This week, we're focusing on one of the most common reasons players end up sidelined: knee pain.
Pickleball is fast, fun, and surprisingly demanding on your joints, especially if you're over 30, desk-bound during the week, or jumping into games without a proper warm-up. In this issue, we're tackling both sides of that equation:
First, we'll break down the knee injuries and overuse patterns that show up most often in rec players, plus what you can do to prevent them.
Then we'll give you a 5-minute movement sequence to loosen up the exact areas that cause trouble, so you can show up to the court feeling ready, not rusty.
Let's keep you moving, not limping.
Knee Pain and Pickleball: What Players Over 30 Need to Know
If you've felt a twinge during a quick lunge or noticed your knees barking the day after rec play, you're not alone.
Knee pain is one of the most common complaints I hear from adult pickleball players. For most players, it's not a full-blown injury but a warning sign. Your joints are absorbing more force than they're built to handle. The good news? It's often fixable.
Why Pickleball Challenges Your Knees More Than You Think
At first glance, pickleball seems easy on the body. The court is small. The paddle is light. You're not sprinting baseline-to-baseline. But the biomechanics tell a different story.
What makes pickleball uniquely stressful on the knees is the repetitive, reactive movement pattern: short bursts of lateral shuffling, quick forward steps, and sudden changes in direction, often from awkward body positions. All that stress loads a knee that may already be compromised by:
Tight hip flexors from prolonged sitting
Weak glutes and hamstrings
Limited ankle mobility
Poor joint prep before activity
When one area isn't doing its job, the knee picks up the slack. That's where problems start.
Most Common Knee Issues in Pickleball
Patellofemoral Pain Syndrome (PFPS)
Also known as runner's knee, this causes aching or burning around or behind the kneecap, especially with squatting, lunging, or prolonged walking. It's usually due to poor kneecap tracking caused by muscle imbalances or biomechanical overload.
Quadriceps or Patellar Tendinopathy
Pain at the base of the kneecap (patellar tendon) or slightly above it (quadriceps tendon) often means overuse. These tendons don't get much blood flow, so they're prone to chronic irritation if not managed early.
Meniscus Irritation or Degeneration
Quick twisting motions or frequent pivoting can stress the meniscus, the shock-absorbing cartilage in your knee. Even without a dramatic tear, wear-and-tear adds up, especially in players over 40.
Pes Anserine Bursitis
A lesser-known cause of inner knee pain, this involves inflammation near where tendons attach on the inside of your shinbone. It's often linked to poor mechanics and tight hamstrings.
Warning Signs You Shouldn't Ignore
Pain doesn't have to be sharp to be meaningful. Look for:
Pain that shows up during play, not just afterward
Morning stiffness that lasts more than 30 minutes
A sensation of instability, "giving way," or sudden clicking
Swelling (even minor) that comes back after each match
Needing to compensate by changing how you move, stand, or recover
These aren't just signs of soreness. They're cues that your knees are being asked to absorb more than they're ready for.
What You Can Do (That Actually Works)
Building a better foundation doesn't mean backing off the game. Here's your tactical approach:
Mobilize What's Above and Below
Tight hips and ankles force the knee to move outside its natural range. Add ankle dorsiflexion work, hip openers, and thoracic rotation drills into your weekly routine.
Re-Activate Neglected Muscles
The glutes are your primary decelerators and stabilizers. If they're not firing, your knees absorb the load. Glute bridges, monster walks, and slow step-downs can make a big difference.
Warm Up Like You Mean It
Don't skip the pre-court prep. Five minutes of focused movement can turn your knees from sitting-ducks into shock absorbers. See the second section of this issue for a warm-up routine built exactly for this.
Use Pain as Feedback, Not a Badge of Honor
If you feel knee pain consistently during or after games, don't push through it. Modify your activity, adjust court time, and address the mechanics that might be contributing.
Pickleball should be sustainable. If your knees are talking, don't wait until they're shouting.
The 5-Minute Pre-Game Stretch Routine for Pickleball Longevity
Most rec players show up cold. A quick rally or two, then straight into explosive movement. That's one of the fastest ways to aggravate your knees, ankles, or back, especially if you've been sitting at a desk all day.
You don't need a full warm-up circuit. You just need to reset the right joints, wake up the right muscles, and signal to your nervous system that it's time to move.
Here's a simple 5-minute routine you can do courtside. No foam roller. No yoga mat. No excuses.
1. Ankle Rocks (30 seconds per leg)
Stand facing a wall or fence. Step one foot back into a lunge and gently drive your front knee toward the wall, keeping your heel down.
Why it matters: Limited ankle dorsiflexion is one of the most common causes of bad knee mechanics. This movement restores range and helps absorb shock on the court.
2. 90/90 Hip Openers (30 seconds per side)
Sit on the ground with one leg bent in front at 90 degrees, and the other behind you also at 90 degrees. Rotate between sides slowly.
Why it matters: Tight hips reduce your ability to rotate and lunge efficiently, which puts more torque on the knees and lower back.
3. Glute Bridge Marches (10-12 reps)
Lie on your back, feet flat. Press up into a glute bridge. While staying lifted, alternate raising one knee at a time without dropping your hips.
Why it matters: Glutes stabilize the pelvis and control deceleration. This activates them under low load before you ask them to do real work.
4. Thoracic Rotations (10 per side)
In a half-kneeling or hands-and-knees position, rotate your upper back to open toward one side, then return to start.
Why it matters: Upper body rotation is key in dinks, drives, and overheads. Opening the thoracic spine takes pressure off the low back.
5. Controlled Lunges (5-8 per leg)
Stand in a staggered stance and lower into a controlled lunge. Keep your front heel grounded throughout.
Why it matters: This pattern activates your quads and glutes through a functional range, while gently loading your knees with control.
Total Time: ~5 Minutes
Move through these slowly and with intention. You're not trying to burn calories. You're telling your joints, muscles, and reflexes: We're about to move like athletes again.
Do this every time and you'll feel it in your joints, in those first few points, and in how your body bounces back the next day.
That's a Wrap
Pickleball should be fun, not painful. A little prep goes a long way toward keeping your knees happy and your game sharp.
If this helped, share it with a friend who's still showing up cold or dealing with knee pain. Let's keep each other moving.
See you next week.
— Dr. Boris
Paddle Prescription
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.