Pickleball Shoulder Injuries: Types, Causes, Treatment, and Prevention

In pickleball, your shoulder is one of the hardest-working joints. Every serve, drive, and overhead shot depends on your shoulder doing a lot of the work. 

Because of the high demand on the shoulder and the required range of motion, it is particularly vulnerable to injury when playing pickleball. 

Interestingly, pickleball has a low-impact reputation that draws players who may already have a history of shoulder issues, such as arthritis or previous shoulder injuries. But having a history of a pre-existing shoulder injury doesn’t mean you can’t still enjoy pickleball. 

The article below covers types of shoulder injuries, how they occur, how to treat them, and how to keep playing.

The shoulder is the most mobile joint in the body. This allows you to rotate, lift, and move your arm through various ranges of motion. Although mobility is critical, it also makes the joint the least stable. Essentially, you sacrifice stability for mobility. 

For support, the shoulder relies on ligaments, tendons, and muscles rather than just bone. 

Due to the relatively low stability and high mobility, sudden forces, repetitive motions, or poor mechanics can lead to injury. Pickleball-specific shoulder stressors include reaching for wide balls, overhead shots, serving mechanics, and repetitive swinging. 

In addition to repetitive injuries and force injuries, falls on an outstretched arm can also lead to a shoulder injury.

There are several types of pickleball shoulder injuries. Although rotator cuff injuries tend to get the most attention, other types of shoulder injuries may also occur. 

Below are several types of shoulder injuries that can develop as a result of pickleball play.  

Rotator Cuff Injuries 

Rotator cuff injuries get a lot of attention because they are the most common pickleball shoulder injury.  A 2025 peer-reviewed study published in the  Orthopaedic Journal of Sports Medicine involved over 600 pickleball orthopedic injuries. The study found that rotator cuff injuries accounted for 11% of all injuries. 

Your rotator cuff consists of four muscles and tendons that help stabilize and move the shoulder. Injuries to the rotator cuff due to pickleball can occur because of overuse, such as repetitive reaching and overhead shots. 

These types of rotator cuff injuries usually involve inflammation, leading to tendonitis rather than an actual tear. This is especially true if you have poor swing mechanics. The second type of injury is a partial or full rotator cuff tear. 

Symptoms usually differ between tendonitis and a tear. With tendonitis, you'll usually feel aching pain with activity. However, with a tear, you typically feel weakness when reaching to the side. 

A tear requires medical treatment. While tendonitis may resolve with home remedies, such as ice, active rest, and a topical relief product to ease soreness. 

Shoulder Impingement Syndrome

Shoulder impingement syndrome occurs if the bursa or tendons become pinched under the acromion. The acromion is the bone that extends from the scapula to the highest part of the shoulder. 

The most common pickleball mechanism that may lead to shoulder impingement syndrome is repeated overhead shots. This can include overhead smashes and high volleys.

These movements can compress the subacromial space, leading to irritation, inflammation, and pain. If ignored, it can lead to a rotator cuff tear. Symptoms include sharp pain when lifting your arm to the side or overhead. Pain may worsen at night. 

Bicep Tendonitis

Another common pickleball shoulder injury is bicep tendonitis. It involves inflammation of the long head of the bicep tendon that attaches at the top of the shoulder. The tendon helps stabilize the shoulder during overhead movements.

Repeated overhead smashes can place stress on the tendon, especially when they're performed frequently during pickleball. Symptoms typically include pain at the front of the shoulders, which may radiate down the arm. The pain in the front of the shoulders is often a specific clue that the biceps tendon is involved. 

Labral Tears

The labrum is a ring of cartilage surrounding the shoulder socket, which helps improve joint stability. A tear can also develop from a single traumatic event, such as a collision or fall on an outstretched arm on the court or overuse.

Symptoms may include a clicking or catching sensation, a feeling of shoulder instability, and deep aching within the shoulder joint. A labral tear can mimic other shoulder conditions. It's important to confirm a diagnosis with imaging, which also helps determine the severity of injury.

AC Joint Injuries and Shoulder Separations

The AC joint is located where your clavicle meets the bony part of the shoulder blade. The term AC injury is used interchangeably with shoulder separation. The distinction is the severity of the separation. 

Shoulder separation severity ranges from:

Grade 1: The ligament is stretched but not torn. 

Grade 2: This injury involves a partial tear and mild separation of the ligament from the joint. 

Grade 3: This is a complete tear. 

Symptoms of shoulder separation include pain on the top of the shoulder, especially when lifting the arm across the body. Grade 3 AC injuries result in a prominent bump on top of the shoulders. 

This type of pickleball shoulder injury usually occurs due to a fall on an outstretched arm.

Frozen Shoulder

Frozen shoulder involves progressive stiffness and pain that significantly reduces normal movement. It can develop after another shoulder injury, particularly if movement was restricted during recovery. 

