Pickleball is the fastest-growing sport in America. Nearly 50 million Americans played in the last 12 months alone. The average age of players is dropping, but the core demographic remains older adults -- active, motivated, and increasingly showing up in emergency rooms.

Pickleball injuries cost the U.S. health system $377 million in 2023. Emergency department visits for pickleball-related injuries increased 91% between 2020 and 2022. Hospital admissions from pickleball injuries increased 257% in the same period. 73% of those injuries occurred in players between 60 and 79 years old.

Pickleball has been very good for hospital and orthopedic revenue.

You don't need to contribute to those numbers.

What's actually causing the injuries

Falls account for 65% of all pickleball injuries. The most common injuries are fractures, strains, and sprains. Wrist fractures from catching a fall. Shoulder injuries from reaching too far. Tennis elbow from swinging with the arm instead of the body. Achilles tears from sudden lateral movement on a court that demands quick changes of direction.

Here's what I see at the court every week: people stretching before the game. Stretching between games. Stretching after. The belief is that tight muscles cause injury and stretching prevents it. The research on this is not what most people think -- static stretching before activity has not been shown to reliably prevent injury. And it completely misses the actual mechanism behind most pickleball injuries.

The injuries aren't happening because muscles are tight. They're happening because players are moving inefficiently. Reaching with the arm instead of the whole body. Swinging from the wrist or elbow instead of the shoulder and pelvis. Lunging for a ball that isn't worth the risk. Going from inactive to high-intensity rotational sport without preparing the nervous system for what's required.

The movement problem nobody is addressing

Pickleball demands quick lateral movement, rotational power, overhead reach, and rapid direction changes. These are complex whole-body movement patterns. And most recreational players arrive at the court with movement habits built up over decades -- compensation patterns, areas of restricted mobility, nervous systems that haven't been asked to coordinate these demands in years.

Stretching doesn't change movement patterns. It temporarily changes muscle length. The pattern underneath -- the habitual way the nervous system organizes the body -- stays exactly as it was.

What changes movement patterns is movement education. Specifically the kind that asks the nervous system to find more efficient options.

Where the swing actually comes from

When I watch recreational pickleball players, the most common thing I see is people playing from their arms. The swing originates at the wrist or elbow. The reach comes from the shoulder alone. The body isn't involved.

The power in any racquet sport comes from the ground up. From how the foot meets the court. From the rotation of the pelvis. From the spine moving through its full range. From the whole kinetic chain working together so that the arm is the last link in a connected movement rather than the only one doing the work.

When the swing comes from the arm alone, the elbow and wrist absorb forces they weren't designed to absorb repeatedly. Tennis elbow -- technically lateral epicondylitis -- is the predictable result. Shoulder impingement follows the same logic. The arm is working too hard because the rest of the body isn't contributing.

Feldenkrais Awareness Through Movement® lessons work on exactly this. Not by drilling the correct technique but by helping the nervous system discover how the whole body can be involved in a movement. When the pelvis participates in the swing, when the reach comes from the foot rather than the arm, when rotation is available throughout the spine -- the arm does less. And the injuries that come from the arm doing too much become far less likely.

Falling safely is a skill

65% of pickleball injuries come from falls. 

Moshe Feldenkrais defined health not as the absence of difficulty but as the ability to be knocked down and return to standing. Not to avoid falling. To fall well and get back up.

Falling safely is a learned skill. The nervous system can be trained to respond to a loss of balance with a protective, efficient response rather than a panicked one that results in a wrist fracture or a shoulder injury. ATM lessons that work on balance, ground contact, and whole-body coordination build exactly this capacity -- not by teaching you not to fall but by teaching your nervous system to respond better when you do.

Balance and proprioception -- the body's sense of where it is in space -- are trainable. And they are what determine whether a stumble becomes a fall, and whether a fall becomes a fracture.

The point isn't worth it

I'll say something that might be unpopular at the court: there are points not worth chasing.

The diving lunge for a ball that's probably out. The sprint to the kitchen line when you're slightly off balance. The overhead smash when your shoulder isn't ready for it. These are the moments that produce the injuries. Not the regular game. The moments when players push past what their body is actually prepared to do.

Part of playing well -- and playing for decades without injury -- is developing the judgment to know which points are worth your body and which ones aren't. Lose the point. You don't need to contribute to medical revenue.

Pickleball injury prevention: what actually works

If you're new to pickleball or returning after time off, the preparation that matters isn't stretching. It's movement pattern work.

Awareness Through Movement® lessons are an ideal on-ramp. They improve balance and proprioception. They build the whole-body coordination that makes a swing efficient and safe. They train the nervous system to organize the body for complex multi-directional movement. And they do all of this gently and progressively, without the injury risk that comes from jumping straight into a sport that demands a lot.

If you already play: a consistent Awareness Through Movement practice alongside your pickleball will build the resilience that makes the game sustainable. Less compensation. More whole-body movement. Better balance. And the judgment that comes from a nervous system that knows what's available to it and what isn't.

Stay on the court. Stay out of the emergency room.

For the research behind the method, visit pauseture.com/research.