John Niematka returns a volley to his wife Michi at Sierra Sport and Racquet Club in Fresno. Photo by Ben Hensley

A new sport has taken the country by storm, with amateur athletes of all ages clamoring to take part.

Pickleball has burst onto the scene over the last five years, with local sport and racquet clubs resurfacing their courts to accommodate. Tennis courts around the Valley have made way for the new sport.

The beauty of pickleball, according to many, is its versatility and accessibility. It’s very common to see families — multiple generations — gearing up and reaching for the paddle and ball on their way to a family outing.

But what happens when amateur athletes and weekend warriors aren’t prepared for the unexpected physical toll that such a harmless-looking sport can potentially cause? And how might it cost Americans $500 million in added health insurance costs?

 

What is pickleball?

Pickleball largely resembles tennis, being played on many tennis courts across the country. The rules are simple and resemble that of tennis — one or two players on either side of a 34-inch net volley a plastic “wiffle ball” styled sphere until one player has scored a point.

The sport traces its roots to Washington in the mid 1960s — and was even named the official state sport of Washington in 2022. Initially invented as a children’s game, the game has rocketed into popularity, particularly after the pandemic.

“It’s easy to pick up in the sense that the ball doesn’t move as much,” said Christopher Melsom, director of tennis and pickleball at Sierra Sport and Racquet Club in Fresno. “When it hits the ground it doesn’t ‘play.’ it slows down so there’s less room to cover compared to tennis.”

Melsom said that the accessibility of the sport has made it a hit among the racquet sport community.

General Manager of Sierra Sport and Racquet Club Gina Woodworth said that the sport also opens up opportunities for those who haven’t been able to grasp the game of tennis.

“I swing a tennis racquet like a baseball bat because I’m a softball player,” she said. “There was no topspin. I played pickleball and I loved it. I actually had a chance because it’s more hand-eye and quick wrist.”

Sierra Sport and Racquet Club and many other clubs throughout the country have transitioned some or all of their tennis courts into pickleball courts, creating the opportunity for four games to be played simultaneously in the space of one court.

As with any physical activity, there is risk involved, particularly for vulnerable populations.

 

The injury uptick

Doctors and surgeons have noted a dramatic uptick in the number of pickleball-related injuries, in particular, in older demographics.

Dr. Anthony Yu, orthopedic sports medicine surgeon at Kaiser Permanente Fresno, said with pickleball, the most common joint-related injuries he sees are to the knee and shoulder. These include rotator cuffs (shoulder) and anterior cruciate ligament (ACL), medial collateral ligament (MCL) and meniscus tears, all in the knee.

A main concern that Yu and other specialists have in regards to pickleball-related injuries are those seen by individuals moving from a sedentary or non-active lifestyle into a sudden active lifestyle by playing pickleball.

“One of the beauties of pickleball is it attracts people of all ages,” Yu said. “The downside is that some people in certain age demographics might not be ready to jump into a sport like that after they’ve maybe been kind of sedentary for a while.”

Younger players, though less commonly injured while playing the sport, can suffer problems as well. Yu and others said repeated-motion injuries can still take place. “Tennis elbow,” or the overexertion of the ulnar collateral ligament (UCL), though less common in younger athletes, can still take place in all age ranges of pickleball players.

“I’ve seen injuries of repetitive use like tendinopathies and acute injuries like wrist fractures with this sport, as well as exacerbations of common comorbidities like arthritis or back pain —  things that folks have already that are getting exacerbated when they’re playing,” said Dr. Robert Gousse, sports medicine doctor at Sierra Pacific Orthopedics. “It’s really interesting as far as the dynamic and the age range that we’re seeing with pickleball.”

 

The potential cost

While pickleball can be great for those looking to get into a physically active lifestyle, the cost can add up, not only physically but also from a monetary perspective.

A July article published in The Kiplinger Letter noted that insurers have reported a considerable uptick in health care costs, largely due to pickleball-related injuries — to the tune of $500 million in the U.S. this year alone.

“Insurers UnitedHealth and Humana recently warned that a jump in medical costs this year was due to higher-than-expected demand for surgeries and other procedures,” the article reads. “Swiss bank UBS concluded that pickleball is a major culprit and will cost the U.S. between $250 million and $500 million this year.”

The article continues to add that a majority of the injuries in question occur in individuals over 50, estimating approximately 366,000 outpatient visits, as well as 67,000 emergency department visits, in addition to 8,800 outpatient surgeries and 4,700 hospitalizations.

 

How to prevent major issues

What can players do to avoid initial injury and recover from minor injuries on their own?

Dr. Maria Fermoile, doctor of physical therapy at Pro PT and director of the Fresno North Location, said that the issue is less stretching-related and more sudden-movement related, urging players to walk or jog first to loosen up.

“The other issue is moving laterally,” she said. “As we all age we tend to move forward and not side to side; so now all of a sudden you’re out here doing pickleball or tennis and there’s a lot of lateral moves.”

Additionally, Fermoile recommends taking “bursts” in exercise routines, advising players “pick up the pace” for 45-second bursts — walking faster or jogging faster for short periods of time in order to simulate playing out a point on the court.

Additionally, Yu advised any new pickleball players to start thinking about their continued exercise off the court.

“Ease into the game, not only from a learning standpoint, but also physically,” he said. “Your body’s just not in any shape to be cutting and running round a pickleball court at full speed.”