THE PICKLEBALL DOCTOR
COMMON PICKLEBALL INJURIES
As with any sport, injuries are part of the game. I will describe common injuries and break it down into five categories:
Falls
Strains
Sprains
Joint Dysfunctions
Tendinopathies
Falls: falling while playing Pickleball happens fairly often. The most common type of fall occurs when someone trips while back peddling to try to get an overhead ball. The tripping is not necessarily the worst part, as the landing can lead to bruises, bone bruises, and fractures. Everyone knows what a fracture is: a breakage in one of our bones. The most common fracture in Pickleball occurs in the wrist and hand as people try to catch themselves when falling, leading to a "FOOSH" fracture (fall on out-stretched hand). A good way to avoid falling while back-peddling, is to turn around and run back toward the end of the court when a lob is hit.
Strains: a strain occurs anytime a muscle in our body is overstretched. Strains range from mild pull on the muscle to complete tearing, and are classified in 3 different grades:
Grade I: mild strain that causes tenderness and pain but results in no significant impairments (full range of motion and no loss of strength). General recovery timeframe: 2-4 weeks.
Grade II: a grade II strain results in moderate impairment, marked pain and tenderness, decreased range of motion at the joints involved with the strained muscle, and a noticeable loss of strength secondary to pain. General recovery timeframe: 4-8 weeks.
Grade III: a grade III strain results in immediate pain at the time of the injury with possible audible "pop" at the time of injury, possible palpable defect in the muscle surrounded by swelling (edema), with complete rupture of the muscle structure. General recovery timeframe: 8-14 weeks (surgery may be required which would delay the recovery process).
Sprains: a sprain occurs when a non-contractile tissue (usually a ligament) is overstretched. These injuries usually occur when one of our joints moves in an abnormal way beyond the available joint range of motion (rolling your ankle, twisting your knee). As with strains, sprains are also categorized into grades based on the severity:
Grade 1 Sprain (Mild): Slight stretching and microscopic tearing of the ligament fibers. Mild tenderness and swelling around joint. General recovery timeframe: 2-3 weeks.
Grade 2 Sprain (Moderate): Partial tearing of the ligament occurs. There is moderate tenderness and swelling around the joint, and some instability may be noticed during physical examination. General recovery timeframe: 4-8 weeks.
Grade 3 Sprain (Severe): Complete tear of the ligament, with significant tenderness and swelling around the joint. There can be audible popping at the time of the injury, and instability can be noted during physical examination. General recovery timeframe: 8-14 weeks (surgery may be required which would delay the recovery process).
Joint Dysfunctions: there are times when we perform certain movements without causing damage to the muscles or ligaments, but cause abnormal movements in our joints which may result in pain and dysfunctions. This often occurs in the spine, leading to pain, stiffness, mechanical locking, and inability to perform our activities. There may be no finding on Xrays or MRIs, but range of motion limitations and pain with movement are observed. Joint dysfunctions will often lead to muscle spasms and create a cycle of pain which renders us even more inactive. Correcting the joint dysfunction is imperative in order to decrease pain, restore proper mobility in the joints, enable the muscles to relax, and begin restoring movement into our bodies. Performing strengthening exercises once the dysfunction has been corrected can help support our joints in order to prevent future joint dysfunctions.
Tendinopathies: tendinopathies are dysfunctions involving the tendons in our bodies. Tendons are the portion of our muscles that connect to bones in order to provide a link between muscle and bone, and enable us to create movement. Tendinopathies can be classified into two categories based on the duration of the injury: tendinitis and tendinosis.
Tendinitis: this is an acute process. This usually is due to overuse and poor biomechanics, and can be controlled with rest and coaching. If your injury is less than 4 weeks old, it can be called tendinitis. Anything lasting more than 6 weeks is no longer considered tendinitis, as it is no longer in the acute stage, and inflammation is no longer the primary problem. Therefore, if your elbow has been hurting for 2 years, you no longer have tendinitis. Ice and anti-inflammatory medications will likely not resolve the problem. Rest, compression, soft tissue work, heat, and gentle stretching may be beneficial. Once the pain has been controlled, starting targeted exercises in order to change the faulty mechanics that led to the problem will ensure the problem does not persist.
Tendinosis: once your injury has been lasting more than 6 weeks, it is now referred to as tendinosis, which is a degeneration of the fibers of the tendons, and requires targeted rehabilitation in order to decrease pain and improve function. Focusing your attention on correcting faulty biomechanics, correcting muscle imbalances, and focusing on eccentric strengthening is the key to improving your symptoms and getting back to playing without pain.
Two most common types of tendinopathies in pickleball:
Lateral epicondylosis (also referred to as Tennis Elbow, or epicondylitis if in early stage): the primary tendon affected in this case is usually the Extensor Carpi Radialis Brevs (or ECRB), which is responsible for extending the wrist.
Patella tendinosis (or tendinitis if it is in the early stage): the problematic tendon in this case is the patella tendon, which connects the patella to the shin bone (technically making this a ligament since it connects bone to bone). This problem often arises from an overactivity of the quadriceps muscles, paired with underactivity of the gluteal muscles, leading to muscle imbalance and increased stress on the patella tendon.
In both cases, controlling the pain and correcting the muscle imbalances is the best way to ensure the problem goes away in the long run and ensure you can get back to playing!