The Achilles’ Heel of Pickleball: Sharp Rise in Tendon Injuries

As pickleball's popularity grows, Cedars-Sinai orthopedic specialists are seeing an increase in injuries related to the sport.

"We are seeing an epidemic of pickleball Achilles tendon injuries," said Cedars-Sinai orthopedic surgeon Timothy Charlton, MD.

Pickleball is the fastest-growing sport in the United States, especially among older adults, and offers a fun, social way to boost physical activity. With 13.6 million players and a 200% increase in participation over the past three years, pickleball's rapid rise is notable. So is the increase in injuries.

SportsMed.org says injury numbers have increased nearly ninefold in the past decade. In 2023, pickleball injuries in the U.S. accounted for more than $350 million in medical costs.

The Cedars-Sinai Newsroomspoke with Charlton, a foot and anklesurgeon and a United States Professional Tennis Association certified instructor, to discuss common injuries, prevention, and the benefits of playing racket sports.

What type of outdoor sports injuries are you seeing this summer?

We're seeing a significant number of injuries from tennis and pickleball, with pickleball gaining immense popularity in the last five years. In tennis, shoulder injuries are common, while both tennis and pickleball players frequently experience lower extremity injuries, particularly Achilles tendon tears. These injuries have become especially prevalent in pickleball, reaching epidemic proportions and affecting older age groups that typically wouldn't suffer from Achilles tendon injuries. This increase in injuries is largely due to the rapid rise in the number of people playing pickleball, often without adequate preparation or conditioning.

Why are there so many pickleball injuries?

Pickleball is really fun, and I encourage anyone to play it, but it's important to do so in a healthy way. We're seeing many injuries because new athletes are returning to the court after a long time away or are starting to play competitively without proper training. This creates an environment where injuries are more likely to occur. Specifically, we're seeing a significant number of Achilles tendon ruptures in the 60 to 70 age group, often among women. This is a demographic that historically didn't experience such injuries as frequently before the rise of pickleball.

What is an Achilles tendon rupture and how is it treated?

An Achilles tendon rupture is a complete or partial tear of the Achilles tendon, which connects the calf muscles to the heel bone. This injury often occurs during activities that involve sudden, forceful movements, such as jumping or sprinting, which are common in sports like tennis and pickleball.

Treatment for an Achilles tendon rupture can vary depending on factors like the patient's age and activity level. There are two main treatment options. One option is non-operative, involving a cast and functional brace. The other option is surgery. Both approaches aim for the same endpoint: It typically takes about nine months before a patient can return to a basic level of competition.

Recovery can take several months, and the risk of re-rupture or other complications can be reduced by following a rehabilitation plan and avoiding premature return to high-intensity activities.

Why are Achilles ruptures common injuries when playing pickleball?

Achilles tendon ruptures in pickleball often occur due to the movement patterns and body positions typical in the sport. Players frequently move backward and then forward while staying very upright, with their feet aligned in the same direction. This increases the strain on the Achilles tendon. In contrast, professional pickleball and tennis athletes, who rarely experience Achilles tendon ruptures, maintain a low, athletic stance with their feet turned outward, like a duck. To prevent Achilles tendon ruptures, recreational players should adopt this lower, more stable stance with feet positioned outward.

Can an Achilles injury be prevented?

Yes, an Achilles injury can be prevented with proper techniques. The simplest recommendation for preventing an Achilles tendon rupture on the tennis or pickleball court is to adopt a low, athletic stance and position your feet outward, like a duck.

To make this a habit, try touching your racket to the ground. This action naturally lowers your body and helps position your feet outward, reducing the strain on your Achilles tendon and preventing the injury. This stance helps avoid the problematic alignment of your feet with your plane of motion.

What are the advantages of playing racket sports?

Tennis, pickleball, and racket sports in general are wonderful for many reasons. These sports have been proven to extend life and contribute to overall health. If you look at vibrant individuals in their 80s, 90s, and even 100s, many of them play racket sports or swim.

Playing racket sports can help you maintain a healthy lifestyle, provided you practice proper techniques to avoid injuries. Our goal is to keep you on the court, enjoying the sport you love, and out of the doctor's office. By staying injury-free, you can continue to experience the joy and passion these sports bring to your life.

Read more on the Cedars-Sinai Blog: Torn Achilles Tendon FAQ

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