Pickleball exercises: a warm-up, strength and balance for older players, and avoiding falls, Achilles and eye injuries

Real exercise

In players aged about 62, over 70% of playing time was moderate to vigorous by heart rate. In one small trial, 8 weeks of pickleball improved balance and walking speed in women aged 60 to 75.

Sources 1, 2

Injuries cluster in older players

Over 85% of pickleball injuries treated in US emergency departments from 2010 to 2019 were in players aged 60 or over, and falls caused about two-thirds of injuries.

Sources 3, 4

Falls and broken wrists

Fractures are among the commonest diagnoses, mostly after falls and mostly in the arm. Among injured players aged 60 and over, women had about 9 times men's odds of a broken wrist.

Sources 3, 5

Achilles ruptures in new, older players

In a large US surgical series, players who ruptured an Achilles playing pickleball had a median age of 60, against 45 in tennis. In one small series of 28 players, about two-thirds of ruptures came in the first month of playing.

Sources 6, 7

Protect your eyes

Eye injuries are rising. Eyewear made to the racket-sport standard, which now includes pickleball, is the protection to choose; lensless frames failed in other racket sports.

Sources 8, 9, 10

Strength and balance prevent falls

In older adults, exercise cut falls by about a quarter, and guidelines suggest 3 sessions a week for at least 12 weeks. It hasn't been tested in pickleball players, and no pickleball warm-up has been tested either.

Sources 11, 12

How hard it is

In 53 recreational players aged about 62, heart rate averaged about 70% of predicted maximum in singles and doubles, and over 70% of playing time was moderate to vigorous by heart rate. By movement sensors, singles was moderate for 80.5% of the time and doubles for 50.4%. Singles meant about 3,300 steps an hour and doubles about 2,800. The Compendium of Physical Activities has no pickleball entry; casual paddleball is 6.0 metabolic equivalents (METs).

Sources 1, 13

The main movements

Short lunges and quick steps forwards and sideways, dinks and volleys close to the net, reaching for low balls, overheads, and backing up for lobs. The court is about half the size of a tennis court, and the American Academy of Ophthalmology (AAO) notes a served ball can travel at up to 40 miles per hour, reaching the other player in under half a second.

Source 14

Where the load falls

The sites the studies point to:

• Balance and bones: falls caused about two-thirds of emergency visits, and fractures about a third.
• The Achilles and calf, when lunging and pushing off.
• The shoulder (rotator cuff) and the forearm tendons (tennis elbow), the commonest upper-body problems in clinic series.
• The eyes, from balls, paddles and falls.

Sources 4, 5, 15, 16, 17, 8

Who plays (our reading)

A sport that suits beginners and older adults, many of whom start from low activity levels. That's why building up gradually, and strength and balance work, matter.

Sources 18, 14

What to train (our reading)

Balance and quick footwork, leg strength to lunge and recover, calf and Achilles strength, shoulder and forearm endurance for the paddle, and the confidence to move without falling.

Rising, and mostly in older playersStrong evidence

Pickleball injuries treated in US emergency departments have risen year on year. One analysis estimated 66,350 from 2013 to 2022, with an average age of 64; estimates vary between studies. Younger players' injuries are rising faster, often strains and sprains from sudden stops and lunges.

Sources 4, 3, 19

Falls and fracturesStrong evidence

Falls, including slips, trips and dives, caused about two-thirds of injuries, and fractures were about a third of diagnoses. Among injured players aged 60 and over, women had 3.7 times men's odds of a fracture and 9.3 times the odds of a broken wrist. Across all ages, 69% of pickleball fractures were in women and 92% followed a fall. Our broken wrist guide covers recovery, and advises anyone 50 or over who broke a wrist in a fall to ask about a bone health check.

Sources 4, 3, 5

Achilles rupturesEmerging evidence

In a US surgical series of 1,028 Achilles repairs, the 40 pickleball players had a median age of 60, against 45 for the 46 tennis players and 37 for other sports, and 82.5% were over 50. Achilles rupture was the commonest pickleball diagnosis at one foot and ankle clinic, where lunging forwards and planting the foot were the commonest ways players got hurt. In one small series of 28 players, about two-thirds of ruptures came in the first month of playing. Our Achilles rupture guide covers what to do.

