Pickleball is all the rage. Each day, more and more individuals, across all age groups are heading to the pickleball courts. With over 4.8 million participants nationwide in 2022, and 39.3% growth over the last two years, pickleball has become the fastest-growing sport in America for two years in a row according to The Sports & Fitness Industry Association (SFIA). The Prichard family could never have imagined this. Pickleball had an accidental start in the summer of 1965 on Bainbridge Island, Washington in the Pacific Northwest, when Joel Prichard and two of his friends returned from golf, only to find their family sitting around bored. Unsuccessful at attempting to set up a badminton game, Pritchard challenged the kids to improvise and come up with their own game. They lowered the badminton court net and began experimenting with different types of balls and rackets. A new sport was born! Pickleball is now played with a paddle and large plastic wiffle-ball on a badminton-sized court (mini tennis court) with a slightly modified tennis net. It combines elements of tennis, badminton, and ping-pong and can be played as doubles (more common) or singles. It is fast-moving and fun!

So why has pickleball suddenly become so popular? After a slow period of growth, it suddenly exploded in recent years. Racquet sports have become somewhat more popular, but tennis can be challenging and frustrating for a beginner. Pickleball has a much shorter learning curve, and almost anyone can be playing, and enjoying the game, on day one. Initially, it was mostly seniors and mature athletes, but younger and younger individuals have taken a bite of the pickle. According to SFIA, growth from 2020 to 2021 was the fastest among players under 24 years of age (21%). Both men and women are taking it up in droves. Pickleball has also been shown to be a wonderful workout. Recent scientific research has placed pickleball in the moderate intensity level exercise category, confirming numerous fitness-related health benefits. Pickleball will also improve balance and hand-eye coordination. It is also extremely social, another important factor in healthy aging and improved longevity. The pandemic also helped fuel the growth of this relatively new sport. Unlike many team sports and gym workouts, racquet sports allowed for “social distancing” and were considered safe not only outdoors, but indoors as well.

As with all sports, there are pluses and minuses in terms of your health. Pickleball clearly has activated a large segment of the population which is wonderful. This will lead to improved health and longevity. Racquet sports (especially tennis) have been shown, according to two recent large scientific studies, to be the best overall activity and/or sport in terms of improved longevity. The reasons are many- improved fitness, strength, agility, and even fall prevention. Also, the social element, which has been shown to be a critical part of healthy aging. The downside is a significant increase in injuries. In my orthopedic office, I am seeing more and more pickleball players every week. My specialty is knee disorders, but there is a wide range of injuries that can occur. I also believe that many of those are preventable. Common orthopedic injuries include strains and sprains (especially ankle), contusions, knee injuries including meniscus tears and ACL tears, shoulder tendinitis and rotator cuff problems, elbow tendinitis, muscle pulls (especially calf), and even fractures from falls. Wrist fractures are far more common in females, most likely related to weakened bones from osteopenia and osteoporosis, which is more prevalent in adult women. Serious eye injuries can also occur.

Certainly, the benefits of pickleball far outweigh the risks, which can be easily mitigated with some simple preventive measures. Here are my recommendations to stay out of the sports medicine office, and on the pickle courts:

• Warmup and stretch: Even before you step onto the court, you should warm up (jumping jacks or run in-place) for a few minutes to break a sweat. This greatly reduces the risk of muscle or tendon injuries. Next do both passive and active stretching of key muscle groups including shoulder, forearm/elbow, lower back, hamstrings, and calves. This is especially true for older athletes and anyone who has had prior injuries. Once on the court, do some light hitting for a few minutes before starting the game.
• Overall fitness: Fitness protects against injuries and improves athletic performance. Never rely on your sport for overall fitness. Your weekly workouts should include equal amounts of cardiovascular/aerobic training, strength training (including core), and stretching/flexibility. Balance exercises such as yoga tree pose (or even take up yoga) help with agility and fall prevention.
• Proper footwear: Wear sneakers specific for racquet sports. Running shoes are not appropriate as they do not have enough side-to-side stability and ankle sprains or falls will happen. Go to a local tennis shop for proper footwear and sizing. Also, unlike tennis, pickleball can be played if it is raining lightly or if the court is wet, something I do not recommend because of the higher risk of slipping and falling. Also, sometimes pickleball is played on a paddle tennis court, which has a gritty surface, and it is much easier to twist your knee.
• Eyewear: Consider wearing protective goggles. Rallies and volleys in Pickleball can be close-up and fast. Although serious eye injuries are more common in tennis than in pickleball, they can occur and are sometimes catastrophic. This is especially true in beginners or individuals who have not yet developed great hand-eye coordination. I strongly recommend protective eyewear.
• Get checked: For any individuals with medical conditions, check with your primary care physician to be cleared medically to participate in any new sport or fitness activity. This will significantly lower your risk of a medical issue that sends you to an emergency room.

I believe pickleball is here to stay. There are now professional leagues and tournaments, and even LeBron James has invested in a new Major League Pickleball team. Regarding my patients who sustained pickleball-related injuries, all were very anxious to get back to the new sport they love, and that is a very good thing. If you are looking for a new fun activity with plenty of health benefits and social interaction, give pickleball a try! Learn more at www.usapickleball.org

Nicholas DiNubile, MD is an orthopedic surgeon with Premier Orthopedics, specializing in sports medicine and knee disorders in Havertown, PA. He is a best-selling author of the FrameWork series of health and wellness books, served on the President’s Counsel on Physical Fitness and Sports, and has advised two U.S. Presidents in matters of health policy. He is an avid tennis player and is certified by the United States Professional Tennis Association (USPTA).