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The Racket / Paddle Athlete
Racket and paddle sports including tennis, pickleball, table tennis, and racquetball are associated with a unique set of movements and injuries compared to other sports. Understanding the demands of the sport, specific movements and joint range of motion required, and how to either modify or build strength in these movement patterns is crucial to long term recovery from an injury. Here are a few unique aspects of racket sports we take into consideration during rehab, strength training, and injury risk assessments:
Asymmetrical movements - Hand dominance is a significant factor in injury risk in racket sports, both for upper body but also lower body and trunk injuries. Hand dominance affects which leg leads when hitting, running, or lunging for a ball, the direction and force of rotation through the torso, and more. Research shows a significant difference in both upper and lower body injuries based on hand dominance in tennis. Some of these are obvious, like increased incidence of elbow tendinopathy in the dominant arm. Others, however, are more nuanced, such as the incidence of non-dominant wrist injuries with two hand backhands, or limited hip internal rotation as a risk factor for low back injury. Rehab, performance training, or injury prevention training can work to minimize these imbalances, and make you stronger in the movement patterns you use most in your sport.
Frequent changes of direction - Change of direction and pace are the most common mechanism of lower body injury in racket and paddle sports. In both pickleball and tennis, players frequently perform up to 1000 directional changes in a match. The majority (~70%) are primarily lateral motions, though most are truly multiplanar. Patellar tendonitis, gluteal tendonitis, and knee / ankle sprains are all common injuries during these motions, and during rehab, it is important to re-train the body to these multiplanar directional changes to reduce the risk of future injury.
Overhand vs underhand serve - In tennis, serving is the most strenuous stroke and therefore comes with the greatest risk of injury. The overhand position requires greater than average range of motion in shoulder flexion and spinal extension, and risk of injury to different structures varies during the different phases of a serve. For example, reduced hip extension range of motion on your dominant leg has been linked to increased low back injury while serving. In pickleball, the underhand serve significantly reduces these requirements, though proper force production from the legs and torso is equally crucial to reduce strain on the shoulder and elbow.
One hand vs two hand backhand - Kinematics studies show differences in range of motion, force production and ball contact points between one and two hand backhand strokes, which affects joint and tendon strain. Two hand backhands require greater trunk rotation and dominant shoulder horizontal adduction (reaching across the body), as well as an earlier contact point with the ball. While this allows for greater force production from the trunk musculature, the greater range of motion and earlier contact point may increase your injury risk if you don't have the required hip, spine, and shoulder mobility. Many of these risk factors can easily be screened by a therapist who understands your sport specific movements.
Pickleball
Pickleball has been the fastest growing sport in the US for several years in a row with an estimated 24 million players in 2025, and the incidence of pickleball related injuries has risen steadily as well. While few studies have yet to clearly identify specific risk factors for pickleball, injury incidence has been distinct from other racket / paddle sports. This is likely due to differences in court size, paddle make, and rules, as well as demographic characteristics of players, and beliefs about the sport.
Pickleball has also been promoted as a safer, lower movement, and lower impact alternative to tennis and other team sports, despite the fact that overall injury incidence is comparable to tennis and racquetball. Researchers suggest that this has led to players underestimating the risk of injuries, leading to less engagement in warm-ups and injury prevention strategies compared to other athletes.
The smaller court size of pickleball does reduce top running speed and overall distance travelled on the court, which reduces the risk of some muscular and fatigue related injuries. However, the number and frequency of directional changes, as well as the number and frequency of ball strikes is very similar, which is where we see the highest incidence of lower and upper body injuries, respectively. Quick reaction requirements can also affect a player's ability to adjust their stance to a position where the lower body can effectively generate force for a stroke, therefore increasing the strain on the shoulder and elbow.
The most commonly injured body region is the knee, followed by the elbow, ankle, shoulder, and low back. Soft tissue injuries (tendinopathies, muscle strains, and ligament sprains) are the most common injury type, particularly in male players. However, a high incidence of fractures is seen in female players, which may be due to lower bone density in women, especially over the age of 55, when rates of osteopenia and osteoporosis are higher.
With appropriate strength training, rehab, and routines around the sport, you can reduce your risk for most injuries from ankle sprains, to tendinitis, to fractures. If you have an injury keeping your from playing pickleball at your best, or are looking for a program to reduce your risk of injury, you're in the right place.
Many injuries can be managed in season while continuing to play or train
Reach out to see if you need to stop playing or can continue during your recovery
Common Tennis & Pickleball Injuries we Treat
Patellar / Achilles tendonitis
Ankle sprains
Tennis elbow / golfer's elbow (medial and lateral epicondylalgia)
Muscle strains: calf, quad, groin, hamstring
Patellofemoral pain / patellar dislocations
Knee ligamentous injuries: ACL, MCL, PCL sprains / ruptures
Rotator cuff sprains / tears
SLAP / labral tears
Meniscus tears
Lumbar disc herniation
Lumbar spondylosis / spondylolisthesis
Fractures (Jones', wrist/hand, fibular, etc.)
Plantar fasciitis
Our Difference in Racket Sport Rehab
Regardless of your age or level of play, we will treat you as an athlete and work hard to get you back on the court as quickly, but also safely as possible.
We will assess and treat racket sport specific movements, so your rehab is tailored to your specific needs.
We are familiar with the most common pickleball and tennis injuries, and for longer recoveries, your rehab will not be focused solely on the current injury, but bulletproofing your body to the most common injuries associated with your sport, age, sex, and movement patterns.
Later stages of rehab will include court specific drills, recreating real scenarios as you approach your return to sport.
We will discuss clear return to sport guidelines.
We will directly communicate with coaches when needed.
Conditioning may be built into the process to reduce the risk of fatigue-related injuries when returning.
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