Sources 6, 15, 7

Shoulders, elbows and kneesEmerging evidence

In clinic series, the rotator cuff was the commonest injury site at one institution (11% of injuries); at another, tennis elbow made up 75% of elbow cases, rotator cuff tears 70% of shoulder cases and meniscus tears 48% of knee cases. Our tennis elbow, rotator cuff and knee guides cover them.

Sources 16, 17

Eye injuriesEmerging evidence

Eye injuries reaching US emergency departments are rising, more in players over 50: one analysis estimated 1,262 in 2024, though estimates vary between studies. Severe ones include retinal detachments and broken eye sockets, from the ball, the paddle and falls; most are minor.

Sources 8, 20

Heart eventsEmerging evidence

In players aged 60 and over, 11.1% of emergency cases linked with pickleball weren't injuries but mostly heart problems (21.5% in tennis), and in another analysis, chest pain during play was 16.2% of cases in that age group.

Sources 3, 21

Men and womenEmerging evidence

Overall the split is close to even, 51% men in one analysis. Injured men more often had strains and sprains, and injured women fractures.

Sources 22, 3

Nothing has been tested in pickleball yetMixed evidence

No pickleball warm-up or injury prevention programme has been tested in a trial. A 2026 review recommends dynamic warm-ups, balance training, footwear advice and court checks, but these are expert suggestions. The one trial of a tennis warm-up programme, delivered by app, found no effect, as our tennis and padel page explains.

Source 23

Strength and balance training prevents falls in older adultsStrong evidence

In 108 trials of 23,407 people living at home, average age 76, exercise cut the rate of falls by 23%; balance and functional exercise by 24%; and programmes mixing several types, usually balance and functional exercise with strength work, probably by 34%. Fractures from falls may be fewer too, on low-certainty evidence. In an earlier analysis, programmes that challenged balance and added up to more than 3 hours a week cut falls by 39%.

The World Falls Guidelines recommend balance-challenging, functional exercise, such as sit-to-stands and stepping, 3 or more times a week, made harder over at least 12 weeks and kept up. The UK's National Health Service (NHS) asks over-65s for strength, balance and flexibility work on at least 2 days a week, and its balance routine gives starting doses. None of this has been tested in pickleball players: it's borrowed from older adults generally, and the strength and balance workout on this page is built on it.

Sources 11, 24, 12, 25, 26

Build up graduallyEmerging evidence

In one small series of 28 players, about two-thirds of pickleball Achilles ruptures came in the first month of playing, and Achilles rupture was the commonest foot and ankle diagnosis at another clinic, where lunging forwards and planting the foot were the commonest ways players got hurt. Our Achilles rupture guide lists starting a new sport or building up too fast as a risk.

Our suggestion: in your first month, keep sessions short, such as 30 to 60 minutes of doubles 2 or 3 times a week, warm up first, and strengthen your calves on other days.

Sources 7, 15

Check your heart firstStrong evidence

Mostly heart-related emergencies were 11.1% of pickleball emergency cases in players aged 60 and over, and across racket and paddle sports, visits for medical events led to hospital admission about 11 times as often as other visits. The PAR-Q+ (Physical Activity Readiness Questionnaire for Everyone) flags who should see a GP or exercise professional first.

Sources 27, 3, 28

Bones after a fallStrong evidence

Most pickleball fractures are arm and wrist fractures from falls, mostly in women and in players over 60. Our broken wrist guide advises anyone 50 or over who broke a wrist in a fall to ask about a bone health check and a falls assessment, and our osteoporosis guide covers strength and impact work.

Sources 5, 3

Stretching to prevent Achilles rupturesMixed evidence

We found no evidence. Ruptures cluster in new players, which points to building up gradually instead.

Source 7

Elbow straps

Untested as prevention in pickleball. Our tennis elbow guide says straps can ease pain while you wear them, with no proven long-term benefit.

Pickleball counts as exerciseEmerging evidence

Singles and doubles were moderate to vigorous by heart rate for over 70% of playing time in players aged about 62, so play counts towards the NHS's 150 minutes of moderate activity a week.

Sources 1, 29, 25

Strength and balance for older playersStrong evidence

The NHS asks over-65s for strength, balance and flexibility work on at least 2 days a week, and falls prevention trials favour balance-challenging, functional exercise 3 or more times a week with strength added. In one small trial, 8 weeks of supervised pickleball 3 times a week improved balance by about 28% and walking speed by 13% in 36 women aged 60 to 75.

