St. George has become one of the pickleball capitals of the American Southwest. With year-round sunshine, a large and active 45-plus population, and more courts popping up every season, it's no surprise the sport has taken over. It's fast, social, low-barrier, and for all those reasons, it's also producing a steady stream of injuries that we see walk through our clinic doors at Fortify Physical Therapy.

Pickleball has one of the highest injury rates of any recreational sport in its age demographic. That's not a reason to stop playing, it's a reason to play smarter. Whether you're nursing a nagging elbow, recovering from a rolled ankle, or just trying to stay healthy through a long season on the courts, this guide is for you.


The Most Common Pickleball Injuries

Here are the injuries we treat most frequently in pickleball players at our St. George clinic, along with what's actually happening in the tissue and why it occurs.

Pickleball Elbow (Lateral Epicondylitis)

Often called "tennis elbow," this is one of the most common upper extremity injuries in pickleball. It involves inflammation and micro-tearing of the tendons that attach the forearm extensors to the lateral epicondyle — the bony bump on the outside of the elbow.

Why pickleball players get it: The dinking game — the soft, controlled shots played at the kitchen line — requires repeated, precise wrist and forearm control. Done hundreds of times per session, this repetitive loading overloads the extensor tendons faster than they can recover. Grip size and paddle weight also play a significant role. Pain is typically sharp on the outside of the elbow and can radiate down the forearm, and it's often worse when gripping, lifting, or extending the wrist.

Knee Pain & Meniscus Irritation

The low, ready stance that pickleball demands — knees bent, weight forward, ready to explode in any direction — places continuous compressive load on the knee joint. Combined with rapid pivoting and direction changes, this makes the knee one of the most commonly injured structures in pickleball.

Why pickleball players get it: Most knee pain in pickleball players traces back to hip and glute weakness. When the glutes don't fire properly during lateral movements, the knee compensates by rotating inward under load — a pattern that stresses the medial meniscus, patellar tendon, and patellofemoral joint. This is why treating knee pain in our clinic almost always includes significant work on hip and glute strength, not just the knee itself.

Calf Strains & Achilles Tendinopathy

Calf strains — often described as feeling like "getting shot in the back of the leg" — are among the most dramatic acute injuries on the pickleball court. Achilles tendinopathy is the slower-building cousin: a gradual onset of stiffness and pain just above the heel that gets worse with activity over time.

Why pickleball players get it: The explosive push-off required to reach a drop shot or sprint to the kitchen line loads the calf-Achilles complex suddenly and at high force. In players who haven't done specific calf and Achilles conditioning, this can exceed tissue capacity in a single moment. Cold morning courts without a proper warm-up are a particularly high-risk scenario in the St. George fall and winter seasons.

Rotator Cuff Strain & Shoulder Impingement

Overhead smashes, serving, and reaching shots all load the rotator cuff — the group of four small muscles that stabilize the shoulder joint. In players with existing rotator cuff weakness or poor shoulder mechanics, this overhead demand can quickly lead to impingement, bursitis, or partial tears.

Why pickleball players get it: Most recreational players have never done rotator cuff-specific strengthening. The muscles that produce the big power movements — the deltoid and pectorals — are typically much stronger than the stabilizing rotator cuff muscles. This imbalance means the humeral head (the ball of the shoulder) isn't held in its optimal position during overhead movements, creating pinching of the bursa and tendons in the subacromial space.

Ankle Sprains

Lateral ankle sprains — rolling the ankle outward — are the most common acute injury in pickleball. They typically occur when a player changes direction quickly, lands awkwardly after a jump, or steps on the court boundary line. What feels like a minor twist can involve significant ligament damage if not assessed properly.

Why pickleball players get it: Beyond the obvious (quick lateral movement), many players return to the court too soon after a first sprain. An ankle that has been sprained once has compromised proprioception — the joint's ability to sense its position in space — which makes re-injury significantly more likely without specific rehabilitation. A proper ankle sprain rehab program addresses both the ligament healing and the neuromuscular retraining that protects against repeat sprains.

Prevention: What You Can Do Right Now

Most pickleball injuries don't happen randomly — they follow predictable patterns that can be interrupted with the right preparation. Here's a practical prevention framework built specifically for recreational pickleball players in the 45-plus age group.

