Pickleball Injuries: Treatment Without Surgery

Pickleball is the fastest-growing sport in the United States. The Sarasota-Bradenton area is one of the top pickleball markets in the country — with courts at community centers, recreation facilities, and dedicated clubs throughout the region.

As more people play, more people get hurt. Pickleball injuries have increased sharply alongside the sport's popularity, and they present a specific clinical challenge: most of the patients we see are active, motivated adults who want to get back on the court — not sit through months of rest or accept that their playing days are over.

At AcuMed Clinic in Sarasota, we treat pickleball injuries with a toolkit that does not begin and end with cortisone injections or surgical referrals. This article explains the four most common pickleball injuries, why they happen, the limits of conventional approaches, and how our integrative methods address them.

Why Pickleball Produces These Injuries

Pickleball involves rapid changes of direction, overhead arm movements, repetitive wrist and forearm loading, pivoting and lateral movement on hard court surfaces, and frequent deceleration under load. The sport is often played by adults who are returning to regular athletic activity after years of lower activity levels, which means their connective tissue, tendons, and joints may not be conditioned for the demands the game places on them.

The 4 Most Common Pickleball Injuries

1. Pickleball Elbow (Lateral Epicondylitis)

Pickleball elbow — sometimes called tennis elbow — is the single most common pickleball injury. It involves pain and tenderness on the outer side of the elbow, where the tendons of the forearm extensor muscles attach to the lateral epicondyle of the humerus.

Why it happens. The pickleball paddle requires constant wrist and forearm engagement. Dinking, driving, and especially the hard backhand drive create repeated loading of the wrist extensor tendons. Over time, this loading exceeds what the tissue can repair between sessions, and a degenerative process called tendinopathy develops.

Why cortisone has limits here. Cortisone injections can provide meaningful short-term pain relief. But multiple studies have shown that while cortisone injections outperform other treatments at four to six weeks, by six to twelve months patients who received cortisone fare worse than those who received no injection at all. The proposed reason is that repeated cortisone exposure weakens the collagen structure of the tendon, accelerating the very degeneration it was meant to relieve.

How we treat it. Our approach combines acupuncture to target local tendon points and downregulate sensitized pain signals, trigger point injection therapy for the myofascial component, laser therapy to stimulate cellular regeneration in the tendon tissue, ultrasound therapy to promote healing and reduce fibrosis, and manual therapy to address joint mechanics of the elbow, wrist, and cervical spine.

2. Shoulder Injuries

The pickleball overhead places significant demand on the rotator cuff and surrounding structures. Common shoulder injuries in pickleball players include rotator cuff tendinopathy, subacromial impingement, biceps tendinopathy, and shoulder bursitis.

Why they happen. Many pickleball players have not specifically trained the rotator cuff. They may bring considerable power from the larger muscles while the stabilizing rotator cuff lags behind — a mismatch that puts tendons and bursae under repeated stress.

How we treat it. Shoulder injuries respond well to acupuncture combined with laser therapy, manual therapy targeting both the shoulder joint and the cervical and thoracic spine, and exercise guidance to address the muscular imbalances driving the problem.

3. Knee Injuries

Pickleball involves a lot of bending, quick pivoting, and lateral movement — all of which load the knee significantly. Common knee injuries include patellar tendinopathy, IT band syndrome, knee osteoarthritis flares, and meniscal irritation from repetitive pivoting on hard surfaces.

Acupuncture for knee pain has one of the strongest evidence bases in the entire acupuncture literature — it is among the conditions most consistently supported by clinical trials. At AcuMed, we combine acupuncture with laser therapy, manual therapy addressing the hip and lumbar contributions to knee mechanics, and trigger point work for the muscles that pull on the knee joint.

4. Achilles Tendinopathy

The Achilles tendon is responsible for the explosive push-off and rapid deceleration that characterize pickleball movement. Achilles tendinopathy develops when load accumulates faster than the tendon can adapt and repair.

A critical warning about cortisone injections and the Achilles tendon. Cortisone injections near the Achilles tendon carry a well-documented risk of Achilles tendon rupture. The mechanism is the same as with lateral epicondylitis — cortisone weakens collagen structure — but at the Achilles, the consequences of rupture are far more serious: complete surgical repair, immobilization for weeks, and months of rehabilitation with outcomes that are rarely as good as the pre-rupture baseline. Multiple clinical guidelines now advise against cortisone injection near the Achilles tendon for this reason.

How we treat it. Achilles tendinopathy responds to acupuncture, laser therapy, manual therapy targeting the calf and lower kinetic chain, and load management guidance. Complete rest is rarely the answer for tendinopathy — the tendon needs appropriate load to remodel. The goal is finding the right level of activity that promotes healing without re-injuring the tissue.

The AcuMed Approach

What distinguishes AcuMed Clinic is not just what we do, but how we think about these injuries. Pickleball injuries tend to be tendon and connective tissue problems that do not respond well to the standard inflammation-and-rest model because most of them are not primarily inflammatory — they are degenerative. They need regeneration, not just rest.

Our toolkit includes:

• Acupuncture — for pain modulation, local tissue stimulation, and nervous system regulation
• Trigger point injection therapy — for myofascial components that perpetuate joint and tendon pain
• Laser therapy — for cellular regeneration in tendon and joint tissue
• Ultrasound therapy — for deep tissue healing and scar tissue management
• Manual therapy — for joint mechanics and soft tissue restrictions

We accept commercial insurance, VA Community Care, and Medicare. Learn more on our VA Community Care page or our Medicare coverage page.

Frequently Asked Questions

How long does it take to recover from pickleball elbow?

Recent-onset cases often respond within four to six weeks of consistent treatment. Long-standing cases may take twelve weeks or more. The encouraging news is that most patients are able to continue playing at a modified level throughout recovery.

I have already had a cortisone injection. Can you still help?

Yes. A history of cortisone injection does not preclude treatment at AcuMed Clinic. If you have had multiple cortisone injections without lasting benefit, that is a strong signal the underlying problem is degenerative — and a regenerative approach may be exactly what you need.

Can acupuncture help knee osteoarthritis in addition to sports injuries?

Yes. Acupuncture for knee osteoarthritis is one of the best-supported applications in the clinical literature, with multiple systematic reviews finding meaningful reductions in pain and improvements in function.

Do I need a referral to be seen at AcuMed?

In most cases, no. You can contact us directly to schedule an evaluation. VA Community Care patients typically need a referral from their VA primary care provider; our team can help you navigate that process.

Can I keep playing pickleball while I am being treated?

In many cases, yes — with modifications. We will give you specific guidance based on your injury and current treatment phase, including what level of play is appropriate and what technique adjustments reduce strain on the injured structure.

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Visit our conditions page for more on the musculoskeletal conditions we treat, and our blog for additional evidence-based resources.