Sources 25, 12, 11, 2

Calves and Achilles (our suggestion)

No trial in pickleball. Because ruptures cluster in new, older players, build calf strength with slow calf raises, then single-leg raises from a step, for a few weeks before and during your first months of play, alongside a gradual build-up of court time.

Sources 6, 7

Shoulders and forearms (our suggestion)

Rotator cuff problems and tennis elbow lead the clinic series, so the band and forearm work in the strength and balance workout, our shoulder mobility and stability routine, and our tennis elbow guide's loading are worth adding when you need them.

Sources 16, 17

Footwork (our suggestion)

No pickleball trials. Practise short side-steps, a small split step (a little hop onto both feet as your opponent hits), and moving sideways rather than backwards for lobs, slowly at first.

Wellbeing: an associationEmerging evidence

Players report better wellbeing and life satisfaction and lower depression scores, mostly in cross-sectional studies of over-50s. That's an association, not proof that pickleball causes it.

Sources 30, 31

Fitting it in (our suggestion)

Strength and balance work 2 to 3 times a week, on days you don't play or after a short session; short doubles sessions 2 or 3 times a week in your first month; and at least one day off a week, as our rest days guide suggests.

Sources 25, 12

Which eyewearEmerging evidence

Across racket sports, a median 93% of eye injuries happened without eyewear, lensless eye guards failed in squash and racquetball because the ball squeezed through them, and only eyewear meeting updated standards went with no injuries. Since December 2024, the racket-sport eye protector standard from the standards body ASTM International (F3164) includes tests for pickleball eyewear. The AAO recommends polycarbonate safety goggles with front and side coverage; pickleball doesn't require eyewear at any level.

Sources 9, 10, 14

Everyday glasses aren't protectionEmerging evidence

The AAO's general sports advice is that regular glasses don't protect and can make an injury worse if they shatter. Its pickleball page says even sunglasses or regular glasses are better than nothing; we'd choose eyewear made to the standard (our reading).

Sources 32, 14, 9

Who is most at riskEmerging evidence

Doubles players at the net, players over 50 and, the AAO says, people who are short-sighted or have had eye surgery, for whom an injury can be more serious.

Sources 14, 8

Similar injuries, older playersEmerging evidence

In players aged 60 and over, pickleball and tennis injuries in US emergency departments were mostly similar, and pickleball's numbers caught up with tennis's by 2018. Pickleball injuries led to hospital admission about 2.6 times as often as those in other racket sports, and its Achilles ruptures came about 15 years later in life than tennis ruptures, probably because its players are older (our reading).

Sources 3, 28, 6

A smaller court isn't automatically saferEmerging evidence

No link between court size and injury rate has been found, and the ball can still reach your eye in under half a second.

Sources 33, 14

Shared advice

Tennis elbow and rotator cuff problems lead the clinic series, so the elbow and shoulder advice on our tennis and padel page applies, its eye advice for padel and squash carries over, and its racket sport warm-up and injury prevention routine suit pickleball players too.

Everyone: seven questions

The PAR-Q+ (Physical Activity Readiness Questionnaire for Everyone) asks about a heart condition or high blood pressure, chest pain, dizziness or losing consciousness, other long-term conditions and their medicines, a bone or joint problem that activity could make worse, and being told to exercise only under supervision. If you answer yes to any, check with your GP or a qualified exercise professional first. If you're over 45 and not used to hard exercise, ask a qualified exercise professional before the hardest sessions, and delay if you're ill.

Source 27

Heart disease, chest pain or dizziness

Heart-related problems were a notable share of emergency cases in players 60 and over. Use the PAR-Q+ and see your GP first if it flags anything; start with doubles and short sessions (our suggestion). Our heart disease guide has more.

Sources 27, 3, 21

A fall in the past year, or worried about your balance

The NHS advises seeing a GP if you've had a fall or are worried about your balance, and falls services offer strength and balance training. Start with the strength and balance workout, and try our timed up and go and balance tests.

Sources 34, 4

Osteoporosis, or a broken bone from a minor fall

Pickleball fractures cluster in women and in players over 60, mostly in the wrist and arm, after falls. See our osteoporosis and broken wrist guides; a bone health check is worth asking about after a broken bone from a fall at 50 or over.

Source 5

New to the sport, or past Achilles or calf problems

Keep sessions short for the first month, warm up, and strengthen your calves (our suggestion). Our Achilles guides cover the warning signs.

