The Rise of Pickleball in the U.S.
It is not surprising to some that pickleball is the fastest growing sport in North America. In the United States, the Sports and Fitness Association noted recently that pickleball grew 51.8% from 2022 to 2023 and a whopping 223.5% over the last three years.
The current number of pickleball players in the US is estimated to be 36.5 million. There are over 10,000 locations to play in the nation. 48.3 million Americans have played pickleball in the last 12 months.
The average age of participation has decreased to 34.8 years of age with the largest group being 25-34 years old. However, this sport remains exceeding popular among older adults with over half of core players aged 55 or older.
Gender distribution shows that men constitute 59.1% and women 40.9% of the community called “Pickleheads”.
The Injury Epidemic in Pickleball
In a study from 2017 to 2022, a reported 6.8-fold increase were seen in hospital emergency rooms and med care centers for pickleball related injuries. These injuries include a myriad of orthopedic related problems, but also ocular, lacerations, fractures, contusions, head injuries, hernias, cardiac related and multiple other organ system dysfunctions.
Why Older Adults Are at Higher Risk
While the sports rapid expansion is particularly notable among the younger age groups, pickleball became popular among older age groups drawn to its cardiovascular benefits, accessibility, ease of learning and adaptability across fitness levels and activity levels. As opposed to other racket sports with larger court sizes, pickleball utilizes a smaller playing field making it easier for the older individuals to participate. One third of pickleball players are currently greater than 65 years old.
While it is generally considered a low impact sport, pickleball involves twisting, jumping, lunging, pivoting and shifting which puts tremendous stress on the body and the joints causing a huge risk on injury especially in the older age groups. Recent reports suggest pickleball related injuries are projected to cost Americans 500 million dollars in 2023 or nearly 10% of total unexpected acute medical costs in the United States.
Demographics and Types of Pickleball Injuries
In a large study examining pickleball related injuries, the mean age at injury was 57-70 years old. This is significantly greater than the mean age of pickleball participants nationally at 36 years. As participation in this sport has increased so have the injuries.
Breakdown of Common Pickleball Injuries
Soft tissue injuries were the most common, with hand, shoulder, wrist and elbow the most common in the upper extremity. Arthritis related pain, back pain and a myriad of lower extremity injuries were also common. As the age of the participants increases, so do fracture related injuries especially in the female population.
In a large medical center, pickleball injuries were classified from 2017 to 2022;
- Rotator cuff strain and tears 67%
- Arthritis related pain 62%
- Back pain 48%
- Calf strain/tear 35%
- Knee sprain 31%
- Hand/wrist fractures 30%
- Achilles tear/strain 27%
- Meniscus tear 27%
- Lateral epicondylitis 20%
- Plantar fasciitis/rupture 19%
- Hip related 18%
- Ankle sprain 16%
- Wrist injury 15%
- Hand injury 14%
- Ankle/foot 11%
- Hip/pelvic fracture 11%
- Hamstring tear 10%
The list continues with multiple fractures, dislocations and tears. Medical injuries include cardiac related chest pain and palpitations, facial lacerations, head injuries, syncope, hypertensive emergencies, hyperthermia and multiple ocular injuries.
Injury Trends by Gender
In injuries by sex, women are 2x more likely to have an injury than men. And in all age groups, women are 2x more likely to sustain fractures than men. Men sustained more soft tissue strains or rupture than women.
Diagnostics and Surgical Trends
Imaging was the most common evaluation after examination. Most injuries received at least one form of x ray, CT, ultrasound or MRI. 16.7% of patients went on to surgical intervention for their injuries. Among the most common surgical procedures, arthroscopic (rotator cuff tears, anterior cruciate reconstruction for example), subacromial decompression, open soft tissue repair (Achilles tendon repair), tendon repair and open reduction and internal fixation (Distal radius fracture for example).
Conventional Treatment Pathways
The most common prescribed treatment is rest.
- Rest – ice and or heat
- Medications such as non-steroidal anti-inflammatory agents
- Referral to a physical therapist for targeted exercise, strengthening and other modalities in their scope of practice.
- Bracing when indicated
- Injections such as steroids to reduce pain and inflammation. However, these types of injections may further damage tissues.
- Surgery if all conservative measures fail or the injury is such that surgery is indicated such as Achilles tendon rupture
If the participant recovers, equipment should be evaluated. For instance, pickleball elbow can occur with an ill-fitting paddle. Shoes should be examined as they can cause injuries and pain in the lower extremity.
If the injury does not resolve, prior to the contemplation of surgery, other regenerative treatments should be explored. These include Platelet Rich Plasma, Shockwave Therapy and Exosomes, as these modalities can stimulate healing and regeneration of tissues.
What Is Platelet Rich Plasma (PRP)?
Platelet Rich Plasma is an autologous blood derived concentrate that is activated to release growth factors, cytokines and bioactive proteins. PRP has been shown to have the capacity to reduce inflammation and improve tissue for regeneration. The use of PRP provides repair of tissues due to its abundant growth factors and cytokines which are key in initiating and modulating microenvironments for soft and hard tissues. Platelet Rich Plasma has been proven in many studies to repair, revive and regenerate damaged tissues especially those involved in sport related trauma. Due to the increase in orthopedic injuries such as those in pickleball, more clinicians have accepted platelet rich plasma as a first line treatment.
