The Pickleball Injury Guide: Treating "Pickleball Elbow" & Achilles Strains
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Published in The Ospina Orthopedic Blog ~ 5 min read ~ Last Updated: December 01, 2025
The Rise of Pickleball—and Pickleball Injuries
Pickleball has exploded in popularity, particularly among the "active aging" demographic. It is social, fast-paced, and accessible. However, this surge in participation has led to a parallel rise in orthopedic injuries. In fact, studies estimate that pickleball-related injuries in older adults have increased significantly in recent years, with the majority occurring in players over 60.
Emergency department data reveals a startling trend: injuries in pickleball players aged 60 and older are now on par with tennis-related injuries. The most common injuries include strains, sprains, and fractures, particularly of the lower extremities and wrist. Specifically, older adults (ages 60-79) have significantly increased odds of sustaining wrist/hand injuries (OR 1.47) and fractures (OR 1.75) compared to younger players. Falling is the primary mechanism of injury for this demographic, being 2.10 times more likely in the 60-79 age cohort.
At Ospina Medical, we see a specific pattern of injuries in our pickleball patients: overuse injuries like "Pickleball Elbow" (Lateral Epicondylitis) and acute soft tissue strains, particularly of the Achilles tendon and calf. For the informed athlete who wants to stay active without downtime, the traditional "wait and see" or "cortisone shot" approach is increasingly outdated.
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Why "Pickleball Elbow" Happens (and Why Cortisone Is Not the Fix)
Lateral epicondylitis, commonly known as tennis or pickleball elbow, is a classic overuse injury. The repetitive impact of the paddle, often combined with improper mechanics or grip strength issues, causes micro-tears in the tendons of the forearm where they attach to the elbow.
Historically, the go-to treatment was a cortisone injection. While this potent anti-inflammatory can vanish pain quickly, it does so by shutting down the metabolic activity of the cells. Research now shows that cortisone can actually weaken tendon tissue and increase the risk of recurrence or further degeneration in the long term. A systematic review found that corticosteroid injections were superior to PRP at 1 month, but PRP was significantly more effective at 6 months for both pain reduction and functional improvement.
The Regenerative Alternative:
For persistent tendon pain, PRP by Regenexx is a superior option. Instead of masking the pain, PRP delivers a high concentration of your body’s own platelets to the site of the micro-tears. These platelets release growth factors that support the body's natural healing process, working to strengthen the tendon structure rather than degrade it. A 2024 meta-analysis confirmed that PRP provides better long-term functional improvement and pain relief for lateral epicondylitis compared to corticosteroids.
The Achilles Heel of the Sport
The stop-and-start nature of pickleball, combined with the lunging required near the "kitchen" line, places immense stress on the Achilles tendon and calf muscles. For players over 50, whose tendons may have less elasticity and vascular supply, this creates a vulnerability to strains and, in severe cases, ruptures.
A study comparing ankle movements in pickleball versus tennis found that pickleball involves significantly more "at-risk" movements that can stress the Achilles tendon. Specifically, the rapid transition from a plantar-flexed (toes down) to a dorsiflexed (toes up) position during quick volleys can overload the tendon.
Prevention is key. We advocate for a comprehensive warm-up routine that includes dynamic stretching. However, if you do experience persistent heel pain or a calf strain, it is vital to address it before it becomes a rupture.
Interventional Solutions:
For chronic Achilles tendinopathy, procedures using Bone Marrow Concentrate (containing stem cells) or Platelet-Rich Plasma can be effective. While some systematic reviews show mixed results for PRP in Achilles tendinopathy specifically in older adults 63, our precise, ultrasound-guided approach ensures the biologic is delivered exactly to the site of pathology. Newer research suggests that high-concentration PRP, tailored to the patient's age and condition, may be necessary to overcome the reduced cellular response in older tendons.
Staying in the Game
The goal of sports medicine at Ospina Medical is not just to fix an injury but to keep you playing. We understand that for our patients, pickleball is more than a game—it is a community and a lifestyle.
Our approach combines advanced diagnostics (using high-resolution ultrasound to visualize tendon quality) with regenerative protocols that respect your biology. Whether you are dealing with a nagging elbow or a stiff Achilles, early intervention with the right modality can mean the difference between a few weeks of rehab and months away from the court. If "Pickleball Elbow" or heel pain is affecting your game, schedule a consultation with Dr. Matthew Kohler at Ospina Medical to discuss your non-surgical options.
A Riley Publication ~ Branded Thought Leadership by Riley Partners and Publications, Inc.
Medically Reviewed by: Matthew Kohler, MD