Pickleball Shoulder Pain: Overheads, Dinks and the Overuse Trap

Pickleball asks the shoulder to do several things. Overhead serves and smashes take the arm above the shoulder. Dinks, the soft shots played near the net, involve many small, repeated arm movements. Quick side steps and reaching wide add sudden loads.

The overuse trap happens when players add more hours and more intensity while their strength and endurance lag behind. Rest days shrink, and the shoulder gets less time to adapt.

• Upper-body injuries are rising. A 10-year US analysis found upper-extremity injuries rose significantly from 2014 to 2023. They were highest in older adults and women [R31].
• Older players are most affected. Emergency visits for pickleball rose sharply after 2020. Adults 50 and older made up 91% of reported injuries, and falls were the most common cause [R32].
• Sprains and fractures are common. Among players 60 and older in an earlier US study, strains and sprains were about a third of injuries and fractures about a quarter [R33].
• The shoulder is not the only area. In a South Korean study of self-reported injuries, the knee was most common at 23%, followed by the elbow and forearm at 18%. The shoulder and upper arm came next at 17% [R34].

These studies count injuries. They do not show which exercises prevent them. Falls and knees matter as much as the shoulder in this data.

• Progressive resistance probably helps shoulder pain. Exercise with resistance that builds gradually is the type most likely to help, while gentle movement alone probably does not move the needle much [R01].
• Warm-up and balance matter. Because falls cause many reported injuries [R32], practice in footwork and balance is worth including alongside shoulder work.

1. Plan rest days. Keep at least one lighter or rest day between long play sessions.
2. Build up slowly. Add play time gradually, rather than doubling your weekly hours in one go.
3. Build shoulder control seated first. A seated high-shelf reach, with the other arm gently resisting, loads the shoulder without a weight. Progress by resisting harder, reaching through more range, or doing longer sets.
4. Shorten your swing for dinks. Keep the elbow close to your body and let the paddle do less of the work.
5. Practise footwork and balance. Light side steps and split-step practice reduce the chance of a fall. Seated reaches while holding a sturdy chair are a good option if standing balance is a concern.
6. Use strength work across the week. WHO guidance recommends muscle-strengthening activity on at least two days a week for adults [R07].