As pickleball's popularity soars, so do injuries

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Anna Leigh Waters was the No. 1 women's singles player in the country when she competed in a PPA Tour event in 2023. Many older amateurs have turn to the sport to stay fit, but experts say bone fractures related to the sport have increased 90-fold over the last 20 years. File Photo courtesy of Professional Pickleball Association

Pickleball has become the darling of older folks trying to stay in shape, but new research shows that with that popularity has come a surge in serious injuries.

Bone fractures related to pickleball have increased 90-fold over the last 20 years, with most injuries occurring in adults ages 60 to 69, finds a new analysis presented this week at the annual meeting of the American Academy of Orthopaedic Surgeons in San Francisco.

"Despite its reputation as a low-impact sport, pickleball can pose serious risk for players, especially if they have weaker bones from osteoporosis," researcher Dr. Kurt Spindler, an orthopaedic surgeon at Cleveland Clinic in Florida, said in a meeting news release. "It's important to understand your risk profile of injury and to speak with your physician to see how you can lower your risk."

Pickleball, which resembles its cousin tennis, is played with a perforated plastic ball and wooden paddles on a badminton-sized court. It is the fastest growing sport in the country, with the number of players rising from 4.8 million in 2021 to 8.9 million in 2023, according to USA Pickleball.

Importantly, the new analysis only looked at fractures, not some of the most common injuries like sprained ankles or damage to the anterior cruciate ligament (ACL). Other common pickleball injuries include rotator cuff injuries, worsening of arthritis and Achilles tendon tears/strains, NBC News reported.

What caused most of the fractures seen in the study? Ninety-two percent occurred during falls, researchers report.

"While pickleball is a great sport, nothing is without risk," study lead author Yasmine Ghattas, a student at the University of Central Florida's College of Medicine in Orlando, told NBC News.

The researchers don't think folks should put down their paddles, but they should be better prepared before they play.

"Well-informed participation in any activity is key," Ghattas said.

In the study, researchers turned to the Consumer Product Safety Commission's National Electronic Injury Surveillance System, which includes a representative sample of injuries gathered from 100 U.S. emergency departments.

Ghattas and her colleagues found descriptions of 377 pickleball-related fractures in the database between 2002 and 2022. When extrapolated to the entire U.S. population, that translated into roughly 5,400 pickleball-related fractures annually, NBC News reported.

Women, especially those 65 and older, were more likely than men to break a bone. Most occurred in the forearms and hands. The researchers suspect they were related to osteoporosis or other bone-thinning conditions.

Even though women had more fractures overall, men were 2.3 times more likely to be admitted to the hospital after breaking a bone, the research found. Ghattas and her colleagues suspect that's because men's fractures tended to be in bones of the lower body, which are more likely to lead to a hospital stay.

While the rise in injuries may mostly be tied to the growth of the sport, other factors may be coming into play, Dr. Eric Bowman, an assistant professor of orthopedic surgery at Vanderbilt University Medical Center, told NBC News.

"It's not enough to just pick up a paddle and get out there," he said. "As with any sport, you have to learn the mechanics and the form that leads to better performance and injury prevention. Some people may not have learned enough, or be physically prepared in advance."

While pickleball might help your heart, the study shows that people need to be careful about how they start, Dr. Spencer Stein, an assistant professor of orthopedic surgery in the division of sports medicine at NYU Langone Health in New York City, told NBC News.

"You want to be careful any time you enter a new sport," Stein said. "You should get checked by your primary care doctor and get screened for osteoporosis or thinning bones."

It's also important that you warm up before playing and choose the right shoes for the sport, Stein said.

Last but not least, you should learn to fall in a way that's unlikely to lead to injury, he said. "If you fall more towards your side, you can protect your head but not putting your wrists at risk," he noted.

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