Symptoms include progressive shoulder pain and stiffness over several weeks or months. This highlights why shoulder pain should not be ignored. Limited range of motion due to pain may increase the risk of a frozen shoulder. 

If you experience pickleball shoulder pain, you might not always know the cause right away. Before locking in a diagnosis, it is useful to focus on the symptoms.

It is important to have an accurate diagnosis from a healthcare professional. But certain symptom patterns may provide clues about the cause. Consider the following pain patterns:

Pain During or After Play

Pain during or after play may include: 

• Discomfort during serves or overhead shots
• Pain that eases after warm-up but returns after play
• Discomfort that continues for hours after playing 
• Common causes may include bicep tendonitis or shoulder impingement syndrome. 
• Weakness and Decreased Range of Motion

Weakness and decreased range of motion are common early symptoms of shoulder injuries. This may include: 

• Difficulty raising your arm overhead, such as getting something off a shelf
• Weakness when reaching behind your back
• Inability to hold the paddle at shoulder height without fatigue or pain

Shoulder weakness is a red flag that a rotator cuff tear may be the culprit. Additionally, when everyday movements become difficult, it's time to seek a professional medical evaluation. 

Night Pain

If shoulder pain keeps you up at night, it is important to pay attention to it. It can indicate the shoulder injury has progressed beyond post-play soreness.  

Typical shoulder soreness usually does not wake you up in the middle of the night. Increased pain may occur due to inflammation, which may become more noticeable with inactivity. 

Night pain may also include pain when lying on the affected shoulder. It could be a sign of a rotator cuff problem and warrants evaluation. 

Clicking, Catching, or Instability

Some shoulder injuries cause symptoms beyond pain. It is also possible to feel: 

• Clinking, grinding, and hearing a popping sound as you move.
• A feeling of catching or a sensation that the shoulder is loose or unstable 

These symptoms may point to injuries involving the labrum, as shoulder stability may be impaired.

When to Stop Playing and See a Doctor

If you wonder if you can play pickleball with a bad shoulder, it may depend on the cause and extent of the discomfort. In some cases, it is critical to pause playing and see your healthcare provider to avoid making an injury worse.  

Signs to stop playing and see a doctor include:  

• Persistent pain that goes beyond 2 weeks despite resting the shoulder 
• Weakness in the shoulder 
• Pain that disrupts sleep 
• Any injury after an acute fall 

When in doubt, it is best to seek professional medical evaluation.  You want to avoid self-treating fractures or dislocations.  

There are things you can do to treat pickleball shoulder pain including home remedies and professional medical treatment.

Rest and Activity Modification

One of the first steps in treating a pickleball shoulder injury is activity modifications. In some cases, completely avoiding activities that place stress on the shoulder is advisable.  

But in other instances, active rest may be a better option. Active rest involves continuing pain-free movements, such as light stretching and walking. The idea is to keep shoulder mobility without aggravating the injury.   

For pickleball play, this may include easy games with dinking and ground shots. But avoiding overhead smashes.  

The timeline for modifying activities is generally 1 to 2 weeks during an acute flare-up of overuse injuries. A general rule to follow is, don’t stop moving entirely. But avoid movements that increase pain. 

Cold Therapy and Topical Relief

Cold therapy and topical relief can help ease symptoms and support recovery. Cold therapy reduces inflammation and numbs the affected area.  

Consider applying cold to the shoulder after activity for about 15 to 20 minutes several times a day during the acute phase, which is usually the first 3 days.  

Topical analgesics can also help manage ongoing soreness, such as a fast-acting pain relief cream. They are easy to apply to an area, such as the shoulder. Applying it directly to the painful area has advantages over an oral NSAID, such as no stomach irritation or other systemic effects.  

Physical Therapy and Targeted Exercises

Physical therapy or targeted exercises have the most evidence as an effective conservative treatment for shoulder impingement and rotator cuff injuries.  

Early-stage therapy and exercises should focus on restoring the range of motion. Examples of effective exercises include:  

• Pendulum swings 
• Wall crawls 
• Associated shoulder flexion  

As pain decreases, rotator cuff strengthening exercises help prevent future injuries. Keeping this area strong helps stabilize the shoulder during pickleball, especially during overhead shots. Some typical rotator exercises with resistance bands include:  

• Resistance band external rotations 
• Resistance band internal rotations 

A comprehensive pickleball stretching routine should always include the shoulders, even for people who do not currently have shoulder problems.  

Bracing and Support

Although shoulder braces are not as common as knee or elbow braces, a compression sleeve can improve body awareness. Kinesiology tape may also help provide a little support. This may be most relevant for AC joint injuries and mild instability rather than significant injuries. A brace is also not a substitute for strengthening exercises and rehabilitation.

