Pickleball: A tendency for tendon injuries

Pickleball is the fastest-growing sport in the United States, particularly among older adults.

It's also a quick way for seniors to hurt themselves, unless they watch their form and warm up properly, experts say.

"We are seeing an epidemic of pickleball Achilles tendon injuries," said Dr. Timothy Charlton, an orthopedic surgeon at Cedars-Sinai Medical Center in Los Angeles.

"Pickleball is really fun, and I encourage anyone to play it, but it's important to do so in a healthy way," Charlton added in a Cedars-Sinai news release. "We're seeing many injuries because new athletes are returning to the court after a long time away or are starting to play competitively without proper training. This creates an environment where injuries are more likely to occur."

More than 13 million people have picked up pickleball, with a 200% increase in participation in the past three years, Cedars-Sinai experts said.

Unfortunately, with that has come an increase in injuries. Pickleball injuries in the United States accounted for more than $350 million in medical costs in 2023, experts said.

In particular, doctors are seeing a significant number of Achilles tendon ruptures among people ages 60 to 70, particularly among women, Charlton said.

"This increase in injuries is largely due to the rapid rise in the number of people playing pickleball, often without adequate preparation or conditioning," Charlton said.

The Achilles tendon connects the calf muscles to the heel bone, and is often injured during activities that require sudden, forceful movements like jumping or sprinting, Charlton said.

"Achilles tendon ruptures in pickleball often occur due to the movement patterns and body positions typical in the sport," Charlton said. "Players frequently move backward and then forward while staying very upright, with their feet aligned in the same direction."

Amateur pickleball players should take a tip from the pros, who "maintain a low, athletic stance with their feet turned outward, like a duck," Charlton said.

To make this a habit, Charlton suggests people touch their racket to the ground when preparing for the next serve.

"This action naturally lowers your body and helps position your feet outward, reducing the strain on your Achilles tendon and preventing the injury," Charlton said. "This stance helps avoid the problematic alignment of your feet with your plane of motion."

If you do get injured, there are two main treatment options for a ruptured Achilles tendon—a cast and brace to keep weight off the tendon or surgery to repair it, Charlton said.

"Both approaches aim for the same endpoint: It typically takes about nine months before a patient can return to a basic level of competition," Charlton said.

Charlton hopes people will avoid this long healing process by using proper position during play, and by making sure they are warmed up and conditioned beforehand.

"Playing racket sports can help you maintain a healthy lifestyle, provided you practice proper techniques to avoid injuries," Charlton said. "Our goal is to keep you on the court, enjoying the sport you love, and out of the doctor's office. By staying injury-free, you can continue to experience the joy and passion these sports bring to your life."

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