3 Common Pickleball Injuries & How to Fix Them (Shoulder, Elbow & Back Pain)

Pickleball is one of the fastest growing sports today. However, it can also cause aches and pains. This is especially true when we play more often or play competitively due to wear and tear.

As a physical therapist with almost 37 years of experience, I own Aguila Pickleball Physio. I have seen a lot of different injuries in the pickleball players that I work wtih and have also gone through my own injuries!

In this post, I will discuss three common injuries I treat and help players with: shoulder pain, pickleball elbow, and back pain. I’ll walk you through what’s causing these issues and how to fix them so you can stay strong, stable, and pain-free on the court.

1. Shoulder Pain: Understanding Muscular Imbalances

Let’s start with shoulder pain—something I am also personally familiar with. After a car accident, I had rotator cuff injuries and had to undergo rotator cuff surgery. I had suffered a complete supraspinatus tear, along with partial tears in my other rotator cuff muscles. That personal experience transformed how I approach shoulder rehab and prevention today.

Most shoulder pain in pickleball players stems from muscular imbalances. Four muscles make up the rotator cuff: the supraspinatus, infraspinatus, teres minor, and subscapularis. Of these, only two are primarily responsible for external rotation—which is crucial for shoulder stability.

In contrast, five major muscle groups help with internal rotation. These are the pectorals, latissimus dorsi, anterior deltoid, teres major, and subscapularis. This imbalance can pull the shoulder joint out of alignment, creating pinching, grinding, and chronic pain.

Fixing the Issue

The solution and pain relief lies in restoring muscular balance through strengthening and stabilization:

• External rotation exercises using resistance bands at multiple angles.

• Chest-opening stretches to improve range of motion.

• Scapular stabilization drills to keep the glenoid fossa aligned for better shoulder function.

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I personally love a tool called the Shoulder Reliever. It helps activate the rotator cuff and improves posture and muscle use. Even simple clockwise and counterclockwise arm and shoulder motions with it have helped me stay pain-free and improve performance.

Shoulder stability is not just about relieving pain. Shoulder stability is important for almost every shot in pickleball. This includes forehand drives, slices, volleys, and overheads. Without it, your rotator cuff can’t fire correctly, and you risk further injury with every swing.

2. Pickleball Elbow: It's More Than Just the Elbow

The next injury we will discuss is what I call “pickleball elbow.” Also called lateral epicondylitis, this injury causes burning pain on the outer elbow. This pain often happens during backhand drives, low volleys, and dinks.

But here’s the truth: elbow pain is often a downstream effect of poor shoulder or upper body stability. If your shoulder isn’t doing its job, the force transfers down to the elbow—and that’s where players start feeling the pain.

Real Solutions (Not Just Quick Fixes)

• Improve shoulder and proximal stability to take the strain off the elbow.

• Modify your hold or swing technique. Many players feel better when they switch to a two-handed backhand. This method spreads the load more evenly.

• Reduce shock with gear tweaks—adding an overwrap or using vibration-dampening paddle grips can help minimize force transfer.

• Manual therapy and specific exercises: I use my manual therapy skills to break up old scar tissue and inflammation. This can be developed over years of playing. Then I prescribe targeted exercises like:

  • Reverse wrist curls

  • You can strengthen your forearm with a towel-roll exercise. Wrap a towel around a weight. Then, roll it up for controlled resistance training.

You shouldn't have to endure pain in your elbow joint. With the right rehab strategy, you can get back to your game stronger than before.

3. Back Pain: The Hidden Role of Spine & Hip Mobility

Last but not least is back pain, another common issue I treat regularly at Aguila Pickleball Physio. Many of my clients come in concerned about MRI results showing herniated discs. But here’s the reality: disc degeneration is extremely common, especially in players over 60. That doesn’t always mean it’s the source of your pain.

Often, back pain on the court comes from limited hip and thoracic spine mobility, not just lumbar issues. If rotating or bending is difficult, your body attempts to compensate. This is when strain and pain can start.

Key Areas to Address

• Thoracic rotation and extension: Help your upper spine move better. This way, your lower spine is not taking on all the motion.

• Hip mobility: Evaluate and work on both internal and external rotation.

• Core and glute stabilization and strengthening exercises: These help support the spine and reduce overuse of compensating muscles.

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In my practice, I use hands-on manual therapy to improve soft tissue movement. I also focus on strengthening to support and stabilize the back. When these elements come together, my clients often say they are playing better than ever. They are once more clinching tournaments!

Final Thoughts: Stay in the Game, Pain-Free

If you have shoulder pain, elbow problems, or low back discomfort, there is always a solution. This solution relies on biomechanics and muscle balance.

You do not have to accept just temporary relief. True recovery and prevention of overuse injuries come from understanding your body. Train your body to move correctly.

At Aguila Pickleball Physio, I’m here to help you stay on the court longer and play stronger. Are you interested in learning more about how we can work together? Schedule a free consultation here.