It was a beautiful spring afternoon at Pocahontas Park, and Michelle Sechen of Vero Beach was participating in a friendly yet competitive round-robin on the pickleball courts. Suddenly, one of her opponents fired a low shot toward her left foot. Tall and athletic, she instinctively twisted to reach the ball with the paddle in her right hand. Her feet became entangled and she lost her balance.
“I came down hard on my left hand and I could immediately tell something bad happened,” recalls Sechen. Her doubles partner, a retired first responder, applied ice to her rapidly swelling hand and drove her to Indian River Hospital Pointe West Urgent Care. X-rays revealed multiple fractures and the need for surgery. A few days later, an orthopedic surgeon implanted a plate and screws to stabilize Sechen’s wrist, and she spent the next month in physical therapy.
As pickleball continues to surge in popularity, so have the number of injuries related to the sport. According to a national 10-year study published in the Journal of the American Osteopathic Academy of Orthopedics, between 2013 and 2022 there were an estimated 77,963 pickleball-related injuries in the United States. Since 2020, the number of pickleball injuries treated in emergency departments increased 88 percent. More than 90 percent of those injuries occurred in players aged 50 and older, with 54 percent of fractures occurring in the wrist or lower arm, particularly among women.
According to Dr. Laszlo Harmat, an orthopedic surgeon at Cleveland Clinic Indian River Hospital, FOOSH (fall on outstretched hand) injuries are common in racket sports like tennis and pickleball. They result from quick lateral movements combined with upper extremity swinging motions. Although injury rates among men and women in the study were nearly equal, women experienced more than twice the number of fractures compared to men. “That’s not surprising,” says Harmat, “since postmenopausal women are more prone to fractures due to lower bone density. “Men of the same age group develop more strains and sprains and less fractures.”
Of course, not all injuries are caused by accidents on the court. Many are triggered by the overuse of certain joints. “Pickleball elbow is now replacing tennis elbow as one of the most common overuse injuries we diagnose,” says Harmat, who has seen an increase in the number of pickleball injuries sustained by players of all ages.
Pat Ritacco learned to play pickleball 10 years ago and admits she immediately became addicted to the sport. Soon, the petite, fit retiree was playing two-and-a-half hour sessions four to five times a week. The wear and tear on her shoulder eventually necessitated rotator cuff surgery. After a four-month recovery, she was back on the court, no worse for wear but a little wiser.
“I do yoga in the morning and make sure I really stretch before I play,” says Ritacco. It’s also important, she says, to “take that extra few minutes to hit the ball around a little bit, take a few serves, and get yourself warmed up. If I don’t warm up before playing, that’s what winds up causing injury.” These days, if her shoulder pain returns, she takes anti-inflammatories as well as a few days off from pickleball.
“People must accept that age becomes a factor at some point, and the game is not the same as when we first started playing,” she adds. “A lot of young people and tennis players have come into the game, and they’ve really made it more about power. Some of my friends’ kids have black-and-blue marks on them from playing that they jokingly call ‘pickleball tattoos.’”
That’s true, according to recent data. Pickleball isn’t just for grandmas. There is a notable rise in the number of younger players taking up the sport, specifically those 25 to 34 years of age.
Data also confirm that many new pickleball players are current or former tennis players attracted by the smaller court, faster learning curve, and social aspect of the sport.
What does all this mean for older players?
Ritacco says she and her husband, Rich, an International Pickleball Teaching Professional Association Level II–certified pickleball instructor, want to continue to play as long as they can, which might mean modifying how they play or even whom they play with. “Although Rich can, I don’t usually play with younger players anymore,” says Pat. “I know, for example, that I can’t play against a 25-year-old guy who just wants to bang it out.” That’s why, she points out, it’s helpful to have the north and south courts at Pocahontas to separate those who want to play more recreationally from those who want to play more competitively.
