I started playing pickleball this year and have discovered just how addictive it can be. Not only is the game itself fun, the people who play are great as well. I have met so many wonderful folks on the court. This is a sport that can be enjoyed by most people without excessive practice or training required before being able to play an actual game. It is often touted as an activity that can be enjoyed by almost anyone. So why are injuries so common?
From what I’ve seen on the court, injuries occur when people do not play within the limits of their own bodies. Let me explain what I mean by that. At only 44 feet by 20 feet, a pickleball court is quite small. These dimensions mean that one generally does not have to displace oneself too far to reach the ball. That’s a good thing, and that is where the anyone-can-play idea comes from. However, you also have a lot less reaction time, as the ball is coming at you from a much shorter distance than say, tennis. If you and your opponent are just outside the kitchen then there is a mere 14 feet between you.
This means that movements in pickleball are smaller but quicker. It also means that should you have to run for a ball, your acceleration has to be short but explosive, and your deceleration extremely quick as well. This is where people get into trouble.
These are the most common scenarios involved in acute injury that I have seen:
- Quick forward acceleration (dang those pesky drop shots)
- Quick forward deceleration (I got that drop shot but yikes, here comes the net!)
- Quick lateral displacement with a sudden stop (I thought you were going there but you’re going THERE?)
- Sudden bending combined with twisting (who has the nerve to hit that perfect low shot right down the middle on my backhand side??)
Let’s start with the first one – quick forward acceleration. As I mentioned, the pickleball court is small, but things happen quickly. So when you gotta go, you have to do it explosively. The major muscle groups involved in quick acceleration are the gluteals (butt muscles), hamstrings (back of the thigh), and calf muscles. The tremendous force needed to propel your whole body forward with explosive speed is supposed to be spread amongst these three muscle groups, with the bigger hamstrings and gluteals taking most of the load.
What I have seen happen several times now though, are calf muscle and Achilles tendon injuries with sudden acceleration. This is happening because there is inadequate force being generated by the bigger muscles, so the load is being borne by the smaller calf muscles. This is like asking tiny little me (picture very small person of Asian descent) to push a car off a snowbank on which it is high-centred. And yes, someone actually once asked me to do this. I walked away laughing.
The other factor in calf muscle and Achilles injuries is flexibility. If you have tight calves, as a lot of people do, then you are at higher risk of hurting this area. In pickleball we spend a lot of time bouncing on the balls of the feet and absorbing impact with the calves. This requires flexibility as well as strength. Ideally, you should be able to do a full squat, as in getting your butt within a few inches of the ground because you’re trying not to pee on your shoes (some of you will have to use your imagination here), without your heels leaving the floor. The majority of people cannot do this.
It’s clear to see now why pulled or badly torn calf muscles, or worse yet the disastrous complete tear of the Achilles tendon, could happen. In order to avoid this type of injury you have two choices. One is to strengthen the heck out of your gluteals and hamstrings with a sustained, concerted, targeted effort. I mean, you need some SERIOUS strength in these muscles to quickly propel the weight of your entire body forward safely. And now I’m going to go completely radical here so bear with me. The second option is to not even try to return that drop shot. Gasp! Yes, I said it. You could just stand back there at the baseline, admire your opponent’s shot, and applaud their skill while conceding the point.
THIS is what I mean when I say playing within the limits of your own body. Unless you have significant strength in your gluteals and hamstrings, which from my practice I can tell you is quite rare, you are putting yourself at very high risk of an injury accelerating like a maniac. So think about it. Which would you rather do – concede a point, or be out for months?
Scenarios number two through four above have one thing in common – the need to decelerate quickly. Deceleration requires a robust braking mechanism, which most people just don’t have. In order to brake a movement our muscles need to work in a very particular manner. They need to lengthen with control, gradually decreasing momentum.
There are two types of muscle contraction – concentric and eccentric. Concentric contraction is when we shorten a muscle with force, as in shortening your biceps to pick up that heavy bag of groceries. Eccentric contraction involves letting the muscle lengthen in a controlled fashion against force, as in slowly letting your biceps lengthen to put that heavy bag of groceries down carefully because you realize you had a brain fart at the grocery store and put the eggs in the bottom. Who are we kidding? You’re having a dozen scrambled eggs for dinner.
The problem is, for people who actually do strength training, most work almost exclusively on concentric strength and ignore eccentric strength. We use concentric power to accelerate quickly and eccentric power to stop all that momentum. We need both or we are in trouble, especially when moving quickly on a small pickleball court.
So scenario number two, having to stop suddenly after a forward sprint, demands a lot of eccentric force from a lot of different places. Essentially your feet are stopping and the rest of you is going forward with a lot of momentum, like you secured the cake in the car but there’s nothing you can do about the icing that’s maybe a bit runny because you added too much milk to it. The car and the cake stop and the icing keeps going. Not pretty. This may have happened to me once. Sorry kid, no birthday cake for you.
Sudden forward deceleration creates a lot of shearing forces, particularly at the knees and ankles, that your muscles have to counteract by generating eccentric force. If your muscles lack the strength to do so, then the ligaments take the brunt of the force. Trust me, no one needs to be tearing an ankle or knee ligament. That can be a seriously debilitating injury. In fact, ligamentous injuries are generally worse than broken bones, as they often leave you with permanent instability.