The Essential Pre-Play Warm-Up (10 Minutes)

Static stretching before play does not reduce injury risk and may actually impair performance. Instead, use a dynamic warm-up that prepares the joints and muscles for the specific demands of pickleball.

Leg Swings

Forward/back and side-to-side, 10 reps each leg. Warms up the hip flexors, adductors, and glutes that drive lateral movement.

Lateral Shuffle

2–3 lengths of the court at moderate speed. Activates the hip abductors and prepares the ankle stabilizers for direction changes.

Arm Circles & Thoracic Rotation

10 each direction. Prepares the shoulder and upper back for overhead shots and cross-body reaches.

Calf Raises

15–20 slow reps. Specifically warms the calf-Achilles complex — the most acutely vulnerable structure in older pickleball players.

Dink Rallies

Start your first 5–10 minutes with soft kitchen shots at 60% effort. Let the body ramp up naturally before playing full speed.

Mini Band Walks

If you have a resistance band, lateral band walks activate the glute medius — the single most important muscle for knee and hip protection in lateral sport.


How Physical Therapy Treats Pickleball Injuries

At Fortify Physical Therapy, we treat pickleball injuries with a different philosophy than "rest and see how it feels." Rest alone rarely resolves the underlying movement dysfunction that caused the injury in the first place, which is why so many players return to the court after a few weeks off only to get hurt again.

Our approach combines three tools that work especially well for the kinds of injuries pickleball produces:

Dry Needling is particularly effective for the tendon and muscle injuries common in pickleball. Lateral epicondylitis, calf strains, rotator cuff tendinopathy, and Achilles issues all involve myofascial trigger points and dysfunctional tissue that responds well to targeted dry needling. By inserting a thin needle directly into the affected tissue, we produce a twitch response that releases tension, stimulates local blood flow, and breaks the pain-spasm cycle that keeps these injuries from healing. For pickleball elbow specifically, dry needling to the forearm extensors combined with eccentric loading is one of the most effective conservative treatments available.

The Neubie device excels at identifying and correcting the neuromuscular dysfunction that underlies many pickleball injuries. For knee pain, it helps us identify exactly which portions of the quadriceps and glutes are under-activating, information that dramatically focuses and accelerates the strengthening process. For ankle sprains, the Neubie's direct current waveform supports neuromuscular re-education of the stabilizing muscles, helping restore the proprioceptive feedback that protects against re-injury faster than traditional exercise alone.

Manual therapy is often the fastest path to immediate pain relief and restored mobility. For shoulder impingement, joint mobilization of the glenohumeral and acromioclavicular joints can restore pain-free range of motion in a single session that might otherwise take weeks to recover. For knee and hip dysfunction, mobilization of restricted segments in the lumbar spine and hip joint often produces immediate downstream improvements in how the knee tracks during movement.

Our Goal for Pickleball Players

We don't just want to get you out of pain, we want to get you back on the court playing better than before. That means understanding the specific demands of pickleball, identifying the physical deficits that led to your injury, and building a body that's genuinely more resilient when you return to play.


When to Stop Playing and Get Help

One of the most common patterns we see is a player who manages a nagging injury for weeks or months before finally coming in, and who almost always wishes they'd come sooner. Minor issues that are caught early resolve in a handful of sessions. The same issue left to develop into a chronic problem can take months to fully address.

⚠ Stop playing and get evaluated if you experience: Pain that changes how you move, hit, or position yourself on the court · Swelling in any joint that persists overnight · Sharp or stabbing pain during play (not just post-game soreness) · Elbow, wrist, or shoulder pain that affects everyday activities like lifting or carrying · Any acute injury involving a pop, snap, or sudden sharp pain, especially in the calf or ankle · Symptoms that haven't improved after 1–2 weeks of rest.

If you're playing pickleball in St. George, Washington, Santa Clara, Ivins, or anywhere in the greater southern Utah area and something doesn't feel right, don't wait for it to become a bigger problem. The courts will still be there, and with the right care, so will you.


Get Back on the Court Faster

Whether you're dealing with pickleball elbow, a sore knee, or just want a movement screen before something becomes a problem, our team at Fortify PT in St. George is ready to help.

Book a Free Consultation →
Fortify Physical Therapy
792 S 3000 E Unit 104, St. George, UT · (435) 216-7929