Pickleball is the fastest growing sport in the United States! Stay on the court with our expert tips on injury prevention & treatment.
NYU Langone Orthopedics' Dr. Mehul Shah, MD & Dr. Natasha Desai, MD review the risks and rewards of playing America's fastest growing sport - Pickleball! Whether you're a new player or have years under your belt, our experts talk about common injuries, risks and how to avoid being sidelined.
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Dr. Mehul Shah: Hello, I'm Dr. Mehul Shah, a sports medicine specialist and orthopedic surgeon here at NYU. And you are listening to the Bone Whisper Podcast brought to you by NYU Langone Orthopedics and SiriusXM Radio. Today's episode is titled Pickleball: Preventing and Treating the Most Common Injuries. And we are talking with Dr. Natasha Desai, clinical assistant professor in our division of Primary Care Sports Medicine and co-director of the Women's Sports Medicine center here at NYU Langone. Dr. Desai, welcome to the podcast.
Dr. Natasha Desai: Thank you for having me.
Dr. Mehul Shah: Okay, so Natasha, before we get into this topic of pickleball injuries, maybe we should explain to our audience if they've been living under a rock or so what pickleball is and uh, what's making it so popular these days.
Dr. Natasha Desai: Yeah, so pickleball has actually been around for many years. Uh, it was first invented in 1965 by a few dads, three dads who kids were bored with the usual activities, the usual games, and they used the equipment that they already had handy like a paddleball rackets and a wiffle ball and created this sport, uh, called pickleball. It's now the fastest growing sport in America, third year in a row. I think it has a little bit of a Covid effect where it kind of just took off. And it's up to around 8.9 million players in the US alone. And people as young as six and kind of going all the way to well into their 80s and 90s are playing pickleball. It's increased from 4.8 million just two years ago. And so it's just it's taking off, uh, as the sport for the masses.
Dr. Mehul Shah: Yeah, you know, even though it's been around for 50, 60 years, you, I think it's become more in vogue, right? It's not as daunting of like, getting into a new sport because everyone's sort of getting into it at the same time. So we're seeing so many people starting playing pickleball relatively quickly. I know my kids play it. They like, have a little net, they draw out their little chalk diagrams on the street. And even my kids are playing pickleball these days. So, yeah, it involves - it's a paddle sport, I think it's a pretty social thing. You can play with like two to four players. You can play singles, you can play doubles.
Dr. Natasha Desai: Yeah. The tennis courts, uh, the courts are much smaller than tennis courts. And so people are finding space for it much easier, especially in urban areas, But also, um, in regular playgrounds and everything, like you said, uh, you could just make a court with chalk. It's kind of great.
Dr. Mehul Shah: So how does it exactly differ from tennis? How is the game different?
Dr. Natasha Desai: So first, the court is much smaller. About four pickleball courts can fit in one regular size tennis court. Like you said, it could be two or four players. And I think one of the bigger things is that you're not running around as much. With the courts being smaller, your surface area that you're covering, trying to volley the ball back and forth is much smaller. It's more a side to side motion than a running forward and back and side to side. The other big thing I think is important to note is there's a lot less overhead activity. The serve is not overhead, the serve is underhanded. And so definitely decreases the amount of intensity on the upper extremity as well.
Dr. Mehul Shah: Right. Also, like, they have to like, run up to the net a lot. And there's like what they call the kitchen or what they call the no-volley zone. I think kitchen is much more fun to think about.
Dr. Natasha Desai: But, um, yeah, it's about seven feet from the net. And so you don't have to go forward and back as much. So there's a lot more space between. So you know, that intensity of running up to the net and slamming the ball is just not there.
Dr. Mehul Shah: But it does involve a lot of cutting and pivoting and side to side motion. So hence people can get injured. Right. And the ball's different Right. It's more of a wiffle ball.
Dr. Natasha Desai: Yeah. There's holes in it. It's got a little bit, uh, more of a bounce than a regular tennis ball.
Dr. Mehul Shah: It's like lighter. When it hits your racket with any type of Speed, it's not this jolting kind of thing.
Dr. Natasha Desai: Exactly. Lower impact.
Dr. Mehul Shah: So easily accessible. Right. And it's also like fun for all ages. That's what we're seeing all, all these patients coming in with like newer injuries.
Dr. Natasha Desai: Yeah, all ages, definitely.
Dr. Mehul Shah: So what kind of injuries are we seeing with pickleball and why do you think they're happening?
Dr. Natasha Desai: Sure. I think, as with all sports, uh, there's three major categories of injuries. In pickleball, just like any other racquet sport, you are seeing a ton of overuse type of injuries from the repetitiveness of the motions. There is that category. And then there's also a category of traumatic injuries where you fall down and you actually break something or something tears. Then there's aggravations of the chronic conditions. People have pre-existing conditions of tendonitis and things like that that they get aggravated from the increased level of activity. So in terms of those broader groups, the overuse injuries, the ones that I see the most are going to be the shoulder kind of rotator cuff strains and tendonitis. A lot of Achilles tendinitis and hamstring tendinitis.
Dr. Mehul Shah: I think you think that's mostly because of the starting and stopping.
