Who plays, and who gets hurtStrong evidence
Pickleball's injuries follow its players. In US emergency departments from 2013 to 2022, an estimated 66,350 pickleball injuries were treated, at an average age of 64, and falls caused 65.5% of them; in another analysis over 85% of injured players were 60 or over, and slips, trips, falls and dives caused 63.3%. Estimated emergency injuries rose 91% from 2020 to 2022. Fractures, mostly of the wrist and arm after a fall in women over 60, and strains and sprains, often of the calf or Achilles in men, lead the lists.
It is a real sport with real injuries: pickleball injuries led to a hospital admission about 2.6 times as often as other racket and paddle sports, older players' pickleball and tennis injuries look much the same, and a review found nothing to show that the smaller court makes it safer.
Sources 1, 2, 3, 4, 5, 6
How often it is the knee depends on who is countingEmerging evidence
In a self-selected online survey of 1,758 US players who play at least monthly (average age 62.7), 29.1% reported a knee injury in the past year, more than for any other area, and overuse injuries led their most serious problems (35.3%). At a 2024 South Korean tournament, the knee was the commonest site (23.3%) of injuries in 232 players, 78% of them overuse. Both are surveys of players who chose to answer, recalling a year. In US emergency departments the knee was 7% of pickleball injuries; another national analysis gives 10.9% in its summary, but its own table gives the knee about 6%. No study has counted knee injuries per hour of play.
Clinics see a different slice. At one US academic orthopaedic and rehabilitation clinic, the knee was the largest group, 52 of 164 pickleball patients, rising from 6 in 2019 to 20 in 2023; in one health system's records, knee sprains were 6.09% and meniscus tears 5.30% of 618 diagnoses, and players over 60 had more fractures and arthritis-related pain.
Sources 7, 8, 1, 9, 10, 11
What the knee injuries areEmerging evidence
At that single clinic, meniscus tears made up 67% of the 52 knee injuries, mostly of the inner meniscus (48% of knee injuries). The clinic's pickleball patients averaged 54 years old, so many were probably tears in a meniscus worn with age (our reading). Then came knee osteoarthritis (15%), arthritis behind the kneecap (8%), kneecap cartilage or tendon pain (8%), and ACL tears and sprains (8% each); 71% were managed without surgery at first. The authors write that meniscus injuries can come from twisting or pivoting while reaching for the ball.
Working-age players have relatively more leg injuries than older players (59.4% against 39.8% of arm and leg injuries), players aged 40 to 59 had twice the odds of a leg injury, and younger players' strains and sprains came more often from sudden stops and lunging. Across 15 studies of adult players, falls were the leading cause of injury, then running or lunging forward and rolling the foot or ankle; at a foot and ankle clinic, running or lunging forward (30.9%) and planting the foot (16.5%) led.
Sources 10, 12, 13, 14, 15, 16
What a game asks of the kneeEmerging evidence
Short, quick steps forwards and sideways, a lunge and a low bend for dinks at the net, sudden stops, pivots on a planted foot, and backing up for lobs. In 53 players aged about 62, over 70% of playing time was moderate to vigorous by heart rate in singles and doubles alike; by movement sensors, singles was moderate for 80.5% of the time and doubles for 50.4%, with about 3,300 and 2,800 steps an hour. That makes doubles the lighter game for a sore knee (our reading).
Source 17
Who gets itEmerging evidence
In the US survey, being a man (odds ratio 1.33), more weekly play (1.45), under 5 years' experience (1.50) and paying little attention to injury prevention (2.02) went with injury, while longer sessions and a higher body mass index didn't significantly raise the odds; in the Korean survey, more weekly hours and higher skill went with lower odds. Surveys like these can't separate cause and effect, so the amount of play that suits a knee is still a matter of trying and watching.
In our reading, a sore knee from pickleball is likeliest in new players playing several long sessions a week from the start, players with knee arthritis or a past knee injury, singles players who lunge and stop hard, and anyone in running shoes or worn shoes on a hard court.
Sources 7, 8, 12, 13
Courts and shoesEmerging evidence
No study has tested court surfaces or shoes in pickleball. In a survey of 3,656 Dutch recreational tennis players (average age 49, and only 18% of those invited answered), injury rates didn't differ between hard court, clay and artificial grass, but players who switched between surfaces had more overuse injuries, and hard courts had more leg overuse injuries. In a lab study of 13 athletes making sharp cuts, a high-grip shoe raised the twisting and sideways loads on the knee with no gain in performance, and in 555 high school American football players, non-contact leg injuries rose from 4.2 to 19.2 per 1,000 games as the shoes' twisting grip rose.
The American Academy of Orthopaedic Surgeons (AAOS) advises shoes designed for pickleball or tennis, for support and grip on the court. In our reading, court shoes with firm sides and a sole made for the surface suit quick sideways steps better than running shoes, without needing the grippiest sole.
Sources 18, 19, 20, 21
When a scan or test mattersStrong evidence
After a fall or a sudden injury, clinicians use the Ottawa knee rule to decide on an X-ray. For a mid-life knee with joint line pain, a magnetic resonance imaging (MRI) scan often finds a meniscus tear whether or not it is the cause: from 19% of women in their 50s to 56% of men aged 70 to 90 had one, many with no knee pain, and a guideline panel says such tears are usually chance findings and unlikely to be the cause of knee pain, aching or stiffness. The National Institute for Health and Care Excellence (NICE) diagnoses knee osteoarthritis from symptoms, without imaging. A scan matters for a knee that is locked, after a pop with fast swelling in a younger player, or when surgery is being considered.
Sources 22, 23, 24, 25
How it usually goesStrong evidence
The NHS says a meniscus tear can get better on its own, but it can take a while. In 140 adults aged 35 to 60 with a worn inner meniscus tear, 12 weeks of supervised exercise did as well as keyhole surgery over 2 years, and 19% of the exercise group later had surgery, with no extra benefit. With arthritis, exercise improves pain and function by modest amounts on average, and NICE warns that joint pain may rise at first when you start exercising. No one can promise a date.
Sources 26, 27, 28, 25
