Pickleball courts are packed with new players every year.
Along with the fun comes a real number of trips to the emergency room.
Dr Barb Wally, a physical therapist who posts online, closed out a five part video series on this exact problem.
Her final video is called “Final Notes to Pickleball Injury Prevention, Part 5.”
We checked the science behind pickleball injuries and behind Dr Wally herself.
Here is what the research actually shows.
What the Video Claims
This video is the closing chapter of a five part injury prevention series from the Dr Barb Wally, LLC channel.
Since it wraps up a longer series, it does not introduce one single new claim to fact check.
Instead it offers general wrap up advice on avoiding pickleball injuries, the kind any physical therapist might give a patient.
We treated it as a general pickleball injury prevention topic rather than trying to isolate one number from the video itself.
We could confirm real things about the presenter, and we want to be upfront about the limits of that check.
The channel’s own About page describes Barbara as a Doctor of Physical Therapy who has practiced since 2010 and who moved into telehealth and video content in 2025.
A search of the federal National Provider Identifier registry turned up an active, licensed physical therapist in Pennsylvania.
Her name is listed as Barbara Wally Slowik, with a specialty in orthopedic physical therapy and an active state license.
The first and middle names, the DPT credential, and the specialty all line up closely with the “Dr Barb Wally” name used on the channel.
We were not able to independently confirm that this exact NPI record and the YouTube presenter are the same person.
That link rests on a name and credential match, not a confirmed one to one identity check.
The American Physical Therapy Association’s ChoosePT directory lists Barbara Jean Wally, PT, DPT, and the Dr Barb Wally, LLC practice. That independently supports the presenter and practice connection, though it is not a review of every claim in the video.
What Real Research Shows About How Often These Injuries Happen
Pickleball injury research is still a small field, but it is a real and growing one.
A 2021 study in the journal Injury Epidemiology pulled data from the federal injury surveillance system that emergency rooms report to.
Among players age 60 and older, the researchers estimated close to 29,000 pickleball injuries treated in United States emergency rooms across the study years.
That number had already caught up to senior tennis injuries by 2018, even though far more people play tennis overall.
A separate 2025 study looked at emergency room visits for pickleball from 2004 through 2023.
That study estimated close to 100,000 pickleball related injuries nationally over that period, with fractures as the single most common diagnosis.
Falling straight onto the court, not getting hit by a ball or paddle, caused roughly half of those injuries.
Researchers found that nearly half of all pickleball injuries treated in emergency rooms came from players falling straight onto the court, not from being struck by a ball or paddle.
An earlier 2020 study in The Journal of Emergency Medicine reached a similar conclusion using an earlier slice of the same national data.
All three studies point the same direction: injuries are climbing as the sport grows, and falls are doing most of the damage.
What Real Research Shows About Upper Body Injuries
A 2025 survey study published in the Journal of Functional Morphology and Kinesiology asked 253 recreational players about their injury history.
About 41 percent reported at least one upper extremity injury in this self selected survey; it is not a population wide injury rate.
The elbow was the single most common trouble spot, mostly on the outside of the joint, the same area affected by classic tennis elbow.
The shoulder and wrist showed up often too, especially as sudden strains rather than slow overuse pain.
The same researchers found real patterns behind who got hurt.
Playing more than two hours in one sitting was associated with about 2.4 times the risk of a reported acute upper extremity injury in this survey.
Playing on consecutive days was associated with about five times the risk of a reported acute upper extremity injury in this sample. The confidence interval was wide, and this association does not prove that the schedule caused the injury.
In one small self reported survey, consecutive day play was associated with higher acute upper extremity injury risk. It was not a controlled test of rest days.
A tight grip on baseline shots was also associated with roughly 2.7 times the risk of a reported acute upper extremity injury in that survey.
Interestingly, the researchers found no clear benefit from general stretching or strengthening in their sample.
That does not mean warming up is useless, and we cover why in the caveats section below.
What Real Research Shows About Falls and Lower Body Injuries
A 2026 systematic review in the journal Cureus pulled together 15 separate studies on lower body pickleball injuries.
Sprains, strains, and fractures topped the list, and the review also flagged a small but serious number of Achilles tendon ruptures.
Falling was named as the single leading cause of these injuries across the studies reviewed.
