Staying safe playing this fast-growing sport

The fastest growing sport in America could, shall we say, land you in a pickle.

Pickleball, a racquet sport played on a court about a third the size of a tennis court, has soared in popularity in the last few years, with participation jumping 21 percent from 2019 to 2020, according to the Sports & Fitness Industry Association. There are dozens of courts around the Cape, and the sport is particularly popular among older athletes. But, like any racquet sport, pickleball can lead to injuries.

“In the injuries I see among people who are over 65, I would say 10 or 15 percent come from some level of pickleball,” said James Boyle, MD, an orthopedic surgeon with Cape Cod Orthopaedics & Sports Medicine in Hyannis. “It can affect so many different parts of the foot and ankle because of the technique. It’s a huge pivoting and starting and stopping sport, just like tennis.”

Pickleball can be played indoors or out and is easy to learn. It’s become popular even among Hollywood stars like Leonardo DeCaprio and George Clooney, according to Vanity Fair. Players use a composite paddle similar to an oversized ping-pong paddle. The plastic ball is about three inches in diameter and perforated like a Wiffle Ball. Pickleball is usually played as a doubles match; the winners being the first team to score 11 points by at least a 2-point margin.

Pickleball was created by three men in Washington state more than 50 years ago; one version of its history claims it’s named after one inventor’s dog who liked to chase the ball. There were 4.2 million players in the United States in 2020, according to the Sports and Fitness Industry Association, and the majority of those who play regularly are over 55. Injuries tend to mimic tennis and other racquet sports and, besides foot and ankle, could include falls or shoulder strains, according to a 2019 report published in Missouri Medicine, the journal of that state’s medical organization.

One of the more severe injuries could be a ruptured Achilles tendon, Dr. Boyle said. It can knock a player out of the game for at least 16 weeks following surgery.

“If you rupture your Achilles – or you’re even concerned that you ruptured or partially tore it – you want to get to the emergency room right away,” he said. “You want to get it fixed within three to four days at most because it can retract. It’s a relatively small incision, although it depends on the level of the tear. Stitches are put in both ends of the tendons and these are used to bring the ends of the torn tendon directly together so they can heal back to one another.” Sometimes, surgeons use a graft from a cadaver to reinforce the tendon repair, he said.

Other typical pickleball injuries include sprained ankles and forefoot overload injuries. And, conditions such as plantar fasciitis, tendinosis, arthritis, flat feet, bunions and hammertoes can be exacerbated by court sports, Dr. Boyle said. So, some should ask their doctor about seeing a specialist for evaluation before playing pickleball. For those without existing conditions, it is still a good idea to check with a doctor before your start or if you have any pain while playing.

How else can you prevent pickleball injuries? Dr. Boyle has several suggestions:

• Wear the right shoes. Consider a shoe that has a leather upper for good support and a broad sole, so your foot and ankle won’t twist when you stop quickly. If you have weak ankles, consider wearing elastic supports like you can find at the pharmacy.
• Consider physical therapy to treat earlier injuries and build strength before you start playing pickleball. “It’s a great way to make sure that your foot and ankle are in balance and you’re not over compensating or overusing one section to protect another.”
• Try plyometric exercises, which include lunges, pushups, throwing, running, jumping, and kicking, to build the microstructure of the tendons and muscle. “The best example of a good plyometric exercise is a standing lunge. You don’t have to go into a full-out 90-degree flex at the knee with the forward leg where you’re in a deep squat, but just lunge and lean and then come back into an upright position and switch legs,” Dr. Boyle said. “See a licensed physical therapist or athletic trainer to learn plyometric exercises which you can continue on your own and use to warm up each time you play.”
• Build up your cardio. “You don’t want to go out there if you haven’t at least trained yourself to walk a mile or two without shortness of breath or even chest pain. Of course, if this occurs, you should contact your primary care doctor,” Dr. Boyle said. He suggests using an exercise bike in the off-season or walking indoors at a track like the one at the Hyannis Youth and Community Center.
• Build your core strength. Core strength helps with balance and prevents falls, he said. “It’s a rare instance where someone trips and falls but that gets back to good leg strength, quadriceps strength and core strength, too.”
• Stretch before you play. “Pickleball is a really good way to find a base level of good cardiovascular and musculoskeletal health and to maintain it. But …you have to warm up a little bit before you do it,” Dr. Boyle said. “And you really have to be careful about jumping into this and being a ‘weekend warrior’ where you do nothing in between.”