Lakewood Ranch is one of the most active pickleball communities in Southwest Florida. The courts at Bob Gardner Park fill up by 8 a.m. most mornings, and the broader Sarasota-Manatee area now hosts regional tournaments that draw players from across the state. The sport's appeal is real: it is social, relatively easy to learn, and more forgiving on the cardiovascular system than tennis.
What it is not, unfortunately, is low-risk for the musculoskeletal system. We see pickleball-related cases at our Lorraine Road office with increasing regularity, and the pattern is consistent: adults in their 50s and 60s, playing three to five times per week, dealing with something that "just won't settle down." The issues range from lateral elbow pain (what most patients call pickleball elbow) to rotator cuff strain, patellar tendinopathy, and lower back pain that gradually worsens with each session.
The thing these patients have in common is that they are not looking to stop playing. They want to know what is actually wrong and how to address it so they can stay on the court. For the injuries we see most often, conservative care makes that achievable without surgery. This guide covers what those injuries are, why pickleball creates them specifically, and how we approach recovery.
Why pickleball demands more from your body than most people expect
The "gentler than tennis" reputation is partly earned. The court is smaller, serves are underhand, and rallies are shorter. For your heart and lungs, pickleball is genuinely lower intensity than tennis. But the mechanics of the game create specific musculoskeletal stresses that are worth understanding.
The dinking game. Playing close to the non-volley zone requires repeated small, precise wrist movements with the paddle held in a semi-pronated position. Over 90 minutes of play, the extensor tendons of the forearm, which attach at the lateral epicondyle on the outside of the elbow, absorb hundreds of loading cycles. That is how "pickleball elbow" develops, not from one big moment, but from accumulated repetitive stress.
Lateral movement on hard courts. Pickleball involves quick lateral shuffles and split-step recoveries, almost always on concrete or asphalt. Each lateral push-off sends a ground reaction force up through the ankle, knee, and hip. If the hip stabilizers and glutes are not doing their job, the knee absorbs more than its share.
Overhead put-aways. The overhead smash is one of the highest-velocity movements in pickleball. Done with proper mechanics, it is fine. Done repeatedly with a tight posterior shoulder capsule or a weak rotator cuff, it becomes a setup for impingement and, eventually, partial tearing.
Rotational demands. A cross-court drive or a backhand requires rotation at the thoracic spine and lumbar region. When spinal segments are stiff or fixated, that rotation gets forced through one or two levels rather than distributed across many. That is how disc and facet irritation develops, insidiously, over weeks of play. For a closer look at how this mechanism plays out, our page on herniated and bulging discs explains the structural picture.
The most common pickleball injuries
Lateral epicondylitis (pickleball elbow)
This is the most common pickleball injury we see. Patients describe a sharp pain on the outside of the elbow, present during play and sometimes when gripping a coffee mug or turning a doorknob. It often starts as mild aching and progresses over weeks until play becomes difficult.
Despite the "-itis" name, this is not primarily an inflammatory condition. It is a tendinopathy: structural change in the extensor tendon tissue from repeated mechanical loading without adequate recovery. The tissue does not remodel the way healthy tendon does, and rest alone often fails to resolve it. The tendon needs targeted loading to stimulate healing, not just offloading.
Treatment at our office typically involves soft-tissue work to reduce tension on the affected tendon, shockwave or softwave therapy to stimulate tendon remodeling, and a progressive loading protocol that rebuilds the tendon's capacity to handle the demands of the game. Most patients who follow through see meaningful improvement over 4 to 8 weeks.
Rotator cuff strain and shoulder impingement
The shoulder is the second most common site for pickleball injuries. The overhead mechanics of the put-away require the rotator cuff, particularly the supraspinatus, to stabilize the humeral head in the socket while the larger deltoid drives the arm upward. When that stabilization is compromised by a tight posterior capsule or weak rotator cuff muscles, the soft tissue in the subacromial space gets pinched on the downswing. That is shoulder impingement.
Early presentations look like aching in the outer shoulder, worse when reaching overhead or sleeping on that side. If left unaddressed and the overhead volume stays high, it can progress to a partial or full-thickness rotator cuff tear, at which point grip strength on the affected side noticeably declines and pain becomes more constant.
Most early shoulder cases in pickleball players respond well to posterior capsule stretching, adjustments to restore thoracic extension (which directly affects shoulder mobility), and Class IV laser therapy to accelerate soft-tissue repair. Any patient who presents with sudden, severe weakness after an overhead movement gets a same-day referral for imaging. That is a red flag that changes the clinical picture.
Knee pain (patellar tendinopathy and IT band syndrome)
The quad-dominant landing pattern many recreational players use puts chronic load on the patellar tendon, particularly on hard courts. Patellar tendinopathy in pickleball players presents as pain directly below the kneecap, often worst when getting up from a chair, descending stairs, or at the beginning of a session before warming up.
IT band syndrome produces pain on the outer knee that worsens the longer you play and then stiffens up within an hour of stopping. The mechanism is typically weak lateral hip stabilizers, with the IT band overworking as a compensatory stabilizer during the repeated lateral shuffles of the game.