Running backward, lunging for a short shot, and rolling an ankle inward were the next most common mechanisms.
Age 50 and older showed up as a consistent risk factor across nearly every study in that review.
The review also found that women were more likely than men to suffer a fracture specifically, even though men reported more total injuries overall.
That pattern matches the 2021 senior injury study, which found women were roughly nine times more likely than men to fracture a wrist in a pickleball fall.
Anyone recovering from a joint replacement or a major lower body injury should weigh that fall risk carefully before rushing back into fast paced rallies.
Our piece on what real hip replacement recovery actually takes covers how gradual that kind of return to sport needs to be.
What Real Research Shows About Who Gets Hurt Most
A 2024 systematic review and meta analysis in the journal Health, Sport, Rehabilitation looked specifically at what predicts pickleball injury.
The researchers combined findings from six studies that met their quality standards.
Age, sex, technique, warm up habits, and court surface all came up as contributing factors.
But one factor stood out above the rest: a previous injury was the single strongest predictor of a new one.
A 2023 narrative review in Cureus focused specifically on older adults taking up the sport.
The authors noted that many new pickleball players are older adults who were previously sedentary before picking up a paddle.
That combination, a fast reactive sport plus a body that has not trained in years, is exactly the setup injury researchers keep flagging as risky.
The same review still framed pickleball as a genuinely good option for getting inactive older adults moving again, injuries and all.
The Mechanism
Pickleball courts are small, which is part of the appeal and part of the risk.
Players stand close to the net for fast paced volleys, then have to sprint backward for a lob a second later.
Moving backward for a lob is one plausible way to fall, but emergency department data alone cannot tell us what fraction of falls happened during that specific move.
Running backward is mechanically harder to control than running forward, especially for someone who has not trained agility in years.
Repeated hitting can load the forearm tendons involved in lateral elbow pain, often called tennis elbow.
A tight grip, the kind players use when they are nervous or new, transfers even more of that shock straight into the elbow with every hit.
For older adults, bone density plays a role too.
A fall that would just bruise a 30 year old can fracture a wrist in someone whose bones have already thinned with age.
And because pickleball rallies come in short, intense bursts, the heart has to shift gears quickly, which matters for anyone with underlying heart disease, something we return to below.
What This Evidence Does Not Prove
None of these studies prove that any single tip, including anything said in Dr Wally’s video, will personally prevent your injury.
The national injury data comes from emergency rooms only, so it almost certainly misses the much larger number of sprains and strains handled at home or in a physical therapy clinic.
Most of the risk factor research is observational, meaning it can show a pattern without proving the cause.
A tight grip and more injuries showing up together does not fully prove the grip itself is the cause, though it is a reasonable and common sense target for coaching.
The finding that stretching and strengthening showed no benefit came from one small self reported survey, not a controlled trial designed to test exercise programs.
That is a thin basis for concluding warm ups do not matter, especially given decades of broader sports medicine research showing they generally do.
The systematic reviews here are also built from a small stack of pickleball specific studies, sometimes as few as six.
That is because the sport is young, and the research is still catching up to it.
Common Mistakes
Skipping a warm up and walking straight onto the court cold is one of the most common mistakes new players make.
Backpedaling flat footed toward the baseline for a lob, instead of turning the hips and running, is a classic setup for a fall.
Playing through an old ankle or shoulder injury without addressing it first ignores the single strongest risk factor the research has found.
Gripping the paddle in a tight fist, rather than a relaxed hand, adds unnecessary strain to the elbow with every shot.
Playing several days in a row with no rest day between sessions is another common and avoidable mistake.
Skipping eye protection is a smaller but real risk.
A pair of published case reports described two adults who suffered retinal tears from blunt eye trauma during pickleball while playing without any eye protection.
Jumping straight into competitive, fast paced games as a complete beginner, rather than easing in with slower drills, is another common mistake.
Who Should Be Extra Careful
Older adults who were sedentary before starting pickleball should ease in slowly rather than diving into full speed games right away.
Anyone with a history of ankle, wrist, or shoulder injury should treat that joint as a known weak point, not old news.
People with osteoporosis or low bone density should be aware that a routine fall carries a higher fracture risk for them than for a younger, denser skeleton.