The main muscles needed to safely decelerate when running forwards are the quadriceps (front of the thigh), gluteals, hamstrings, and calf muscles. And yes, if you’ve noted, more muscles are involved in deceleration than acceleration. Stopping quickly is serious business.
Scenario number three involves putting the brakes on a quick lateral movement. This is where ankle sprains occur. Your momentum is taking you sideways, you plant your foot to stop, but your body keeps going sideways and you essentially fall off your foot, pulling it over onto the outside and spraining your ankle. In order to avoid this injury, you need a ton of strength in pretty much every muscle around your hips. That’s right – spraining your ankle doesn’t happen because you have “weak” ankles. It happens because you have weak hips. When was the last time you strengthened the muscles of your inner thigh? Eccentrically. Probably never.
Well now you may be asking yourself how the sharp bend-twist in number four involves the need to decelerate. If you are, then brownie points to you because it means you’re really thinking. This particular movement often ends in lower back injury, as when the back is in a flexed position it rotates more than when it is extended. That should be a good thing for that twisting bending shot I’m trying to do, shouldn’t it? Well, it may allow you to make the shot, but bragging about it tomorrow ain’t going to happen if you can’t get off the couch.
Because so much rotation is available to the lower back in a flexed position, again we need brakes on that movement or we over-twist and hurt something. The deceleration of rotation of the trunk requires eccentric contraction of our deep abdominal muscles. I’m not talking about your sexy six pack here, so no, those thousand sit-ups you do every day (as if) are not going to help you.
You need to work the deeper layers of the abdominals, known in medical circles as obliques and transversus. These are just fancy names for core muscles that are crucial in our stability. You need to strengthen these both eccentrically and concentrically. The eccentric work will help protect your lower back when you twist, and the concentric work will give you more force with those driving shots from the baseline and when smashing. Now what could be sexier than that?
If you’re still with me by now, then you must be serious about avoiding injury, so I will reward you with the keys to the safe pickleball universe. To sum all this up, you can do one of two things. You can play in a leisurely fashion, avoiding mad dashes and scrunching twisting shots. This is what 95% of people I see playing should be doing in order to play safely within the limits of their own body. The game can absolutely be greatly enjoyable playing in this way. And I might add, I’ve seen some formidable players who can place the ball like nobody’s business and kick your ass without ever accelerating like a crazy person or twisting themselves up like a pretzel. I’ve had my butt whooped on many an occasion by someone playing a “leisurely” game.
If minimizing acceleration and quick movements isn’t for you and you plan on going for it all, then first of all you need to be realistic about where you have strength and where you lack it. For example, can you honestly say you have good concentric and eccentric strength in all the muscles of your hips? Do you have excellent stability in your core muscles? How is your flexibility?
If any of these things are an issue then these are the things you need to incorporate in your training going forward. I will include the fancy medical terms here so that you can convey this to a trainer (or let’s face it, look it up on YouTube more likely) should you so desire.
- Be sure to work main muscle groups both concentrically and eccentrically.
- Strengthen all the muscles of your hips including gluteals, hamstrings, deep flexors, abductors (muscles that bring your leg away from your other leg) and adductors (muscles that bring your leg towards your other leg).
- Strengthen your deep core muscles including internal and external obliques, transversus abdominis, and multifidus.
- Work on flexibility everywhere, but particularly in the hips and calves.
- Bonus – give up on the sit-ups. They do nothing to help you functionally. But hey, a great six pack is definitely hot. There are just better ways to get one.
While all of this may seem daunting, if you know what you’re doing, or find someone to work with who does (notwithstanding Dr. YouTube), you can hit all of these requirements in a 45 minute workout. It’s completely doable, and entirely worth it, not just for pickleball but for life in general. Having strength and stability is key to living a long and healthy life enjoying the things you love to do.
Lastly, I think I would be remiss by leaving you without mentioning the risk of eye injuries in pickleball. I have been hit twice in the eye area so far, and what saved me from serious injury is wearing eye protection. Eye protection is mandatory in other sports such as squash, and I believe it should be in pickleball. The risk of permanent loss of sight is too great. That ball is hard, it’s coming fast, and it can change direction quickly if it glances off of your paddle or your partner’s (that’s what happened to me). If that happens, you just will not be quick enough to stop it.
If you haven’t heard of Kitchen Blockers, you should check them out. They are specifically designed for pickleball and are lens-free so they do not fog up. They are lightweight (I forget I have them on) and meant to withstand an impact at up to 60 mph. I just can’t imagine playing without them. For more information, check out this blog from the manufacturer.
Now go forth and enjoy the game safely so I can meet you on the court someday! If I do and you have read this, then please let me know. Believe me, I much prefer helping people prevent injuries than recover from them.
P.S. You may have noticed that I haven’t at all addressed upper body overuse type injuries here. First of all, stay tuned as I will explain to you in my next blog why these happen and why just treating where it hurts won’t work. Secondly, the lower body is the foundation of your building, so it needs to be addressed first. Don’t worry, we’ll get there.
P. P.S. If you do hurt yourself, we can help you in a holistic way by identifying the underlying cause of the injury, thereby preventing it from happening again. Because who wants to miss pickleball?