Dr. Natasha Desai: Yeah, it's going to be like the quick push offs and then having to brace yourself for the next hit. So I think that is something - I think also it's a lot of beginners. And if this sport is growing so quickly, the majority of people that are playing this or have only been playing for one or two years. So they may not have the same kind of warm up routine and conditioning to their body and ability, um, to be consistent. I think the start and stopping and the weekend playing 10 games and then not playing throughout the week really leads to those types of overuse injuries where you're putting a lot of wear and tear on the support structures like the tendons.
Dr. Mehul Shah: You know, another overuse injury that I see often in my practice too that I used to associate a lot with tennis, now I'm seeing a lot in my pickleball players. And that's like lateral epicondylitis used to call tennis elbow. People are even saying that should now be re-termed “Pickleball elbow”. What is tennis or pickleball elbow?
Dr. Natasha Desai: So the muscles that extend your wrist, lift your wrist up, which you often do in playing tennis and in pickleball kind of to bring the racquet back to swing. Those tendons that control those muscles attach at the outside part of the elbow and they kind of create this broad tendon. And it's just particularly vulnerable to repetitive stress. And so what happens is you are hitting the ball hundreds of times and that tendon starts to get inflamed and then chronically inflamed and then it becomes this whole thing where you can get tendon tearing and it could be a bigger issue.
Dr. Mehul Shah: So I was reading somewhere, regarding the acute traumatic injuries that you see a huge upsurge in the amount of fractures in this age group associated with pickleball, where I think over the last two years it was over a 200 to 300% increase in fracture incidence associated with pickleball. I think that may have to do with an older population, maybe some osteoporotic injuries.
Dr. Natasha Desai: The tripping and falling, but also the normal ankle kind of inversion injuries. Those lateral ankle fractures are quite common - falling outstretched arm, the distal radius fracture. I’ve seen a proximal humerus fracture from falling on the shoulder when it was by its side. So there's definitely a risk of the traumatic injuries as with other more um, uh, established sports.
Dr. Mehul Shah: I've even seen a couple of ACL injuries and again maybe from deconditioning so and so forth, rapidly getting into a sport.
Dr. Natasha Desai: I think people really get into it. Right. So they get pretty competitive, going after that ball.
Dr. Mehul Shah: It sounds like a laid back sport but actually people take it quite, quite, quite seriously. There's professional leagues, national competitions.
Dr. Natasha Desai: Yeah.
Dr. Mehul Shah: And then, I think another thing that makes our older athletes more prone to injury is this aggravation of chronic conditions. That they have underlying arthritis, say in their knees and in their shoulders or they have a rotator cuff tear that they've been dealing with and living with for a long period of time. And now all of a sudden they're getting more active and they're feeling good about themselves. But now they have these aggravations.
Dr. Natasha Desai: Yeah, I think I noticed this a lot in some patients that were previous athletes and then may have stepped away from athletics and then come back to athletics. And they don't understand why their body isn't responding to the same level of intensity. And they aggravate things, especially the underlying tendinitis. I think these type of injuries really require good continual care of both warm up, cool downs, things like that. But if they have underlying issues like arthritis, where it's an activity-related disease, so if you are overactive, it is going to flare up at times. And so we know that arthritis is one of those conditions that can kind of stay asleep in some people. And people are able to live their day to day lives and not feel it. But then they step wrong or they do too much activity or they have like a small fall onto their knee and then it flares up. I've seen that time and time again where they aggravate something that's pre-existing and, it is tough to deal with but it's one of those things that we can manage. You just have to work with your doctor to get it to go back to its normal state and then when we reintroduce the activity level, have a plan in hand um, on how to get back to that.
Dr. Mehul Shah: So let's get into the treatment right of these, Like, so say someone has a patient who's in their 70s, they recently got into pickleball and they're known knee arthritis - which they've been living with - and hasn't really been bothering them. Now they play pickleball and they can't walk for the next five or ten days. Um, and they, you know, as we said pickleball is so social. All their friends are playing it, so on and so forth. What can you tell them to manage it? Like should they be taking preemptive anti-inflammatories, should they be bracing their knee? Should they do a pre season workout to manage? What do you normally tell your patients?
Dr. Natasha Desai: In that situation, I hope that as they are starting to feel pain from something that is known that they come in sooner than later because I think it's easier to address these types of chronic conditions, um, exacerbations because then it doesn't get too flared up. I think when it's really flared up you have to ultimately it's rest and letting things kind of go back to the baseline and then we can re-approach it. But if it's a baseline or just a low level of pain that they can play through, um, I am fine with managing with all of what you said. Whatever works for them. We know in terms of arthritis, its not something that one movement, one injury is going to be the end of their knee. It's that, things will flare up. And so they have to help manage it with prevention by strengthening, Pain medications, either oral, topical and occasional injection. And when we start getting to injections, if they didn't need injections before then we have to really have a real discussion - How important is pickleball to you? If it's like your only method of socialization and exercise and it's very important, sure, I'll do an occasional injection to keep you going. But, that's where we really have to start talking about load management and decreasing the amount of intensity of exercise.
