Why Pickleball Is Sending More People to the ER

Pickleball has earned a reputation as a friendly, low barrier sport. People discover it looking for movement, community, or something social to do after work, and many are surprised by how quickly it becomes a regular part of their week. But as participation has exploded, doctors have started to notice something else happening quietly in the background.

Emergency departments are seeing more pickleball players than ever before.

Over the past several years, emergency physicians and orthopedic teams have reported a steady rise in pickleball related injuries presenting to emergency departments. This trend is not because pickleball is uniquely dangerous. It is because participation has grown rapidly, especially among adults who may not have a long background in court sports.

When millions more people start moving quickly, changing direction, lunging, and reacting at speed, injuries that were once rare become visible at a population level. From a medical standpoint, what matters is not panic but pattern recognition.

Doctors are seeing several consistent categories of injury.

Falls and Balance Related Trauma

Falls are the most common reason pickleball players end up in the emergency department. Many of these occur during lateral movement or quick forward lunges toward the kitchen. Players lose balance, slip on outdoor surfaces, or misjudge footing when reaching for a low ball. The instinct to catch a fall with an outstretched hand often leads to wrist fractures, forearm injuries, or shoulder trauma.

In older adults, even relatively low energy falls can result in significant injury due to changes in bone density and reaction time. What might have been a minor stumble in younger years can become a fracture in the wrist, hip, or shoulder when bone strength declines. The surface matters too. Outdoor courts with wet patches, uneven transitions, or loose debris add layers of risk that indoor facilities minimize.

Upper Extremity Injuries

Upper extremity injuries are another major driver of ER visits. Emergency physicians frequently see shoulder strains, rotator cuff injuries, elbow pain consistent with tendinopathy, and acute muscle tears. These often occur during overhead shots or repeated hard swings late in play when fatigue alters mechanics.

Many players underestimate how demanding pickleball can be on the shoulder, especially when games are long and competitive. The repetitive overhead motion combined with forceful hits creates stress patterns similar to those seen in tennis players, but without the same level of conditioning or awareness. Elbow injuries often stem from improper grip technique, excessive wrist flicking, or playing through early discomfort until inflammation sets in.

Eye Injuries

One of the more surprising trends has been the rise in eye injuries. Balls move quickly in close quarters, especially during kitchen exchanges. Emergency departments have reported corneal abrasions, orbital fractures, retinal injuries, and other forms of eye trauma after players are struck at close range.

Eye protection is still uncommon in pickleball, which makes these injuries feel unexpected to players who view the sport as low risk. The ball is light and plastic, so the assumption is that it cannot cause serious harm. But at close range, particularly when struck with force during net play, the impact can be significant. Unlike racquetball or squash, where protective eyewear is standard, pickleball culture has not yet embraced this safety measure.

Lower Extremity Injuries

Emergency departments have also seen lower extremity injuries involving the knee, ankle, and Achilles tendon. Sudden stops, pivots, and push offs place high loads on these structures. Acute sprains are common, but so are flare ups of underlying tendon issues that finally cross a threshold during play.

Achilles injuries deserve particular attention because they can be season ending or worse. The tendon is vulnerable during explosive forward movement, especially when players are fatigued or playing after long periods of inactivity. Calf tightness, limited ankle mobility, and insufficient warm up all contribute to the risk. Knee injuries often involve ligament strains or meniscus tears during rapid directional changes, particularly on hard court surfaces that do not allow for much give.

Cardiovascular and Environmental Concerns

There is another category that receives less attention but matters clinically. Some ER visits are related to cardiovascular strain, dehydration, or heat related illness. Pickleball often involves long sessions with minimal breaks, particularly in warm environments. Players may not perceive themselves as exercising intensely, even though heart rates remain elevated for extended periods.

This is especially relevant for older adults or those returning to exercise after time away. The social nature of pickleball can mask exertion levels. Players keep going because the game is fun and competitive, not realizing their body is working harder than it feels. Dehydration compounds the problem, particularly in outdoor settings where sun exposure and heat add stress.

From a physician's perspective, none of this suggests pickleball should be avoided. In fact, most doctors strongly support patients staying active through sports like pickleball. The key insight is that the sport sits in a unique middle ground. It feels accessible, but it still places real demands on the body.

Many injuries share common risk factors. Rapid increases in play volume, especially going from occasional sessions to daily play, are a major contributor. Connective tissue adapts more slowly than cardiovascular fitness, which means players can feel ready before their tendons and joints truly are. Fatigue also plays a role. Late game mechanics change subtly, increasing joint load without the player noticing.

There is also a mismatch between expectation and preparation. Many players warm up minimally, stretch cold muscles, or skip strength work entirely. Pickleball rewards quickness and reach, but those qualities depend on strength, balance, and coordination that must be maintained off the court.

The age demographic adds another layer. While pickleball attracts players of all ages, a significant portion of the participant base is over 50. This group benefits enormously from the activity but also faces age related changes in muscle mass, bone density, flexibility, and recovery capacity. These changes do not disqualify anyone from playing, but they do change what the body needs to stay healthy during play.

Doctors often emphasize prevention over restriction. Gradually increasing play time, warming up dynamically, rotating intensity across the week, and incorporating basic strength training can dramatically reduce injury risk. For eye injuries, simple protective eyewear could change the risk profile substantially, yet adoption remains low.

Dynamic warm ups that include leg swings, arm circles, light jogging, and movement specific drills prepare the body far better than static stretching alone. Strength training does not need to be complicated. Basic exercises targeting the shoulder stabilizers, core, hips, and lower legs can improve resilience significantly. Balance work, even just standing on one foot while brushing teeth, translates directly to better stability on the court.

Recovery matters as much as performance. Playing multiple days in a row without rest increases injury risk, especially when fatigue begins to accumulate. Alternating high intensity days with lighter play or complete rest gives connective tissue time to adapt. Listening to early warning signs, like stiffness that lingers or soreness that does not improve overnight, prevents minor issues from escalating.

Knowing when an injury requires medical evaluation versus rest is another area where education helps. Soreness that improves within a day or two and does not worsen with movement is often part of normal adaptation. Pain that persists, escalates during play, causes night discomfort, swelling, numbness, or loss of function deserves medical assessment. Early evaluation often prevents minor issues from becoming prolonged problems.

Certain red flags warrant immediate attention. Sharp pain during a specific movement, inability to bear weight, visible deformity, significant swelling within the first few hours, or any loss of sensation should prompt an ER visit or urgent care evaluation. For less acute concerns, seeing a primary care physician or sports medicine specialist early can identify problems before they require more invasive treatment.

The rise in emergency visits is not a failure of pickleball as a sport. It is a predictable consequence of mass participation in an activity that challenges balance, reaction time, and coordination. From a health perspective, the goal is not to scare people away, but to help them stay in the game safely and sustainably.

When doctors talk about pickleball injuries, the message is remarkably consistent. Keep playing. Just respect the fact that your body is doing real work.

• Emergency departments are seeing more pickleball injuries as participation grows

• Falls, upper extremity injuries, eye trauma, and overuse issues are most common

• Rapid increases in play time and fatigue are major risk factors

• Preparation, gradual progression, and early evaluation reduce serious injury risk

Pickleball remains one of the most accessible and enjoyable ways for adults to stay active. The rise in emergency visits does not contradict that. It simply reminds us that movement counts, stress accumulates, and preparation matters. The goal is not to play less, but to play in a way your body can support for years to come.

Boris.

Disclaimer: This newsletter is for educational and informational purposes only and does not constitute medical advice. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read in this newsletter.