Sources 6, 7

After a hip or knee replacement

Our replacement guides suggest gentle or doubles tennis from about 3 to 6 months. Ask your surgical team, and treat pickleball doubles as a similar step (our reading).

Short-sighted, or after eye surgery

The AAO says an eye injury can be more serious for you. Wear eyewear made to the racket-sport standard.

Source 14

Pregnant

The NHS advises avoiding sports where there's a risk of falling. Talk to your midwife or GP; gentle dinking practice may suit (our suggestion).

Sources 35, 27

Chest pain: call 999

The NHS says to call 999 if:

• You get sudden pain or discomfort in your chest that doesn't go away; it can feel like squeezing or pressure, burning or indigestion.
• The pain spreads to your left or right arm, or your neck, jaw, stomach or back.
• You have chest pain and feel sweaty, sick, light-headed or short of breath.

Source 36

Fainting: call 999

Call 999 if someone faints while exercising, or faints and can't be woken within a minute, has chest pain or a pounding, fluttering or irregular heartbeat, or has a fit. See a GP after any faint.

Source 37

After a fall

Call 999 if you or someone else has fallen and may have injured the head, neck, back or hip, or can't get up. Get help from NHS 111 if they may be in pain, injured or unwell, and see a GP after a fall or if you're worried about your balance.

Source 34

A wrist or arm injury

Go to A&E (accident and emergency) or call 999 if the arm or wrist is numb or tingling, a bone is sticking out, there's a bad cut that's bleeding heavily, or it has changed colour or shape or is at an odd angle. Get help from NHS 111 if it's very painful, you can't use it, or there's a lot of swelling or bruising.

Source 38

A head injury

Call 999 if someone hit their head and was knocked out and hasn't woken, can't stay awake, has a fit, fell from more than 1 metre or 5 stairs, has problems with their vision or hearing, has new numbness or weakness, or has problems walking, balancing, understanding, speaking or writing. Get help from NHS 111 if they're being sick, feel dizzy or take medicine that thins the blood. With suspected concussion, stop playing: if in doubt, sit them out.

Sources 39, 40

An eye hit by the ball or paddle

Go to A&E or call 999 if something hit your eye at high speed, your sight has changed, you have severe pain in the eye, a headache or sensitivity to light, you feel or are sick, you can't move your eye or keep it open, or blood or pus is coming from it. The AAO advises seeing an eye doctor straight away for any change or loss of vision, or for a lot of pain, bleeding or bruising.

Sources 41, 14

A snap at the back of the ankle

Contact NHS 111 if you heard a snap or popping noise, can't walk on tiptoe or up stairs, or have swelling and bruising in your calf and ankle. Our Achilles rupture guide says to get it checked the same day.

Source 42

Heat

Heat exhaustion should improve within 30 minutes of resting somewhere cool, cooling down and drinking. Call 999 if it doesn't, or for a very high temperature, hot skin that isn't sweating, a fast heartbeat, fast breathing, confusion, a fit or loss of consciousness.

Source 43

"Pickleball is too gentle to count as exercise"Emerging evidence

Over 70% of playing time was moderate to vigorous by heart rate in players aged about 62.

Source 1

"It's safe because it's slow"Emerging evidence

Falls, fractures and Achilles ruptures fill the injury data, and pickleball injuries led to hospital admission about 2.6 times as often as those in other racket sports.

Sources 4, 5, 6, 28

"There are no overheads, so shoulders are fine"Emerging evidence

Overheads are part of the game, and rotator cuff problems were the commonest injury site at one clinic and 70% of shoulder cases at another.

Sources 16, 17

"Lensless eye guards, or everyday glasses, are enough"Emerging evidence

Lensless guards failed in squash and racquetball, and everyday glasses can make injuries worse. Eyewear made to the racket-sport standard, which now includes pickleball, is the one to choose.

Sources 9, 32, 10

"A good stretch prevents Achilles ruptures"Mixed evidence

There's no evidence. Most ruptures in one small series came in the first month of play, which points to building up gradually.

Source 7

"Falls are just bad luck"Strong evidence

Strength and balance training cuts falls in older people by about a quarter. It hasn't been tested in pickleball players specifically.

Source 11

"Pickleball injuries are mostly in men"Emerging evidence

Overall the split is close to even, and among injured players over 60, women were far more likely to break a bone, especially a wrist.

Sources 22, 3, 5