I recently cared for a few older adults who had sustained injuries from playing pickleball. Could you tell me a little about this sport and discuss what patient education players need to avoid pickleball-related injuries?-M.S., DEL.

M. Thomas Quail, MS Ed, RN, LNC, responds: Invented in 1965, pickleball has recently become the fastest growing sport in the US.1 Many active older adults play this low-impact racquet sport because it is easy to learn, promotes competitiveness, creates socialization, expends calories, and promotes a healthy lifestyle.2,3 The US Office of Disease Prevention and Health Promotion recommends that older adults partake in a minimum of 150 minutes of moderate-intensity, aerobic physical activity per week.3-5 They can easily meet this goal by playing pickleball.

Pickleball can be played indoors or outside on a 20-ft by 44-ft pickleball court. Like tennis, it can be played as doubles (two players to a team) or singles.1 The fundamentals of the game are similar to those for tennis, badminton, and ping-pong. To score points, a player hits a small hard plastic "whiffle" ball over the net with a solid wood or graphite racket, which is larger than a ping-pong racket and smaller than a tennis racket. The opponent attempts to return the ball within the boundaries of the court. Serves must be made underhand and paddle contact with the ball must be below the server's waist. Because of the sport's appeal to older adults, many pickleball classes, courts, and leagues are located near retirement communities and recreation departments.

A recent literature search did not reveal any published research describing specific injuries from playing pickleball. A search did locate published journal articles on injuries associated with other racquet sports, such as badminton, squash, racquetball, table tennis, and tennis, that included acute and chronic injuries and hospital admissions.6-8 Males had most of hospital admissions in all racquet sports.7 The most prevalent injuries and injuries leading to hospital admission involve lower extremity injury, which is more common than upper extremity injury. Abdominal and lumbar injuries occur less frequently, as do eye, facial, and head injuries.6,7

This author has played pickleball and has direct knowledge of the common injuries that pickleball players experience. Older adults may be injured directly during a match or indirectly by aggravating a preexisting condition. Direct injuries are similar to those associated with other racquet-type sports. Anecdotal information presented on pickleball websites include such common injuries as extremity strains, sprains, and fractures; tendonitis or tendon rupture; plantar fasciitis; rotator-cuff injuries; and blunt trauma to the head, face, or eyes.

All patients should be encouraged to avoid pickleball-related injury by pregame prevention and protection. These should include warm-up exercises and stretches; proper eye protection and footwear; the use of wrist, knee, and ankle braces; optimal hydration; recognizing physical limitations; frequent rest breaks; and keeping pertinent medications nearby to treat any preexisting medical conditions.

For minor injuries, the mnemonic for the initial treatment is RICE: Rest, Ice, Compression, and Elevation. Advise the patient to seek medical advice or call 911 if signs and symptoms indicate a significant or life-threatening problem, or if they persist or worsen.9

Pickleball is fun, good exercise, and encourages socialization. Primary care providers, ED staff, and urgent care providers will most likely be treating more older adults with injuries as the game grows in popularity. Help players minimize the risk of injury by teaching them about the simple precautions discussed here (see Resources for players).

Resources for players

The USA Pickleball Association: USAPA 2019 pickleball fact sheet

http://www.usapa.org/pickleball-fact-sheet

Dr. David Geier: 5 common pickleball injuries

http://www.drdavidgeier.com/pickleball-injuries

The Volley Llama: Common pickleball injuries and how to avoid them

http://thevolleyllama.com/pickleball-injuries

Syracuse Orthopedic Specialists: Are there any perils of pickleball?

http://www.sosbones.com/news/are-there-any-perils-of-pickleball

Pickle-ball Inc.: The history of pickleball

http://www.pickleball.com/History-birth-of-pickleball-s/115.htm

Tennis.com: Food for thought: The evolution and growth of pickleball

http://www.tennis.com/your-game/2015/10/food-thought-evolution-and-growth-pickle

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