Five Pickleball Overuse Injuries and How Early Physical Therapy Keeps You Playing

Pickleball is the fastest-growing racquet sport in the United States, and summer league play is in full swing. With more people jumping onto the court, clinicians are also seeing a sharp rise in overuse injuries. The sooner aches and twinges are addressed, the lower the odds they turn into stubborn chronic pain. Rotator cuff strain, lateral epicondylalgia (pickleball elbow), plantar fasciitis, patellar tendinopathy, and Achilles tendinitis make up a core cluster of repetitive-stress problems that respond well to evidence-based interventions such as graded loading and manual therapy.

1. Rotator Cuff Strain

Frequent overhead serves and rapid volley exchanges place heavy demand on the small stabilizing muscles that guide the shoulder. Micro-tears in the supraspinatus or infraspinatus can trigger night pain, weakness while lifting the paddle, and a catching sensation during follow-through.

Why it develops

• Limited shoulder-blade control
• Tight pectoral or posterior capsule tissue
• Sudden increase in play volume

Early PT interventions

• Graded loading with light resistance bands builds endurance in external rotators and scapular stabilizers without irritating healing tissue.
• Manual therapy, including soft-tissue release of the pectoralis minor and posterior cuff, improves glenohumeral mobility.
• Postural retraining teaches players how trunk rotation offloads shoulder strain.

A consistent warm-up combined with these drills often calms irritation within two to four weeks.

2. Lateral Epicondylalgia (Pickleball Elbow)

Backhand volleys and wrist flicks overload the forearm extensor tendons where they anchor at the outside of the elbow. Discomfort can radiate into the forearm, making it tough to grip the paddle or even open a water bottle.

Why it develops

• Repetitive eccentric loading from spin shots
• Stiff wrist or shoulder transferring stress to the elbow
• Grip size that is too small for the player’s hand

Early PT interventions

• Eccentric loading protocols strengthen the extensor carpi radialis brevis and promote healthy tendon remodeling.
• Instrument-assisted manual therapy such as the Graston Technique addresses fascial restrictions along the forearm.
• Education on optimal grip width, paddle weight, and shot mechanics reduces recurrence.

With a structured routine, players often regain stronger, less painful grip within six to eight weeks.

3. Plantar Fasciitis

Sharp morning heel pain signals the plantar fascia is under excessive strain. Quick lateral lunges and abrupt stops compress and stretch the fascia at its calcaneal attachment, especially on hard indoor surfaces.

Why it develops

• Calf tightness limiting ankle dorsiflexion
• Weak intrinsic foot muscles
• Back-to-back matches with minimal recovery

Early PT interventions

• Graded loading through towel scrunches, toe yoga, and progressive calf raises restores tissue tolerance.
• Manual therapy—targeted myofascial release along the plantar fascia and gastrocnemius-soleus complex—reduces tension.
• Video gait analysis identifies excessive pronation or first-toe stiffness; taping, mobility drills, or orthotics may follow.

Daily mobility work often lowers morning pain within three to five weeks.

4. Patellar Tendinopathy

Aggressive net play and low defensive squats load the patellar tendon. Aching under the kneecap tends to flare during stairs, prolonged sitting, or post-match cool-downs.

Why it develops

• Rapid increase in jump-smash drills
• Quadriceps strength imbalance
• Limited hip or ankle mobility shifting force to the knee

Early PT interventions

• Isometric loading at mid-range knee flexion controls pain while keeping the quadriceps active.
• Progression to heavy slow resistance training—for example, Spanish squats—rebuilds tendon stiffness and power.
• Manual therapy to quadriceps and iliotibial band improves patellar tracking.

Caught early, athletes often regain confident jumping power in six to ten weeks.

5. Achilles Tendinitis

Explosive push-offs and rapid direction changes deliver repetitive force to the Achilles. Soreness may linger along the tendon or at its heel insertion, then spike again the next morning.

Why it develops

• Tight gastrocnemius limiting ankle dorsiflexion
• Over-striding or heel whip during court sprints
• Footwear lacking rear-foot stability

Early PT interventions

• Eccentric heel drops and progressive calf-raise variations load the tendon safely.
• Manual therapy such as cupping or cross-fiber massage breaks down adhesions and boosts blood flow.
• Plyometric progression reintroduces controlled hops that mirror pickleball footwork once baseline strength returns.

Most players report smoother, pain-free push-offs within eight to twelve weeks.

Why Early Physical Therapy Matters

Overuse injuries share a common thread: tissue is overloaded faster than it can adapt. Addressing symptoms at the first twinge allows clinicians to guide tissue remodeling under controlled stress, correct movement patterns that overload irritated structures, and employ manual techniques to enhance circulation and joint mechanics, which accelerates recovery and reduces the risk of recurrence. Delaying care often sparks compensations elsewhere, setting off a chain of new aches that can keep athletes off the court much longer.

Action Plan for a Pain-Free Season

Pickleball should build community and fitness, not discomfort. Commit to a dynamic warm-up, supportive court shoes, and balanced strength work that targets the shoulders, core, and lower legs.

If soreness lingers for more than a few days, we can help. ProFysio Physical Therapy delivers sports physical therapy tailored to pickleball athletes, combining a comprehensive movement screen, sport-specific video analysis, individualized graded-loading plans, and hands-on treatments such as soft-tissue work, cupping, and Graston Technique. Our team also provides home-exercise progressions, equipment guidance, and convenient telehealth check-ins that keep you accountable.

Reach out to ProFysio Physical Therapy by calling (732) 812-5200 to book your personalized evaluation and keep your rallies going strong all summer.