Pickleball – Know the Risks Before You Play

Pickleball has certainly become a thing. It’s the perfect blend of fun, movement, and social engagement, especially in retirement communities like where I live. One player captured the appeal succinctly in a Reddit thread: “It’s a dopamine fountain.” That sense of joy and instant reward may help explain why the sport has grown faster than any other in the United States for four straight years, according to the Sports and Fitness Industry Association’s 2025 report. Today, more than 20 million Americans play pickleball, with participation more than tripling in just a few years.

But as participation has exploded, a consistent theme has emerged: injuries are climbing just as fast, especially among older players. Several recent studies summarized in JAMA paint a clear picture: while the sport remains accessible, welcoming, and health-promoting, its rapid growth has outpaced player preparedness and formalized safety standards.

A newly published cross-sectional study in JAMA Ophthalmology analyzed pickleball-related injuries using national emergency department data from 2005–2024. After filtering cases for eye involvement, the researchers uncovered trends that surprised even seasoned clinicians. Eye injuries were first recorded in 2014, but since then more than 70 cases have been documented. When weighted, this represents an estimated 3,122 eye injuries nationwide, with a striking 88% occurring between 2022 and 2024 alone. In 2024, the estimate reached 1,262 cases, leading the researchers to describe the trend as “alarming.”

More than 70% of these cases involved players over age 50. While one might expect falls to dominate injury mechanisms in this age group, the authors found otherwise. “Direct ball injuries were the most common,” said study coauthor Corey R. Lacher, MD. The average age for players struck in the eye was 53.

The spectrum of injuries was broad. Many were minor, including cuts, bruises, and corneal abrasions. But a meaningful proportion carried significant risks, including retinal detachments, bleeding into the eye, and fractures of the orbital bones. Even posterior vitreous detachment, which accounted for 2% of the injuries, can predispose players to retinal tears. “Tears in the retina can lead to especially visually threatening pathology such as retinal detachment,” Lacher noted.

The ophthalmology findings match a broader pattern observed in orthopedic and sports-medicine literature. “Pretty much any injury that you look at with pickleball, you’re going to see a rise,” said Eric N. Bowman, MD, MPH, who coauthored a 2025 study examining injury patterns at Vanderbilt University Medical Center. Between 2017 and 2022, player numbers tripled, but injuries increased sevenfold.

Younger players (under age 60) tend to experience sprains, strains, and soft-tissue inflammation. But the picture changes dramatically after age 60, when fractures, joint dislocations, and traumatic falls become far more common. Fractured ankles, wrists, and hips in this age group often require more invasive treatment and significantly longer recovery periods.

One large survey published in the Journal of the American Academy of Orthopaedic Surgeons found that 55% of injuries were soft-tissue damage, while 37% were fractures or joint dislocations. Women, particularly postmenopausal women, were significantly more prone to fractures, particularly of the wrist.

What partly explains these injuries is structural: millions of new players have entered the game. But the causes run deeper. The researchers cited several key contributors:

1. Age-related vulnerability.

Collagen quality declines with age, making tendons and ligaments more injury-prone. Muscle mass wanes, slowing reaction time, particularly relevant for eye injuries. Postmenopausal women face additional challenges due to decreased bone density.

2. Underestimating the sport.

Pickleball appears simple until the demands of quick direction changes, lunges, twisting motions, and lateral movements come into play. Many players, especially older ones, step onto the court without conditioning or coaching. “Most people just jump in without much consideration for form, technique, and the types of movement that are necessary,” Bowman said.

3. Court conditions and gameplay speed.

The sport is played fast, in a confined space, with players rushing the net as they advance. Poorly maintained courts with cracks and uneven surfaces compound fall risks. Acrylic or rubber surfaces tend to be more joint-friendly than unforgiving concrete.

The researchers behind these studies share a common goal: raising awareness. Understanding the main causes of injury, including falls, ball strikes, and paddle impacts allows players to adjust their behavior and equipment choices.

Eye protection is a priority. There is currently no certified USA Pickleball Association standard for protective eyewear, but experts urge the organization to create one. Until then, shatterproof polycarbonate lenses are the safest option.

Proper shoes with lateral support, wrist and knee braces when needed, and attention to court quality all play meaningful roles in prevention. For older players, a pre-participation physical exam to evaluate bone density, balance, muscle strength, and cardiovascular endurance is strongly advised. Working with a trainer or physical therapist can help identify deficits in coordination, range of motion, or form before injuries occur. And for new players of any age, taking a class or joining a clinic improves technique and reduces risk.

Based on the data presented in JAMA, here are evidence-supported ways to stay safe:

1. Protect Your Eyes

• Wear shatterproof polycarbonate eyewear during every match.
• Advocate for standardized protective gear within your local clubs.

2. Strengthen Before You Play

• Focus on leg strength, balance, and core stability to prevent falls.
• Include plyometrics, agility drills, and reaction-time exercises, if appropriate for your age and fitness level.

3. Choose the Right Shoes

• Lateral-support court shoes are essential; running shoes increase injury risk.

4. Evaluate Your Court

• Avoid surfaces with cracks, uneven spots, or debris.
• Whenever possible, choose courts with acrylic or rubberized surfaces.

5. Build Skills Slowly

• Take an introductory class.
• Learn proper footwork, positioning, and paddle control to reduce reckless movements.

6. For Adults Over 50, Get Checked First

• Ask your clinician for a bone-density evaluation, balance assessment, and general cardiovascular clearance.
• Consider a session with a physical therapist or trainer to screen for flexibility or strength limitations.

Let me conclude by explaining that while I absolutely loved the sport, I have hung up my paddle. First, a backhand overhead kill shot did my shoulder in a year ago. I resumed playing just a few weeks ago and committed the cardinal sin of running backward to return a lob shot. Yes, I fell. But fortunately, I didn’t hit my head. One of the hardest things I have had to accept over the years is that I am not invincible. So, better part of valor, I will watch from the sidelines while the rest of you enjoy (safely) this exciting sport.