Medical Interventions

In some instances, shoulder pain from pickleball may not respond to conservative home treatments. With certain injuries, imaging, such as an MRI and ultrasound, is used before deciding on treatment options.  

Medical interventions may be recommended and can include:  

• Cortisone injections: Although not a cure, they can decrease inflammation and pain. It may be appropriate for injuries, such as shoulder impingement and rotator cuff tendonitis.  
• PRP: Platelet-rich plasma (PRP) uses your own blood to promote tissue repair. It is an emerging treatment for problems, such as tendon injuries. More research is needed to determine its effectiveness for shoulder injuries.  
• Surgery: Surgery may be needed for rotator cuff tears and labral repair if conservative treatment did not help or for complete tears. Surgical candidates should not delay repair indefinitely since the tear will not heal on its own.

Prevention is your best strategy when it comes to pickleball shoulder injury. Consider the following suggestions: 

Fix Your Overhead Mechanics

Mastering correct overhead mechanics is essential to reducing the risk of strain placed on the shoulder. Keep the following proper body mechanics in mind:  

• Generate power from the lower body and core. 
• Avoid excessive elbow elevation.  
• Don't force your shoulder into extreme positions.  
• Avoid reaching with maximum extension, reposition the feet instead 
• Use a smooth, relaxed swing as much as possible 

Working with a coach is a good investment to master pickleball body mechanics. 

Choose the Right Paddle for Shoulder Health

Choosing the right paddle for your shoulder health is something some players may overlook. But it can help reduce the risk of pickleball shoulder injury.  

Choose a lighter paddle that places less load on the shoulder. A heavier paddle requires your shoulder to work harder with each swing.  

Select a paddle that suits your grip size. If the paddle grip is too big or too small, it can change the way you maneuver and control the ball. It can also strain the hand and the force travels up to the shoulder. 

Strengthen the Rotator Cuff Off the Court

Some rotator cuff injuries can be prevented or at least the risk reduced. When these muscles are weak, other parts of the shoulder may have to do more of the work. Targeted off-court strengthening exercises can decrease the risk of shoulder injury and improve stability.  

Good choices to strengthen the rotator cuff include:  

• Internal and external rotations with a band 
• Side-lying external rotations  
• Band pull-aparts 
• Scapular stability exercises, such as rows and prone Y/T raises  

Strong shoulders are less prone to injury. They also move more efficiently on and off the court and recover from the demands of the game.  

Warm Up Properly

Before stepping onto the court, doing a light warmup can get your body ready for play. Expecting cold muscles to generate sudden force can lead to strains and tendon injuries.  

A proper pregame warmup prepares your joints, muscles, and tendons for the demands pickleball requires. Light dynamic stretching also helps keep your shoulders flexible. 

Before pickleball, consider a warmup routine that includes:  

• A few minutes of light jogging or side shuffles 
• Arm circles 
• Shoulder rolls 
• Cross-body arm swings  
• Resistance band pull-aparts  
• Rotate your shoulders forward and back 

Manage Your Volume and Recovery

It is also critical to balance volume with recovery time. One intense pickleball game may not cause a shoulder injury. But repeated play too frequently can. Each bad session can put a little more stress on the shoulder.  

Regardless of how addicted you are to pickleball, incorporating rest days is an important way to prevent overuse injuries.  

Part of recovery may also include your sleep position. If possible, don’t sleep on your playing shoulder to avoid additional stress to the shoulder.

If you're wondering, can you play pickleball with a bad shoulder? The answer is that it depends on the severity and type of injury. With shoulder injuries such as mild overuse tendonitis, you may still be able to play with certain modifications. For example, avoid overhead shots or reduce your game length or frequency of play.  

For frozen shoulders, gentle play, such as light volleying, may be OK. But aggressive play is probably out until after it heals.  

With other types of injuries, such as a suspected or confirmed rotator cuff tear, you should avoid playing. Continued play could enlarge the tear.  

With grade 1 and 2 AC joint separation, you might continue to play after an initial rest period and see how the shoulder feels. But grade 3 tears keep you off the court until they heal.  

A good rule to follow is if the pain changes your body mechanics, don’t play. Altering your movement can lead to other injuries.

Shoulder injuries in pickleball can range from minor soreness to surgical-level rotator cuff tears. It's critical not to let a minor injury become serious. Treating pickleball shoulder pain early is vital to prevent more serious problems. Building shoulder strength off the court is also an important step in maintaining shoulder health. 

The bottom line is, do not ignore ongoing pain, night pain, or weakness in your shoulder. Seek professional medical evaluation.  

For less serious shoulder issues, ice, activity modifications, and topical pain relief lotions, including Picklebalm, are part of an at-home recovery toolkit.  

If you're looking for more ways to stay healthy on the court, check out our guides to pickleball injury prevention.