Anyone with heart disease, high blood pressure, or other cardiovascular risk factors should talk with a doctor before jumping into a sport built around short, intense bursts of effort.
Building basic strength ahead of time is one practical way to prepare joints and connective tissue for that kind of load.
Our breakdown of what strength training actually does for an aging body covers why that matters beyond just muscle size.
Checking your baseline cardiovascular fitness first is worth doing too.
A simple test like the one in our piece on the four flight stair climbing test can give a rough read on how your heart handles sudden effort.
A Practical Takeaway
Start with a brief, comfortable dynamic warm up, such as easy walking, side steps, and controlled practice swings. If static stretching feels useful, save longer holds for after play; that timing is practical coaching advice, not a pickleball specific injury prevention result proven by the studies above.
Practice moving your feet backward with a turn and a run, not a flat footed backpedal, before you need to do it during a real point.
Build in at least one rest day between sessions, especially in your first few months of playing.
Hold the paddle with a relaxed grip instead of a tight fist to reduce the strain on your elbow.
Wear real athletic shoes built for lateral movement, not running shoes or flat soled sneakers.
Consider eye protection, especially if you already have any retinal risk factors.
Treat any old joint injury as something to rehab first, not something to play through.
General strength work may help players prepare for the demands of the game, but the small pickleball survey did not prove a specific strengthening program prevents injury. Hydration and sufficient food support participation and recovery; neither has been shown here to prevent a particular pickleball injury. Equipment matters too: choose a comfortable paddle and court shoes that grip during lateral movement without catching excessively.
Our look at why readers increasingly favor weightlifting over running touches on why resistance work pays off for joint durability, not just for looks.
Preserving muscle mass as you age also matters here, since our article on losing weight without losing muscle mass explains how thinning muscle around a joint raises injury risk during any fall.
On shots such as the dink and smash, practice comfortable footwork and swing mechanics before increasing speed or volume. These steps are reasonable precautions, not guarantees that an injury will be prevented.
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References
Atkinson, C. F., Patron, M. E., & Joondeph, B. C. (2020). Retinal tears due to pickleball injury. Retinal Cases & Brief Reports, 16(3), 312 to 313. https://doi.org/10.1097/icb.0000000000000965
Forrester, M. B. (2020). Pickleball related injuries treated in emergency departments. The Journal of Emergency Medicine, 58(2), 275 to 279. https://doi.org/10.1016/j.jemermed.2019.09.016
Hanks, J., & Myers, B. (2025). Risk of upper extremity injury in recreational pickleball players. Journal of Functional Morphology and Kinesiology, 10(3), 247. https://doi.org/10.3390/jfmk10030247
Lee, P. M., Nishi, R., Obana, K. K., Chan, S. M., You, J. K., Weiss, J. M., Levine, W. N., & Trofa, D. P. (2025). Pickleball related geriatric fractures and pediatric equipment related injuries are increasing in emergency departments across the United States. Arthroscopy, Sports Medicine, and Rehabilitation, 7(5), 101228. https://doi.org/10.1016/j.asmr.2025.101228
Okhovat, A., Ferkel, E., & Richards, S. A. (2026). Lower extremity injuries in adult pickleball players: A systematic review of injury types, mechanisms, and risk factors. Cureus, 18(5), e108841. https://doi.org/10.7759/cureus.108841
Pergolizzi, J. V., Matera, J., & LeQuang, J. A. K. (2023). Treating geriatric sports injury among pickleball players: A narrative review of an exercise craze among seniors. Cureus, 15(12), e49909. https://doi.org/10.7759/cureus.49909
Prayudho, S., Nasrulloh, A., & Skaliy, A. (2024). Risk factor of pickleball injury: Systematic review and meta analysis. Health, Sport, Rehabilitation, 10(3), 115 to 124. https://doi.org/10.58962/hsr.2024.10.3.115-124
Weiss, H., Dougherty, J., & DiMaggio, C. (2021). Nonfatal senior pickleball and tennis related injuries treated in United States emergency departments, 2010 to 2019. Injury Epidemiology, 8, 34. https://doi.org/10.1186/s40621-021-00327-9
This article is for general information only and is not medical advice. If you have an injury, ongoing pain, or a medical condition, talk to a doctor or physical therapist before you change how you train or eat.
