An image of a man playing pickleball.

Pickleball has become a smash hit in the U.S. in recent years—and along with growth in popularity of this sport popular with the over-50 set has come myriad pickleball injuries, especially in the feet, knees, hips, shoulders and arms, which may respond well to massage therapy.

Pickleball, a sort of amalgamation of ping pong, tennis and badminton, is the U.S.’s fastest-growing recreational sport, with 4.8 million people registered as players—almost twice the number of players counted five years ago, ago, according to the Sports and Fitness Industry Association.

According to a report by NPR, [m]ost of pickleball’s core players,  those who play more than eight times per year—are over age 65,” although the sport’s players are getting younger.

Pickleball: A History

According to USA Pickleball, the sport was originally invented in Seattle in 1957, by three fathers seeking a fun way to entertain their children. Normal tennis courts were too large for their children to play on, so these fathers invented a smaller, easier version of tennis.

In addition to those 4.8 million registered pickleball players, countless more participate in local leagues. And now, pickleball is going pro.

There are now three professional pickleball leagues. Major League Pickleball, Professional Pickleball Association and the Association of Pickleball Professionals. Additionally, there are hundreds of amateur adult leagues nationwide. In Phoenix alone, there are over 50 pickleball court locations. Similar figures are reflected in other urban areas.

With this increase in pickleball participation, I have seen a wave of current clientele partaking in this sport. These clients are now showcasing common pickleball injuries. Among these injuries are strains at the elbow region (akin to tennis elbow) as well as hip- and knee-fatigue injuries.

Pickleball Injuries: Wear & Tear

One of my clients, “Susan” (name changed), of Phoenix, Arizona, has become an avid pickleball player. She reports not participating in sports until the past year when she and her husband began playing pickleball leisurely. Now this couple enjoys three to four hours of pickleball action five evenings weekly, often well into late-night hours.

As Susan’s massage therapist, it was important for me to recognize that her body was not accustomed to athletic participation until this past year, so her bones and joints are not accustomed to this physically demanding level of stress and strain. This amount of pickleball play has caused wear and tear upon Susan’s body.

“I have noticed pain in my feet from all of the quick lateral movement from pickleball,” says Susan. “My paddle shoulder has also grown progressively tight from overuse.”

Susan also says that massage has helped her body tremendously since she started playing pickleball. “I started playing very consistently very quickly, which caused severe pain in my hips along with tightness throughout my body from picking up a new sport and moving in unexpected ways,” she says. “Incorporating massage has helped me keep my body loose and continue to play and improve. Massage has helped reduce inflammation and increased mobility throughout my entire body.”

Pickelball Injuries: Feet, Hips & Arms

When working with Susan, I address three main areas: her feet, hips and arms. Our sessions ideally are 90 minutes in length to sufficiently address these areas thoroughly.

While working Susan’s feet, I often employ reflexology techniques. When first addressing her feet, I use such relaxation techniques as ankle loosening, ankle rotations, metatarsal spreading and medial arch twisting to ease her feet. Then I employ traditional finger- and thumb-walking techniques upon all four surfaces of the feet (medial, lateral, plantar and dorsal). I also use a scraping tool (my favorite being a jade Gua Sha tool) to loosen the stiff plantar fascia she presents.

While working on her hips, I needed to employ more pain-relieving measures after she had actively played pickleball for several months. Because she had developed hip bursitis, I needed to help ease pain within her hip and relieve inflammation before addressing hip muscles specifically. Once her case of bursitis subsided, I devoted at least 30 minutes (often more) of the massage session to employ massage techniques to address all muscles in this region.

On the anterior side, I addressed the psoas major, iliacus, tensor fasciae latae, sartorius, adductor muscles and upper quadriceps muscles. Additionally, I included stretching for these muscles. On the lateral and posterior sides, I addressed the gluteal musculature (maximus, medius and minimus), the six deep hip rotators and the upper hamstring musculature.

While working her arms, I recognized the tight muscle tension pattern of the lateral and posterior shoulder, triceps and antebrachium extensor muscle unit. I include stretching for all muscles involved in this kinetic chain, including deltoid, triceps brachii, teres major and minor, latissimus dorsi, brachioradialis, and the 12 extensor muscles of the forearm. I spend sufficient time to address forearm muscles individually, using a myriad of friction and petrissage techniques.

I also include reflexology and massage techniques upon the hands. I usually feel more tightness within the hand holding the racket. Stretching the palms can be especially great for loosening this tension felt within their hands, especially at the thenar eminence.

When working with other pickleball injuries, I refer to common pain-relief measures massage therapists may employ with clients. Any of these ideas may be a good option for relieving a client’s pain. I simply find the methods that will work best for each client. These ideas include:

• Employ stretching and range of motion techniques

• Include muscle-relieving essential oils such as lemongrass and Melissa oils

• Encourage breath work

• Use contrast hydrotherapy treatments that involve alternating heat and cold applications

• Use tools such as cups, scraping or foam rollers

• Provide extra bolstering to reposition a limb to decrease pain upon table

• Slow the cadence of massage stroke application

Decrease pressure of massage stroke application

Pickleball Elbow

An inflammation of the lateral epicondyle, aka tennis elbow (lateral epicondylitis) is often witnessed with my pickleball players. Perhaps in these clients, the condition can be termed pickleball elbow, as the same manifestations arise.

More specifically, this injury is described as an overuse injury due to excessive eccentric load upon the extensor muscle tendons attaching at the lateral epicondyle of the humurus bone. Swinging a racket can create the eccentric load demand upon these muscles.

Common signs and symptoms of the condition include pain and stiffness of the forearm and hand region, point tenderness upon the extensor muscles and attachment sites, functional weakness of the hands and wrists of the affected limb, and irritability of the elbow region. If left untreated, severe strains of the forearm extensor tendons may result.

With clients who frequently play pickleball, including Susan, I see pickleball elbow quite often. With this condition, I employ pain-relieving measures as mentioned earlier upon the lateral epicondyle, antebrachium and manus regions. I also employ specific Russian Sports massage techniques to ease tension within these regions.

More Pickleball Injuries to Come

As pickleball continues to gain popularity, massage therapists will begin seeing more pickleball-related injuries upon their tables. People of all ages are now participating in this sport. Try employing any of the above-mentioned tips to provide relief for these patients.

Jimmy Gialelis

About the Author

Jimmy Gialelis, LMT, BCTMB, is owner of Advanced Massage Arts & Education in Tempe, Arizona. He is a National Certification Board for Therapeutic Massage & Bodywork-approved provider of continuing education, and teaches “Gua Sha: Chinese Scraping Method” and many other CE classes. He is a regular contributor to MASSAGE Magazine.