Rich, a former tennis player who has medaled in local, state, national, and international pickleball tournaments, instructs players of all levels at Pocahontas Park. “When I first meet people in a beginner class,” he says, “I always get a feel for who has experience playing any type of sport. What’s so nice about pickleball is that it’s one of the few sports that non-athletic people can pick up and play at any age. You can’t easily play soccer, football, basketball, or baseball when you’re 65!”
One of the advantages of pickleball over tennis for older or less athletic players is that it requires less running, since the court is about one-third the size of a tennis court.
As with any sport, learning the mechanics of the game will lead to better performance and less risk of injury. When it comes to safety on the court, Coach Ritacco stresses the importance of stretching and warming up before playing, as well as staying on your feet. “Staying on your feet sounds simple, but so many people, especially athletic people who haven’t done anything in 40 years, start playing a game and think they’re 25 again. They go for balls that may be out of their reach. And of course, what happens is they lose their balance. Balance is number one.”
Traveling backward is also a no-no, he says. “If you can move on an angle by taking some shuffle side steps and still reach the ball, you can hit an overhead. Or you can turn and make a question mark around the ball, let it bounce, hit it back, and then move forward again. If you can’t get to the ball, you’re only giving up a point. You don’t want to have a life-changing injury.”
Before undertaking a sport like pickleball, Dr. Harmat recommends consulting your primary care provider to assess your risk of injury. “Make sure that all your systems are a go—your bones, heart, lungs, and everything else—to be able to tolerate this new activity,” he says. “Discuss whether your medications, such as blood thinners, predispose you to more serious injury. Women aged 65 and older, and postmenopausal women under 65 who have one or more risk factors for osteoporosis, should have routine bone density screenings.”
Harmat also cites the benefits of maintaining strong core muscles, pre-activity stretching, and topical rubs or heating pads to induce blood flow to muscles, followed by post-activity cool-downs with ice and adequate rest. “Don’t go home after playing and start another strenuous activity. If you have pain, be kind to your body and rest. Try something different on your days off from pickleball to avoid using the same muscle groups and incurring a repetitive injury.”
If pain persists more than several days despite the standard RICE (rest, ice, compression, and elevation) approach, visit your primary care provider or orthopedic specialist. “We will always maximize conservative approaches to treatment such as therapy, injections, ultrasound, and other modalities before considering surgery,” says Harmat.
For traumatic injuries on the court, visit an urgent care clinic, emergency department, or orthopedic express care facility (such as Ortho Express Care at Indian River Hospital Rosner Family Health & Wellness Center or Vero Orthopaedics Urgent Care) for immediate intervention.
Pickleball players of all ages readily admit that the game’s physical, emotional, and social benefits outweigh the risk of injury. One study showed that pickleball players over age 50 spend more than 70 percent of their playing time in a moderate to vigorous heart rate zone. Regular pickleball play has also been shown to improve muscle strength, balance, coordination, brain health, sleep, mental health, and social connections. “We’ve met some really wonderful people through pickleball, and it’s really enhanced our retirement,” says Pat Ritacco.
Michelle Sechen happily admits that the social connections she’d made through pickleball were instrumental in getting her back in the game less than two months after her surgery. “My pickleball friends started calling and texting. I was a little reluctant, but once I started playing, my confidence returned.”
She also acknowledges that getting injured taught her a humbling but valuable lesson. “I learned to say ‘Great shot!’”
Reduce Your Risk of Injury on the Pickleball Court
- Know your risk for fractures (Women: get a bone density screening)
- Consult your physician to evaluate your overall health before picking up a paddle
- Learn the mechanics of the game
- Stretch
- Warm up on the court before playing
- Wear proper footwear
- Wear protective eyewear
- Consider wrist guards, if you’re prone to fractures
- Stay hydrated
- Don’t move backward
- Don’t overreach for a ball
- Stay balanced
- Don’t overdo it
- Learn to say “Great shot”
True Tails is a series written by Amy Robinson for Vero Beach’s dog lovers. Ask Amy about your dog’s behavior by clicking below.
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