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Built To Last

Rapid stops, lunges at the kitchen line and thousands of overhead reaches add up. Here is what published research and clinicians say about protecting the rotator cuff and knees, and why strength training is moving to the center of the conversation.

PUBLISHED NOV 2, 2026 TOPIC Injury Prevention SOURCES 8 LINKED
Neon graphic reading Built to Last with a dumbbell and a pickleball, for an article on pickleball injury prevention

Illustration: Pickleball.BZ

The short version

What the Injury Data Shows

Two very different kinds of data tell the story, and they should not be confused. Emergency-room records skew toward sudden injuries such as fractures. Player surveys capture the slower, overuse problems that never reach an ER.

34.2%
PLAYERS INJURED IN PAST YEAR
78%
OF THOSE WERE OVERUSE
91%
OF ER CASES AGE 50+

The survey figures come from a 2025 study in Frontiers in Public Health of 232 players at a 2024 tournament in South Korea. The average age was about 50. The emergency-room figure comes from a 10-year analysis of U.S. injury-surveillance data covering 2013 to 2022, which estimated nearly 78,000 pickleball injuries nationally, with fractures and sprains each making up about 27%.

A separate analysis of upper-body injuries from 2014 to 2023 found the shoulder was the most common site (36.8%) and that more than half of those cases were fractures. Of the patients, 83.1% were over 60. The authors urged physicians to counsel patients on prevention, including warm-ups, footwear and bone health. The same study found a higher share of fractures among women than men.

The survey study also found a pattern worth noting: players who logged more weekly hours had lower odds of injury, which fits the advice to build exposure gradually rather than in bursts.

The Rotator Cuff: A Slow-Burn Problem

Shoulder trouble in pickleball is not mainly about big serves. According to a physical-therapy industry guide, most of the stress comes from reaching up and forward at the non-volley zone and lunging into overhead putaways from off-balance positions. That loads the supraspinatus and the rest of the cuff through ranges many recreational players rarely use. The guide notes that players who start in their 50s often arrive with weak cuff and shoulder-blade stabilizers and a tight back of the shoulder.

The typical presentation it describes is gradual pain with overhead reaching and volleys, which points toward strain or tendon irritation rather than a sudden tear. Its approach is to restore shoulder-blade control and cuff endurance before adding overhead load, progress more slowly than a younger athlete would, and warm up the cuff with banded external rotation before play.

Shoulder & cuff priorities

  • Banded external rotation as a warm-up
  • Scapular (shoulder-blade) control work
  • Rows and other pulling to balance pushing
  • Rebuild before adding overhead load

Warning signs to act on

  • Pain with overhead reaching or volleys
  • Pain that builds over days, not one moment
  • Weakness lifting the arm to the side
  • Any of these: see a clinician

The Knee: It Is the Stopping, Not the Running

Pickleball is a sport of short bursts, lateral shuffles, lunges and constant changes of direction. A DUPR training guide by Susie Reiner, PhD, argues that deceleration is the key demand, writing, "Most of these injuries don't come from collisions; they happen during normal play." It says knees are more at risk when stopping than when moving.

The same guide says neuromuscular training, meaning strength, balance and plyometrics combined, has been linked in the research it cites to injury-risk reductions of 25% to 40%, with larger drops for ACL injuries in athletic groups. Treat that as a guide-level claim from cited studies rather than a promise: results vary by person and program.

Build the legs

  • Split squats, reverse lunges, step-ups
  • Single-leg Romanian deadlifts
  • Lateral lunges and step-downs
  • Hamstrings matter for controlled stops

Train the stop

  • Drop landings and snap-downs
  • Lateral bounds
  • Short sprints into controlled stops
  • Single-leg balance progressions

Hips and Lower Back: The Stabilizing Link

The knee and shoulder do not work alone. The hips and trunk are the base that absorbs force from a lateral stop and transfers it into a reach or swing. The sources reviewed for this article put hip and core work in the same plan: glute bridges and hip thrusts for the hips, hip abduction, dead bugs and bird dogs for control, and Romanian deadlifts for the lower back and hamstrings. A PPA Tour analysis adds that strong legs and a stable core help with speed, pivoting and balance during rallies.

Strength Training Moves Into the Weekly Plan

On the pro side, the message is consistent even if the details vary. Hannah Blatt, in an interview-based piece on Pickleball 5 Star, is described as training in the gym three to four times a week, with extra attention to her shoulders and back. Connor Garnett wrote on The Kitchen Pickle that "dedicating time to strength and endurance training in the gym is essential."

The PPA Tour piece, which is labeled as sponsored content, quotes Life Time trainer Joel Watts: "Developing strength should be a focus of players' off-court efforts." It recommends two to three sessions a week alongside pickleball drills and cardio, with roughly 48 hours between sessions for the same muscle group, dynamic warm-ups and a balance of pushing and pulling movements.

What the sources do and do not say: the pros quoted above describe regular gym strength and endurance work. The emphasis on plyometrics comes from the neuromuscular-training guidance above, and none of the sources reviewed documents specific pros doing heavy lifting or plyometric routines. Plyometrics are demanding on tendons and joints, so they belong after a base of general strength, and players with existing pain or older athletes should progress slowly.

Illustrative weekly template

This is a sample built from the exercises and frequencies above, not a prescription from any one source. Adjust it with a coach or clinician.

DayFocusExamples
MonLower body strengthSplit squats, Romanian deadlifts, glute bridges
TueCourt play / drillsWarm up cuff with banded external rotation
WedShoulders, back, coreRows, scapular work, dead bugs, bird dogs
ThuCourt play / drillsDynamic warm-up first
FriStrength + stop trainingStep-ups, lateral lunges, then landing drills once the base is built
WeekendRecovery / easy playMobility, walking, sleep
Medical note: this article summarizes published research and guidance for general information. It is not medical advice. If you have pain, a past injury, or a health condition, check with a physician or physical therapist before starting a new program.
A note on sourcing: there is no single official "cross-training guideline" document behind this article. What the sources show is a consistent message from researchers, clinicians and trainers: strengthen the hips, trunk and shoulder stabilizers, train deceleration, and build load gradually. Several sources are industry blogs or sponsored content, and are labeled as such here.

FAQ

Which pickleball injuries are most common?

In a 2025 survey of 232 players at a South Korean tournament, 34.2% reported at least one injury in the past year. The knee was the most common site at 23.3%, followed by elbow and forearm at 18.1% and shoulder and arm at 17.2%. About 78% of injured players reported overuse injuries.

Why does pickleball stress the rotator cuff?

One physical-therapy guide says most shoulder stress comes from reaching up and forward at the kitchen and lunging into overhead putaways from off-balance positions, loading the rotator cuff through ranges recreational players rarely use.

What knee exercises are recommended for pickleball?

A DUPR training guide recommends split squats, reverse lunges, step-ups, single-leg Romanian deadlifts, lateral lunges, and landing and deceleration drills such as drop landings and short sprints into controlled stops.

How often should pickleball players strength train?

A PPA Tour analysis recommends two to three sessions a week alongside pickleball drills and cardio, with about 48 hours of rest before training the same muscle group again. Anyone with an existing injury should check with a clinician first.

Sources & Further Reading