As Pickleball Fever Sweeps In, So Do Emergency Room Visits: JAMA Editorial

Rising Injury Rates and Demographics

Although the player base has expanded, the injury rate has escalated disproportionately. People aged 25 to 34 years constitute the largest group of players, closely followed by those aged 65 years or older. Researchers at Vanderbilt University Medical Center found that a three-fold increase in the number of players resulted in almost a seven-fold increase in the number of injuries, a rise described as alarming.[2]

Musculoskeletal Damage

Musculoskeletal damage is by far the most prevalent type of injury reported in pickleball. A study published in the Journal of the American Academy of Orthopedic Surgeons reported that soft tissue damage, such as a torn meniscus or tendinitis, accounted for more than half of injuries among surveyed players, two-thirds of whom were older than 50 years. Fractures, alongside joint dislocations, accounted for over a third of injuries.[3] A review in Cureus similarly found that strains and sprains were the most commonly reported injuries, followed by fractures.[4]

The severity and type of impairments shifted with age: in players under 60, soft tissue injuries such as sprains, strains, and inflammatory conditions were most common. Conversely, in the over-60 group, there was a transition toward more fractures. Fractured ankles, wrists, and hips often require longer, more invasive interventions for older patients. Women are also more likely to experience fractures, particularly of the wrists.

Ocular Injuries

Ocular injuries represent a growing and concerning trend, with researchers calling the rate of increase alarming. Since cases were first recorded in 2014, an estimated 3,000 eye injuries nationwide have been reported through 2024 via the National Electronic Injury Surveillance System (NEISS) database. A substantial majority of these injuries occurred between 2022 and 2024, with more than a thousand cases in 2024 alone. Over 70% of these injuries occurred in players older than 50 years.

Contrary to expectations that falls would be the primary cause among older players, direct ball injuries were the most common form of ocular damage. The injuries ranged from less severe issues like corneal abrasions or cuts and bruises around the eyes to more serious conditions that carry a higher potential for visual compromise, such as bleeding in the eye, retinal detachments, and fractures of the orbital bones. Even seemingly less serious damage, like posterior vitreous detachment, can potentially lead to retinal tears and subsequent visually threatening pathology such as retinal detachment.

Contributing Risk Factors

Researchers point to multifactorial causes for the injury surge. Age is a key factor, as declining collagen production, reduced muscle mass, and slower reaction times increase the risk of injury and falls. Postmenopausal women face a higher risk for fractured bones due to lower bone density. Many players, especially older participants, may be underestimating the physical demands of pickleball. The game requires extensive lateral movement, stops, and starts, demanding balance, coordination, strength, and hand-eye coordination. These rapid movements can challenge older adults who may be at risk for underlying conditions like arthritis and osteoporosis.

Other factors intrinsic to the game include its fast pace and the small playing area close to the net, which can cause players to rush. Additionally, poorly maintained court surfaces, such as those with cracks or bare spots, increase the risk of falls.

Current Trend in India

India has witnessed a recent surge in pickleball’s popularity, with an estimated 60,000 active players by the end of 2024. The country now boasts more than 1,200 operational pickleball courts, reflecting the sport’s growing popularity and people’s increasing enthusiasm for it. However, as participation rises, so does the number of injuries reported among players. Therefore, effective preventive strategies need to be implemented.