Both conditions respond to hip and glute strengthening, manual therapy to address the relevant hip and knee mechanics, and for patellar tendinopathy, a structured loading program. For patients who also have some joint space narrowing contributing to the knee pain picture, knee decompression is an option we use.
Lower back pain from rotational stress
Repeated rotation with a spine that has stiff or restricted segments is a common mechanism for lumbar facet irritation and disc aggravation in pickleball. The characteristic pattern is lower back pain that worsens during or after play and does not fully resolve between sessions. Over weeks or months, the baseline level of discomfort creeps upward until it is present even on rest days.
This is one reason that earlier evaluation leads to better outcomes. When we can identify which segments are not moving freely and restore normal motion through adjustment and soft-tissue work, the rotational load gets redistributed across more levels and the overloaded structures get a chance to settle. Spinal decompression is an option we use when disc-related compression is contributing to the picture alongside the mechanical restriction.
When to get evaluated vs. when to play through it
Not every sore muscle after pickleball warrants a clinic visit. Here is a practical guide.
Get evaluated soon if any of these apply:
- Pain that has persisted for more than 7 to 10 days past the activity that caused it
- Pain present at rest, not just during activity
- Sharp pain during a specific movement (as opposed to general muscle soreness across a muscle group)
- Any sensation of the shoulder "catching" or "giving way" during overhead movement
- Swelling in a joint
- Grip weakness or strength asymmetry in the arm
- Numbness or tingling down the arm or into the hand (this suggests a nerve component)
Reasonable to watch and rest first if:
- General muscle soreness 24 to 48 hours after a longer-than-usual session, improving on its own
- Mild achiness that resolves completely within two days
- Soreness that improves as you warm up and stays improved after play
The rule of thumb: if you are changing how you move to protect something, get it evaluated. Compensation patterns, favoring one side, altering your grip, avoiding certain shots, are how secondary injuries develop.
Most pickleball injuries we see have been building for weeks before patients feel it is "bad enough" to come in. The sport rewards consistency, and the players who stay on the court the longest are usually the ones who treat recovery as part of the game, not an interruption to it.
How we approach pickleball recovery at Spine and Wellness Center
The first step is an intake exam that maps what is actually happening, not just where it hurts. For a pickleball elbow, we assess the cervical spine and thoracic outlet as well as the elbow itself, because nerve tension from the neck can mimic or amplify lateral elbow pain. For a sore shoulder, we check thoracic extension and rib mobility, because a stiff mid-back directly restricts shoulder range of motion.
From there, the care plan depends on what we find. A common combination for a pickleball-related case at our office:
- Chiropractic adjustments targeting the spinal segments involved in the rotation mechanics of the serve and ground stroke
- Soft-tissue work (instrument-assisted or manual) on the affected tendon or muscle
- Class IV laser therapy for soft-tissue injuries in the shoulder or elbow, where it accelerates cellular repair and reduces local sensitization
- Shockwave or softwave therapy for chronic tendon presentations (elbow, knee patellar tendon) that have not responded to rest and activity modification
- Targeted therapeutic exercise guidance focused on the weak link in the kinetic chain (usually glutes and hip stabilizers for lower back and knee cases; rotator cuff and posterior chain for shoulder cases)
Dr. Banman has worked with active adults and recreational athletes in the Lakewood Ranch area for over 23 years. Many patients also work concurrently with an orthopedist or physical therapist. Our approach is designed to complement that care, not compete with it. For an overview of the conditions we address, the conditions we treat page is a useful starting point.
Preventing the next flare-up
A few practices that consistently reduce re-injury rates in the pickleball players we work with:
- Warm up before the first rally. Ten minutes of dynamic movement (leg swings, arm circles, lateral shuffles) makes a real difference. Static stretching before activity does not prevent injury and may reduce force production during play.
- Use a paddle suited to your forearm strength. A paddle that is too heavy or too stiff amplifies the load on the elbow extensor tendons. A lighter paddle, or one with a more flexible graphite face, reduces that cumulative stress.
- Grip lightly between shots. A constant death grip on the handle is one of the primary drivers of pickleball elbow. Grip firmly at contact. Between strokes, let the forearm relax.
- Drive from your legs and trunk, not your elbow. Ground stroke power should come from body rotation initiated at the hips. Relying on the forearm to generate pace is how elbow and wrist injuries develop over time.
- Build in a recovery day. Daily players who include one complete rest day per week present with fewer overuse injuries than those who play seven consecutive days. The tissue needs time to adapt to the load.
- Address hip and glute weakness proactively. Weak posterior chain muscles redistribute load to the knee and low back. A few targeted exercises three times per week, outside of play, substantially reduces that downstream risk.
If you are local to Lakewood Ranch, Bradenton, or Sarasota and have a pickleball-related injury that is not settling, a brief intake visit gives you a clear picture of what is going on and a realistic path forward. Call us at (727) 213-2982 or book online at celluron.janeapp.com.
