stretch for a minute. Repeat both stretches on the right arm. Don’t bounce or pump the stretch, use steady pressure instead. If the stretch becomes painful, stop.
Figure 1. Pregame stretch to reduce risk for tennis elbow.
Another common injury is shoulder tendonitis involving the rotator cuff or the biceps tendon. This problem usually occurs from overuse, particularly with unusual movements, overreaching, or repetitive movements above the shoulder level, all of which occur while playing pickleball.
A pregame warm up may reduce the risk of developing a game-related injury. To stretch those tissues in the shoulder, begin with the arms straight out parallel to the ground (Figure 2). Advise patients to point their index fingers as if they were pencils and begin slowly drawing circles at the sides, with each completed revolution slightly enlarging the diameter of the next circle until they are drawing the largest circle possible. Then start shrinking the size of the circle with each full rotation until the hands return to the starting position. Repeat the stretch but start by rotating in the opposite direction that you initially started. I would suggest seven to eight complete circles prior to getting to the largest stretch.
Figure 2. Starting position for pregame shoulder stretch.
Together these stretches should take roughly 8-10 minutes to perform. The next column will address dynamic warm-ups for the lower body and torso.
Bruce Berry, MD, is a primary care physician in Wisconsin and a pickleball enthusiast. He is the author, with his son Andrew Berry, DO, of A Doctor’s Guide to Treatment and Prevention of Pickleball Injuries (2023).
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