Nancy Freedman loves playing pickleball, despite fracturing her hip during a game in 2017. At the time, she had been playing two or three times a week, so she was in good shape. But she lost her footing on a routine shot, landing on her right hip.

After having surgery to insert a plate and pin, 11 months later she fractured her femur, though not while playing pickleball. Then she had to get that right hip replaced entirely.

No matter. Freedman, 68, is back on the pickleball court.

“It’s a very social game and is easy to pick up beyond a beginner level,” said the Washington Square West resident. “But then after you’ve played a half-dozen times, you see there’s a lot more strategy to the game than just banging the ball back and forth.”

Pickleball is often described as a mash-up of Ping-Pong, badminton, and tennis. More than three million people in the U.S. play, according to the Sports & Fitness Industry Association (SFIA) 2018 Pickleball Participant Report, an increase of 12% over the previous year.

Along with the gain in popularity have come more injuries.

While there’s no database that tracks pickleball injuries specifically, “the conversation has become much more prevalent in my clinic,” said Samir Mehta, chief of the orthopedic trauma and fracture service at Penn Medicine.

“Two years ago, I hadn’t heard of pickleball or taken care of anybody with a pickleball injury," he said. But in the last year, "I’ve taken care of three ankle fractures and one wrist fracture. That’s a relatively dramatic rise.”

Injuries include broken ankles, wrists, and shoulders, injured knee ligaments, and soft tissue injuries such as tennis elbow, golfer’s elbow, rotator cuff tendinitis, and tears. Most of Mehta’s patients who suffer pickleball injuries are over age 55, which coincides with SFIA’s report that 75% of core participants (those who play eight or more times a year) are 55 and older.

“With older people playing, osteopenia and osteoporosis are a large contributor to the injury risk,” he said. “If a 20-year-old had the same injury event, they probably wouldn’t have the same injury.”

Spare pickleballs rest on a table as a group of morning matches play out at the Sporting Club at the Bellevue.
DAVID MAIALETTI / Staff Photographer
Spare pickleballs rest on a table as a group of morning matches play out at the Sporting Club at the Bellevue.

Older people may already have existing problems, such as arthritis, that playing may aggravate, or that may affect agility.

“I would certainly encourage people to play, especially if they like it,” said Marc Harwood, chief of the nonsurgical sports medicine division at Rothman Institute. “The challenge, though, is that it is a higher impact activity and if you’re already dealing with some baseline wear and tear, it’s a setup for a potential injury.”

To try to avoid soft tissue injuries, Harwood encourages players to warm up with gentle movements and stretch before playing. For instance, resistance-exercise bands are useful to stretch calf muscles. If you are sore before exercise, heat is helpful to warm up muscles, and if you get sore afterward, ice can help control inflammation. Mehta also suggests taking the anti-inflammatory medication your doctor recommends, as needed. (Making a habit of taking too much ibuprofen, for instance, can land you in serious gastrointestinal trouble.)

Guy Smith of Queen Village plays pickleball about four times a week and he’s diligent about stretching before each session. Says Smith, 48, who has had lower-back issues for many years and as a bartender spends a lot of time on his feet, “being proactive by doing a lot of core and ab exercises has helped with my back problem.”

He took up the sport about a year ago, enjoying the workout and competition. But in the last two months, he began suffering from plantar fasciitis, an inflammation of a thick band of tissue that connects the heel bone to the toes. “In between my ankle and heel, if I moved in a certain way I would get this shocking, stabbing pain,” he said. A doctor gave him a cortisone shot, but Smith thinks stretching exercises and orthotics have helped him the most.

Guy Smith (left) returns a volley to Harvey Lowenthal as Dawn Govberg watches during a pickleball match.
DAVID MAIALETTI / Staff Photographer
Guy Smith (left) returns a volley to Harvey Lowenthal as Dawn Govberg watches during a pickleball match.

Plantar fasciitis tends to be a chronic condition, but a person who doesn’t get much exercise may not feel the symptoms, said Harwood. “Then you start doing high-impact activity, running, or specific jumping motions that you weren’t doing before, and it can irritate the plantar fascia. People who tend to get that from pickleball may not have been terribly active before. Going from being sedentary to playing a lot of pickleball is a risk factor, so you have to build up the amount of activity that you’re doing.”

Listen to your body, Mehta added. “If you’re starting to fatigue or hurt, it means you need to take a couple weeks off to let it calm down because pushing through it is like driving your car with a tire that’s out of air. The tire is not going to fill up with air all on its own.”

There’s no short-term fix for osteopenia or osteoporosis. “It’s something people should have already been managing because you’re not going to all of a sudden get rid of osteopenia before a big pickleball game,” he said. The good news is that pickleball is an impact sport that will help with bone density.

Mehta also encourages players to wear supportive sneakers, tying their shoelaces tightly with a double knot. Sometimes a brace or sleeve will give extra support, especially if you have a history of ankle or knee problems. Protective eyewear is also important in preventing eye injuries.

Dawn Govberg returns a volley as she plays pickleball at The Sporting Club at the Bellevue in Philadelphia, PA on December 11, 2019.
DAVID MAIALETTI / Staff Photographer
Dawn Govberg returns a volley as she plays pickleball at The Sporting Club at the Bellevue in Philadelphia, PA on December 11, 2019.

When Freedman returned to the game, she started back slowly, playing at a beginner level to regain her confidence. She’s careful to wear proper all-court shoes and stretch before playing.

“I’m still loving the game,” she said, though she is more wary than before. “Unlike in the past, I hold myself back from playing with people much better than me or really hard hitters.”

Yet, Mehta insisted, “You should not change your lifestyle because of what might happen. The beauty of modern medicine is that we can fix things if something bad happens.”