Lower Extremity Injuries
Sport-related injuries are considered commonplace in athletics. It’s estimated that sports injuries account for about 20 percent of all emergency department visits in children ages 6 to19, and more than two million adults will receive treatment for injuries related sports participation each year. Pickleball is no exception. Injuries occur, keeping players away from this addicting game we can’t get enough of.
Lower extremity injuries are extremely common in pickleball, as the sport requires various movements in multiple directions including running, sidestepping, cutting, jumping (and therefore landing), and back pedaling. All these movements place participants at high risk for non-contact injuries, which can vary from minor (such as a small muscle pull) to severe (such as an ACL tear).
The biggest predictor of future injury is a history of a prior injury. Therefore, it’s important for pickleball players to acknowledge the demands of this growing sport, and realize preparation is the only effective way to prevent injuries. Incorporating a routine that promotes injury prevention is the key to keeping players on the courts longer and playing pickleball in a safer way!
Three keys to preventing lower extremity injuries:
1. Multiplanar Training: There are three planes of motion—sagittal, frontal and transverse. Most people cross-train in the sagittal plane, but most injuries occur in the transverse plane. It’s essential to cross-train in all three planes to best prepare for pickleball play. More details below.
2. Dynamic warm-up and cool down routines:Everyone knows how important it is to properly warm-up, yet no one seems to do it. Pickleball is so addicting that players drop everything to go play—and sometimes at the expense of their health. In addition, a cool down routine is also vital in helping the body recover and prepare for your next session.
3. Consult a Physical Therapist if you have pain: Many players play through pain, and this is not productive and will be detrimental to your game in the long run. Finding a qualified Sports Physical Therapist can make a huge difference in decreasing your pain and making your movement more efficient on the court!
There are three planes of motion and pickleball movements occur in each of them simultaneously.
The frontal plane bisects the body into front and back halves. Movements in this plane include sidestepping and bending sideways, as when someone hits a dink wide to you.
The transverse plane divides the body to create upper and lower halves and generally refers to motion that rotates or pivots, such as with serving, overheads, forehands, backhands, and sudden changes of direction.
The sagittal plane bisects the body into two halves (left and right) and motion in this plane includes running forward, backward, and bending forward (or backward).
Of the three planes, the transverse plane poses the greatest challenges to balance and dynamic stability and most lower extremity injuries occur during transverse plane movements. However, the majority of traditional strength and conditioning exercises occur in the sagittal plane. Typical exercises include bicep curls, chest press, push-ups, running, and cycling (all sagittal plane movements). By training exclusively in the sagittal plane it’s impossible to effectively prepare a pickleball player for all movements of the game.
To learn some drills and exercises encompassing multiplanar training, visit for more information and video demonstrations.
Does this sound familiar? You get to the courts, and just cannot wait to play! You hit a few dinks, a few third shots, a couple serves, and maybe a couple of overheads, then let the games begin! You’re not alone. Most pickleball players do not take the time to properly warm-up when playing recreationally (or even in tournament play!) Performing a proper Dynamic Warm-Up has been shown to reduce the incidence of injuries, especially in the lower extremities. The goal of a dynamic warm-up is to increase your body temperature and tissue extensibility in preparation for playing. It should be different than hitting pickleball shots and should take between 10 and 15 minutes. I would recommend making it part of your scheduled playing time and being disciplined about it. It will pay off in the long run! Visit my website for an example of a dynamic warm-up and modify it to fit your needs.
Playing Through Pain
Pain is your body’s way of telling you that something is wrong, and it should not be ignored. Don’t be afraid to consult a Sports Physical Therapist in order to determine the cause of your pain and to help get you safely back onto the court. Physical Therapists are the experts in movement and rehabilitation, and they can change your game and life for the better.
You can contact me with questions through the website thepickleballdoctor.com and I will help as best as I can.
Noe Sariban is a Doctor of Physical Therapy, Certified Pickleball Teaching Professional through the IPTPA, and a USAPA Rated 5.0 player. Noe started his website to provide pickleball players around the world with a reliable and free source of information.