Dr. Mehul Shah: Is there any, like, if they're coming in two times, three times in a month, in a season, that's obviously too much, right?
Dr. Natasha Desai: So, you have to kind of take each patient and match their expectations with their complaints. So if you are having a ton of pain and expect not to be in pain, I think that doesn't line up, if you continue to be active. So you have to be willing to do and restrict yourself and follow through with the treatments, and have realistic expectations of where your pain is going to be. So a lot of these progressive degenerative conditions like arthritis, you have to learn how to manage and still live your life and be as active as you can be. And that's where we have to toe that line with you.
Dr. Mehul Shah: You're listening to the Bone Whisperer Podcast, brought to you by NYU Langone Orthopedics and SiriusXM Radio. I'm Dr. Mehul Shah and today we’re with Dr. Natasha Desai talking about pickleball injuries and how to prevent and treat them. So, okay, we talked about these chronic conditions, but maybe for our younger athletes who don't really have chronic conditions, but they have, you know, patellar tendonitis or runner's knee or pickle elbow, what could they do to prevent these things from coming about?
Dr. Natasha Desai: Yea, so I kind of alluded to it a little bit earlier in that you have to prepare your body for exercise. I think for anybody entering into a sport that they don't know, I think playing with people of your level and learning the sport to build good foundations and things like that is essential. I think warming up and stretching is vital. A lot of times I think it's hard to make that extra time, sometimes the court’s available at one. So you show up exactly at, ah, like 12:59. So you have to find a way to work that in, because we know that warming up and stretching really does prevent injuries and brings blood flow to the muscles, lets everything be a little bit more pliable. Making sure you have the right equipment - for pickleball, it's going to be shoes. Uh, you can't expect to cut and pivot and be as agile in the wrong type of shoes and footwear. So that's definitely important. I don't see a lot of people wearing eyewear and goggles like they would in a squash court or something. But that…
Dr. Mehul Shah: That’s more for traumatic.
Dr. Natasha Desai: Yeah, exactly. So, um, if to prevent injury that way, it's one of those things that you do have to think about protective gear, especially if you're going to play in high volume in a more intense situation. So for injury prevention, I definitely think that warming up, stretching, good equipment, good hydration, nutrition, good recovery time in between sessions. So like I was saying earlier, the intense activity and then no activity after that for a week or two is really hard for the body to load manage.
Dr. Mehul Shah: A lot of these leagues are all like, based on like a weekend league or one afternoon league. So people are getting in, they're getting in five to 10 pickleball games in one day. And that's sort of a setup for these overuse sort of injuries. What are your thoughts on stretching before or after exercise? That's always like the controversial thing, right?
Dr. Natasha Desai: People always are very fixated on that. I think it really depends on how flexible you are. If you're a naturally flexible person, probably just warming up and playing and maybe a little bit of cool down afterwards is sufficient. If you are a very tight person, if your muscles are very inflexible, the warm up is really for that day, it’s for or preparing your body for that bout of exercise. The cool down and the stretching afterwards is really for your general flexibility. And so I think when your muscles are warm and you know, your body is already feeling good from all the exercise, that is the time that you could really get some good stretching in on the areas that may need a little more attention, like for the people with tendonitis, stretching the associated muscle and things like that. But I'm a big proponent of stretching after for most people, except for maybe the hypermobile, really flexible people.
Dr. Mehul Shah: So as we wrap this up, Dr. Desai, if someone's interested in getting into pickleball and they're having difficulty getting into pickleball, who should they see? What kind of doctor do you think it makes sense that they make an appointment to see?
Dr. Natasha Desai: If they're having trouble with pain or they have preexisting conditions that they want to learn how to manage before they get into pickleball, then I definitely think someone like me, a primary care sports medicine person would be great. Someone like you, an orthopedic, uh, sports medicine personal. Someone who understands that sport is part of, um, wellness, you know, and “gets it” and your desire to want to move past some of the aches and pains of exercise. And so I think it's very important that you find somebody that aligns with your goals.
Dr. Mehul Shah: Yeah, I mean your sports medicine specialist, whether surgeon or non-operative specialist is really want you to really understands the importance in you staying active to your overall health. Not just bone health, but cardiovascular health and everything else. So we're definitely on your side for this, right?
Dr. Natasha Desai: Definitely.
Dr. Mehul Shah: Well, Natasha, thanks for coming in and talking about pickleball again. You're listening to the Bone Whispers Podcast on SiriusXM radio. Get out there and play some pickleball.
Narrator: The Bone Whisperers is a co production of NYU Langone Health and SiriusXM. The podcast is produced by Scott Uhing, sound design by Sam Doyle. SiriusXM's executive producer is Beth Ameen and senior operations manager is Emily Anton. Narration and additional sound design by Michael Luce. Don't miss a single episode of the Bone Whisperers and subscribe for free wherever you listen to podcasts. To hear more from the world renowned doctors at NYU Langone Health, tune into Doctor radio on SiriusXM Channel 110 or listen anytime on the SiriusXM app. For the Bone Whisperers podcast, I'm Michael Luce. Join us next time for the latest advances in orthopedics on the Bone Whisperers.