Pickleball

By Robert Swift, D.O.
Board Certified Orthopedic Surgery and Sports Medicine

Pickleball is a recreational sport that is gaining in popularity and has become one of the fastest growing sports in America. The sport is easy to learn, promotes competitiveness and socialization, and is a great form of low impact exercise.

The game was developed in 1965 by a former Washington state congressman, Joel Pritchard. He and a friend were looking to play badminton, but unable to find a full set of rackets they improvised, playing with wooden ping-pong paddles and a perforated plastic ball. With this collection of equipment, they played on an asphalt surface using a badminton net adjusted to a height like that of tennis. The friends eventually developed a permanent set of rules. Their intention was to develop a sport the entire family could enjoy together. Within two years, the first permanent court was constructed next door to Joel Pritchard’s home. Within a few more years, a corporation was developed to protect the sport. Since its inception, the game has continued to grow, and is now played in all 50 states.

The game was named after the Pritchards’ dog, Pickles. In the early development of the game, there no official name assigned to it. As the game progressed, an official name was needed, and “Pickleball” was it.

Pickleball is currently the fasting growing sport in the US. The Sports & Fitness Industry Association (SFIA) estimated that in 2017 there were over 2.8 million Pickleball players in the U.S., which was an increase of 12.3% from the previous year. Further details from the 2016 SFIA report included that over 1.5 million people were ‘casual’ participants (play one to seven times per year), and that 930,000 were ‘core’ participants (play eight or more times per year). Further breakdown of participation rates by age showed that ‘core’ participants tend to be older, with 75% of core participants being age 55 or older, and 42% of all players over 65 considered to be core participants. Along with fitness benefits of the sport, many older adults enjoy playing Pickleball because it promotes competitiveness and socialization.

Associated Injuries
A recent literature search did not reveal any published research describing specific injuries related to Pickleball. However, there is published research on injuries associated with other racket sports. In tennis, a similar style racket sport played on a similar surface, the most common injuries are sprains/strains of the lower extremity, followed by sprains/strains of the upper extremity and injuries of the trunk and low back. Given the underhand nature of the game play of Pickle-
ball, one would expect a lower occurrence of shoulder injuries than in tennis where overhand serving is a major component of the sport. However, there is still a risk for a variety of other upper extremity injuries in Pickleball.

Acute Injuries
Acute traumatic injuries in Pickleball can result from falls, secondary to a sudden turning or pivoting movement. Sprains of the ankle joint, particularly with inversion, are very common in tennis and the mechanism for this injury would be similar for Pickleball. Depending on the severity of the sprain, this injury could result in significantly impaired movement or inability to bear weight. If weight bearing is painful, initial treatment may initially include crutches (if needed), or immobilization with an ankle brace. Further treatment consisting of relative rest, icing, compression, and elevation (RICE) are generally useful in the treatment of sprains of the ankle and other joints. Depending on severity, ankle sprains can take several weeks to resolve, but patients can generally resume their previous level of play if proper steps are taken during the healing process. Return to sport participation for this and other injuries is often expedited by physical therapy.

Other injuries that can arise near the ankle can involve the Achilles tendon. These can include an Achilles strain, which can present as pain anywhere along the tendon, from the musculotendinous component at the lower calf muscle, to the body of the tendon, to its insertion at the calcaneus. Treatment of Achilles tendon strains typically consists of relative rest, focused stretching of the tendon, and eccentric loading exercises. This injury can take weeks to fully heal. A much less common but more severe injury, Achilles tendon rupture, can occur with forceful movement of the ankle, usually an abrupt plantarflexion. This injury usually results in severe pain in the posterior ankle and an inability to bear weight or actively plantarflex the foot. This type of injury will often require surgical repair and should be evaluated promptly for optimal long term outcome.

Knee injuries are also common in racket sports such as tennis, and likely to affect Pickleball players as well. These can range from acute sprains of the knee to meniscal and ligamentous injuries. A sprain of the knee can affect the collateral ligaments, caused by rapid starting/stopping and sudden turning or pivoting movements. A sprain will often result in pain with weight bearing, usually worse with lateral movement. Acute injuries of the meniscus can include tears, which can present with the same mechanism as a ligament sprain, but often will result in the inability to bear weight, decreased range of motion, and significant swelling. Treatment of these injuries can range from initial non-weight bearing, to bracing, to physical therapy, or even potential surgical repair. Any knee injury that results in pain with weight bearing, decreased range of motion, or significant swelling should prompt immediate evaluation by a physician.

Muscle groups in the lower extremity that can be acutely strained include the hamstring muscles, quadriceps, hip flexors and adductors, and calf. Many strains can involve partial tearing of the muscle body or tendon. These injuries can present as pain in the muscle with stretching or muscle contraction. Mild sprains usually respond to RICE treatment, and participants can usually return to their activity in a matter of a few weeks. More severe muscle strains or tears may have more severe pain, associated swelling or bruising of the muscle, and tend to take longer to recover. As stated above, many of these injuries will respond well to physical therapy, and this can often help to assist players to return to their previous level of competing and can often address other potential biomechanical inefficiencies that can be future injury risks.

For the upper extremity, the wrist is a common site of tennis injury, and Pickleball players are at risk as well. Falls onto an outstretched hand are a common mechanism for wrist sprains and can also result in a fracture. The elbow and shoulder can also be injured by falls. Minor bruising to the upper extremity may be initially treated with RICE, but an injury to the upper extremity that causes significant swelling, bruising, or limited range of motion should prompt a player to be evaluated.

Pickle ball can be a great way to enjoy the beautiful weather and there are many courts in the SWFL area. The benefits of exercise, and socialization out way the risks of injury. Even when we are at our most competitive, it is important to remember to play it safe, give up the point. That way you can always come back to the court to play again.

Always stretch and warm up gently before competitive play. Make sure you are getting your physical once a year to understand and appreciate your health. Drink plenty of water and the occasional sports drink. Wear appropriate gear, and footwear.

In the event of any related Pickleball injury we are available to take care of you and get you back on the court.

American Spine & Orthopaedic

4513 Executive Dr., 2nd Floor,Naples, FL 34119

(239) 877-4662 | www.drrobertswift.com