Study on PRP for Orthopedic Injuries
Platelet Rich Plasma Therapy in the Treatment of Diseases Associated with Orthopedic Injuries
Tissue Eng Part B Rev 2020 Dec;26(6):571-585 PMID 32380937
Conclusion: In the treatment of acute trauma and chronic nonhealing after acute trauma, such as bone injury, wounds, skeletal muscle, ligament, tendon, articular cartilage lesions, osteoarthritis and nerve injury, platelet rich plasma therapy plays a key role and leads to good outcomes.
Shockwave Therapy for Pickleball Injuries
Extracorporeal shock wave therapy is a non-invasive treatment that utilizes acoustic waves to stimulate intracellular and extracellular reactions to promote healing in damaged tissues. The shockwave induces increased blood circulation reducing inflammation and accelerating tissue regeneration. This accelerated blood flow induces vasodilation and angiogenesis restoring cellular homeostasis. Nerve fibers are overloaded by the wave causing the immediate reduction of pain. Initially used for kidney stone treatment, shockwaves are a stand alone or combination treatment for most musculoskeletal orthopedic conditions.
Study on Shockwave Therapy for Athletes
Use of Extracorporeal Shockwave Therapies for Athletes and Physically Active Individuals: A Systematic Review
Br J Sports Medicine 2024 Feb 7;58(3):154-163 PMID 38228375
Conclusion: ESWT may offer an efficacious treatment alone or as an adjunct to concurrent exercise therapy in sports related injuries and without major adverse events.
Understanding Exosomes and Their Role in Healing
Exosomes are small membrane bound vesicles released by cells into the extracellular space. They act as communicators carrying molecules such as bioactive proteins RNA and DNA. These vesicles are involved in a myriad of physiological processes. They transfer information and molecules between cells. Due to this intracellular communication, exosomes have been utilized as therapeutic agents to effect regeneration of tissues.
Study on Exosomes in Sports Medicine
Recent Advances of Exosomes in Soft Tissue Injuries in Sports Medicine: A Critical Review on Biological and Biomaterial Applications
J Control Release 2023 Dec: 364:90-108 PMID 37866405
Conclusion: Exosomes are the main paracrine factors of mesenchymal stem cells containing biological components such as proteins, nucleic acids and lipids. Compared with mesenchymal stem cells, exosomes possess the capacity to escape phagocytosis and achieve long term circulation in an area. The functions of exosomes from various cell sources in soft tissue injuries in sports medicine have been revealed in recent years. Exosomes have the potential of becoming one of the novel therapeutic modalities in regenerative medicine.
Balancing the Risks and Rewards of Pickleball
This article highlights the emergence of the sport of pickleball and the risks in participation. However, it should be noted there are many benefits to pickleball participation including the physical, mental and social aspects. One study reported that pickleball participation was associated with greater life satisfaction, decreased rates of depression and improved psychological well being across all age groups particularly among older participants. Pickleball participation has been associated with increased health benefits as it add up to 3000 increased steps a day, increased caloric expenditure and cardiovascular benefits. (decreasing blood pressure and decreasing cardiovascular disease overall). The benefits of the sport seem to outweigh the risks. However, if there is an injury, consider newer alternative treatments prior to invasive therapies.
Other Studies
Pickleball Injuries in the Aging Athlete: A Critical Analysis Review- PMID 39445252
Pickleball- and Paddleball-Related Injuries to the Upper Extremity- PMID 37397683
Juventix: Leading the Way in Regenerative Medicine
Juventix Regenerative Medical is an industry leader in the regenerative medical field. Our Platelet Rich Plasma Kits are FDA cleared and designed for safety, sterility and effectiveness. Our kits are scientifically manufactured to provide a platelet concentrate, devoid of red blood cells with a minimum number of leukocytes that are critical for the regenerative process.
Juventix Regenerative Medical offers a patented LED Activator to activate the platelets and begin the regenerative process. The activation is a critical step in the release of growth factors, cytokines and bioactive proteins from the granules that are contained on the platelets and is accomplished with LED light. This negates the use of chemical additives such as Calcium Chloride, Thrombin or Collagen. This mode of activation by LED light provides sustained growth factor release versus older methods of activation while adhering to the minimal manipulation standards of the FDA.
This activation should always be accomplished after the gentle swirl of the centrifuged product to maximize the number of captured platelets.
Juventix Regenerative Medical provides exosomes from our collaboration with Evolutionary Biologics of New York. Juventix is also pleased to offer the PhysioPRO radial shockwave system.
Juventix Regenerative Medical has a vast array of products, services and devices for the medical, orthopedic and regenerative professional. With Platelet Rich Plasma Kits, Exosomes and Shockwave options, Juventix has a triad of treatment options for pickleball injuries without the immediate need for steroid injections or surgical consideration.
With our premier line of products and support from our experienced staff, Juventix Regenerative Medical is poised to aid any professional, whether medical, orthopedic or regenerative to provide treatment options and enhanced clinical outcomes.
Get back onto the court with Juventix Regenerative Medical
RESTORE, REVIVE, REGENERATE- JUVENTIX REGENERATIVE MEDICAL
Regenerative Regards,
Dr. Robert McGrath
