Pickleball Knee Injuries - Types, Causes, Treatments, & More

Pickleball has undoubtedly become the fastest-growing sport in the US. The Sports and Industry Fitness Association found that nearly 20 million people in the US played pickleball in 2024, a 45% increase from 2023.

Because of its low-impact nature, social aspect, and accessibility, pickleball continues to grow in popularity. Participation in pickleball has increased by 311% over the last three years. 

Although pickleball can be a great form of exercise, there are some potential unforeseen knee health challenges. Some players, especially those with knee problems or past injuries, may worry about how pickleball affects their knees.

The article below provides information on identifying, preventing, and managing pickleball-related knee injuries.

Anatomy of the Knee

The knee connects to the bones of the leg, including the femur and the tibia. The patella, commonly called the kneecap, covers the knee joint. Knee anatomy also includes ligaments, cartilage, and tendons. 

The top part of the patella is connected to the quadriceps muscle by the quadriceps tendon. The patella ligament connects the bottom of your kneecap to the tibia bone. 

The knee's anatomy allows forward and backward movements and some degree of pivoting and twisting. Because of the complex range of motion, the knee is susceptible to injury when these movements occur:

• Become too forceful
• Or when movement is combined with poor form.

Dynamic sports, like pickleball, involve multidirectional movement that can place the knee in vulnerable positions.

Common Pickleball Knee Injuries

Common pickleball injuries include those listed below.

Sprains and Strains

Quad and hamstring strains are common during pickleball. Abrupt movement and sudden starting and stopping can strain or sprain the muscles. Ligament strains can also occur from twisting, pivoting, and lateral movements. Common ligament strains include the anterior cruciate, medial collateral, and lateral collateral ligaments.

Meniscus Tears

The meniscus is the cartilage pad located in the knee joint. It lubricates the knee, protects the lining, and reduces impact during activity. It is vulnerable to injuries, such as tears, due to twisting knee motions. Activity in pickleball, such as quick direction change, can lead to meniscus injuries. 

Patellofemoral Pain Syndrome (Runner's Knee)

This injury involves pain around the kneecap due to repetitive stress. It's called runner's knee because it's common in people participating in impact sports such as running and pickleball. 

Tendinitis (Patellar or Quadriceps Tendinitis)

This condition involves inflammation around the patella or quadriceps tendon. It can often occur from repetitive stress or a sudden increase in activity.  

Bursitis

The bursae are the jelly-like sacs around the knee. They act as cushions to reduce impact and friction between the bones and the soft tissue. The bursa around the knee can become inflamed from repetitive movements in pickleball.

Why Knees are Vulnerable in Pickleball

The knees are particularly vulnerable in sports such as pickleball. During pickleball, movement includes quick stops and starts. Movements that specifically may stress the knee include:

• Lateral shuffling 
• Quick pivots
• Lunges
• Repetitive bending 

The cause and symptoms of a knee injury will vary depending on the type of injury and the area injured.

Differentiating Types of Knee Pain

Doctors often categorize knee pain into two types: 

• Acute Pain: Acute knee pain is often described as sharp and sudden pain, which can be linked to a specific injury. An individual can usually pinpoint the action that causes the pain. For example, twisting the knee may suddenly cause a ligament tear. 
• Chronic Pain: The onset of chronic pain is usually more gradual. It typically does not occur due to a sudden force or movement. Instead, it's generally persistent or recurring pain due to overuse, an underlying condition, or a combination of both.

Common Causes of Knee Pain During/After Pickleball

Pickleball injuries to the knee can occur during or after play. Common injuries include:

• Overuse: Playing without enough rest (i.e., for too long or too many days in a row) can lead to an overuse injury.
• Poor Biomechanics: Not using the proper techniques, footwork, and pivoting can put the knee in a bad position. This can lead to injury. 
• Inadequate Warm-up/Cool-down: Skipping a warm-up or cool-down can potentially lead to an injury, especially a strain. Without a proper warm-up or cool-down, your muscles are unprepared for play or cannot recover appropriately.
• Weak Supporting Muscles. If the muscles in your calves, glutes, hamstrings, and quadriceps are weak, they cannot stabilize your joints well. This makes it hard for them to handle sudden stops and repetitive movements. 
• Inappropriate Footwear/Court Surface. Wearing the incorrect footwear that doesn't provide lateral support can interfere with knee stability or cause excess friction.
• Pre-existing Conditions: A knee problem you had before, like an old injury, structural issues, or arthritis, can make you more likely to get hurt.

Recognizing Symptoms

Symptoms of a knee injury may depend on the part of the knee injured, the cause, and the severity. Common symptoms include:

• Pain
• Swelling
• Stiffness
• Popping/clicking sounds
• Instability
• Limited range of motion

With all the potential for knee injuries, you may wonder is pickleball bad for your knees?

The "Good" vs. "Bad" Debate

Benefits of Pickleball

Pickleball provides several advantages, such as being a low-impact sport compared to tennis or running. It allows for social engagement and the development of a sense of community. It also provides excellent cardiovascular benefits.

