Why Falls, Not Serves, Cause Most Pickleball Injuries — and Shoulder Strength Still Matters

Pickleball looks gentle, but it asks for quick changes of direction, sudden stops and reaches across the court. A misstep on a damp surface, a lunge for a dink or a collision at the net can send you to the ground. The arm often goes out to break the fall, and that is where many shoulder and wrist injuries begin.

So the shoulder is not always the source of the problem. Footing, reaction time and the ability to recover balance matter a great deal. A strong, well-controlled shoulder may help you steady yourself, though the data above does not test that.

This is a pattern across the data, not a verdict on any one player. Your own risk depends on your health, your court and how you play.

• Pickleball upper-extremity injuries rose significantly over a decade, and they were highest in older adults and women [R31].
• Emergency room visits for pickleball rose sharply after 2020. Adults aged 50 and older accounted for 91% of reported injuries, falls were the most common mechanism, and sprains, strains and fractures were the most common types [R32].
• An earlier analysis, published as a preprint, found that among players aged 60 and older, strains and sprains made up 33% of injuries and fractures made up 28% [R33].
• A South Korean study found self-reported injuries most often at the knee, elbow and shoulder, and age was a documented risk factor [R34].
• For adults 65 and older, the WHO recommends multicomponent activity that emphasizes functional balance and strength on at least three days a week [R07].

1. Warm up for five minutes courtside. Walk, swing your arms gently and take a few small side steps. Do not jump in cold.
2. Practise balance on the court. Seated option: sit tall in a chair and lift one foot slightly, then the other, while you breathe steadily. Stand and do the same if you are steady.
3. Keep your footwork low and wide. Bend your knees, keep your feet under you, and avoid reaching far beyond your base.
4. Train the shoulder blade. Seated option: sit tall and draw your shoulder blades back and down, then let them release. Many coaches use this to build control for reaching.
5. Protect the arm when you fall. Learn to fall onto a bent knee and roll rather than straight onto an outstretched hand.
6. Rest when fatigue shows. Tired legs and shoulders are a common setting for mistakes. Stepping off the court is a smart choice.

For a fuller pre-play routine, read our pickleball warm-up for players over 50. You can also explore what the pickleball injury data says and pickleball shoulder pain from overheads and dinks.