Potential Downsides for Knees

Pickleball also has potential downsides for the knees. Its repetitive motions, sudden changes in direction, and possible falls can lead to knee injuries. 

Factors That Make Pickleball "Bad" for Knees

Certain factors may increase the likelihood that pickleball could potentially be bad for your knees, including: 

• Neglecting Warm-up and Cool-down: Not allowing your body time to adjust or properly recover can increase your risk of injury.
• Skipping Strength Training: Lack of an overall strength training program can lead to weak muscles that provide less support.
• Poor Technique: Poor technique on the court, such as incorrect movement patterns, can place excessive stress on your joints.
• Ignoring Pain: Ignoring the signs that you need time off the court, such as pushing through the pain, can worsen injuries. 
• Lack of Recovery: Not allowing enough rest between playing sessions is a definite risk for knee injuries. 

The Verdict

Pickleball is not inherently bad for your knees. However, certain practices and a lack of preparation can increase your risk of a knee injury. 

The good news is that many of the risks for pickleball knee injuries are controllable. Strategies to protect your knees on the court include those listed below. 

Comprehensive Warm-up Routine

Always perform a comprehensive warm-up routine consisting of light cardio, joint mobility exercises, and dynamic stretches. Good options include walking lunges, squats, leg swings, and standing hamstring curls. 

Proper Technique and Footwork

Good footwork and proper technique help reduce your risk of knee injuries. For example,

• Shuffle Steps: Keep your feet wide, body low, and shoulders square to the net. Avoid crossover steps and focus on lateral movement.
• Controlled Pivots: Control your pivots by avoiding sudden jerky twists. Stay on the balls of your feet to push off quickly without a sudden twist.
• Balanced Weight Distribution: Try to distribute your weight evenly to avoid uneven impact, which can stress the knee.

Strength and Conditioning

An overall strength and conditioning program can help reduce the risk of injury and should include:

• Lower Body Strengthening: Perform exercises that target the quadriceps, hamstrings, and glutes. Exercises include squats, lunges, deadlifts, calf raises, and skater jumps. 
• Core Strength: Working on core strength is crucial for overall stability. Consider exercises such as planks, core rotations, and crunches.
• Flexibility and Mobility: Perform regular stretching exercises to improve range of motion and help with recovery. Good options include a standing quadriceps stretch, hamstring stretch, and piriformis stretch. 

Appropriate Gear

It is vital to wear/use appropriate gear for pickleball, such as: 

• Footwear: Choose court shoes that provide good lateral support and cushioning instead of running shoes 
• Knee Braces/Sleeves: Consider a knee brace or sleeve for compression or support. A knee brace or sleeve may be helpful if you have a history of knee instability or problems, are recovering from a knee injury, or have underlying issues, such as arthritis.

Rest, Recovery, and Hydration

Off-court behavior, including rest, recovery, and hydration, is essential to avoiding knee injuries. Your body needs good nutrition and hydration. This helps your muscles, ligaments, and cartilage stay strong and prevent injury. 

Listening to Your Body

It's critical to recognize early signs of fatigue or pain, listen to your body, and take breaks. Failure to do this can exacerbate a minor injury and make it more severe.

Knowing the proper treatment and rehab for pickleball knee injuries can help you heal quickly and return to playing.

Immediate Action for Acute Injuries

Immediate treatment for acute injuries includes the Rice protocol: 

• Rest
• Ice
• Compression 
• Elevation 

When to Seek Professional Help

In some cases, it may be necessary to seek professional help. See a healthcare professional if you experience persistent pain, severe swelling, an inability to bear weight, or instability. 

Standard Treatment Approaches

Treatment approaches may depend on the type of injury. In many cases, conservative treatment is the first approach. Treatment may include:  

• Physical Therapy: Physical therapy involves tailored exercises to restore strength, flexibility, and function. It may also include pain-reducing modalities such as electrical muscle stimulation, ultrasound, and cryotherapy. 
• Anti-inflammatory Medication: Over-the-counter non-steroidal anti-inflammatory medications, such as ibuprofen, may be an option. Prescription medication to reduce inflammation may also be recommended. It's essential only to take medication as directed by your physician. 
• Injections: As recommended by your physician, injections may also be part of a treatment plan. These may include corticosteroids or hyaluronic acid, which may decrease inflammation, lubricate the knee, and ease pain. 
• Surgery: In severe cases, such as ligament ruptures or meniscus tears, surgery may be recommended. For other types of knee injuries, surgery is usually a last resort after different treatments have not worked. 
• Gradual Return to Play: To prevent re-injury, it's essential to have a structured, progressive return to ease back into pickleball play. Being too aggressive in play and doing too much too soon can lead to a re-injury. 

While pickleball can cause various types of knee injuries, there are essential steps you can take to play safely. Preparing and properly warming up before playing and using appropriate equipment is vital.

Engaging in a strength, flexibility, and conditioning program is also helpful for keeping your muscles ready for the court. Learning proper technique, listening to your body, and not playing through pain are critical for avoiding knee injuries.

Pickleball can be an excellent sport for people of all ages. Taking the proper precautions allows you to enjoy all its benefits and prioritize your knee health.