Common Pickleball Knee Injuries and How to Prevent Them
Pickleball knee injuries have shifted from general soreness to more structural injuries as the game has become faster and more reactive. This article covers the most common knee injuries seen in pickleball players, including meniscus tears, MCL injuries, ACL tears, tendon irritation, and joint inflammation.
The article explains common warning signs, expected recovery considerations, and how movement patterns influence injury risk. It also outlines practical prevention strategies such as footwear, strength training, and warm-ups.
Players dealing with recurring symptoms may benefit from a thorough Assessment to identify contributing movement, strength, and load tolerance factors.
6 min Read
As pickleball has evolved into a more dynamic, fast-paced sport, I've been seeing a shift in the types of injuries occurring. Before it was just general knee soreness and discomfort that come with playing on hard surfaces. But now I’m seeing more ligament and meniscus injuries, the kind that come from cutting, twisting, and making sharp, reactive movements on the court.
For that reason I want to walk you through the most common knee injuries I'm seeing in pickleball players currently, what to watch out for, and, most importantly, how to keep yourself on the court.
(If you haven't already, check out my previous post specifically on meniscus injuries in pickleball, it goes deeper on that one. Go read that now
The Most Common Knee Injuries in Pickleball
Meniscus Tears
The meniscus is the spongy cartilage that sits between the two bones of your knee, acting as a cushion and shock absorber. When you cut, pivot, or twist quickly, all very common in pickleball, that cushion can get pinched and tear.
The severity varies quite a bit. Some tears are stable and respond well to a general rehab protocol, getting you back on the court fairly quickly. Others are more serious and require surgical attention.
Signs you should get it checked out sooner rather than later:
- Significant swelling
- Feelings of instability when walking, turning, or twisting
- Locking, clicking, popping, or snapping sensations in the knee
If any of those are present, don't wait, go see your local Certified athletic trainer or orthopedic physician for an evaluation.
MCL Tears
The MCL (medial collateral ligament) runs along the inside of the knee and can be injured in the same kinds of twisting or pivoting moments that cause meniscus tears. When it's injured, the medial (inside part of your knee closest to your other leg) can feel, unstable, and like it might give way.
Unlike meniscus injuries, MCL tears don't typically produce that clicking or locking sensation. The main red flag here is instability, a feeling that your knee is going to give!
Treatment: Rehab is the primary course of action for MCL tears. Depending on severity, most players can expect 3–6 weeks of rehab before returning to the court. Only recently have doctors started to consider surgery for severe tears, and still most opt for conservative rehab programs.
ACL Tears
ACL (anterior cruciate ligament) tears are also on the rise recently. They also tend to happen during pivoting, cutting, or stopping-short movements, again exactly the kinds of plays that pickleball increasingly demands.
Historically, ACL tears almost always led to surgery. That's no longer the case. There's a growing body of evidence supporting conservative (non-surgical) rehab protocols, and I've seen players return to play successfully without surgery. That said, the rehab process is significant either way, I've seen timelines anywhere from 4 months on the short end to 10–12 months on the longer end.
The key in both surgical and non-surgical cases is building strength around the knee and hip to compensate for the reduced stability the ligament used to provide. Either way, rehab is the key to successfully returning to play and you need to be diligent with it!
Patellar Tendonitis and Patellofemoral Pain
These are some of the more common “overuse” type knee issues in pickleball, and they're usually rooted in tightness or weakness in the hip, not the knee itself. When the muscles and tissues around the hip aren't doing their job, the kneecap doesn't track properly in its groove, leading to irritation and pain.
There's also usually a neurological or visceral protection pattern component to this. If you haven't read my post on the hierarchy of protection, it’s worth reading now.
The fix here is rehab and strengthening: core stability, hip strength, and foot and ankle work all play a role in making sure your knee tracks the way it should. But only after the protection pattern is addressed!
General Joint Irritation from Hard Court Play
Sometimes it's not a specific injury, it's just the cumulative load of playing on hard surfaces for hours on end. That pounding can cause an inflammatory response in the knee joint. This is especially true for new players. They start playing, get addicted and go from never being on a hard court to playing every day!
If this sounds like you, the answer isn't to stop playing, it's to build up your tolerance gradually. Think of it like a progressive training program: ease into court time, add load slowly, and let your body adapt. Going from zero to five hours of pickleball five days a week is a recipe for inflammation. Give your joints time to acclimate.
How to Prevent Knee Injuries
1. Wear the Right Shoes
This one is first on the list because it might be the most overlooked. Court shoes exist for a reason, They're designed for the lateral cuts, pivots, and quick direction changes that pickleball demands. Running shoes you know, cushy Hoka like shoes are not great for pickleball.They are built for forward motion. They don't provide the lateral stability your foot and ankle need, which puts your knee in a mechanically vulnerable position every time you move sideways or twist.
If you're playing pickleball in running shoes, switching to proper court shoes is one of the single best things you can do to protect your knees.
2. Build a Strength Program
Playing pickleball is not the same as training for pickleball. Hours on the court will only build minimal fitness, but they won't address the specific strength demands the sport places on your body. When you're in a ready position, knees bent, hips low, you're asking a lot of your entire body, but specifically from your core down to your feet.
A dedicated strength program two to three times per week is ideal. Focus on:
- Core stability
- Hip strength (glutes, hip flexors, abductors)
- Knee stability(quads, hamstrings)
- Foot and ankle strength
- Even some light plyos to prep you for quick movements
These are currently my favortite core strengthening movement! There is more here than meets the eye!
There is a lot more lateral movement in the current version of pickleball than previously! Let’s get good and strong moving side to side!
Think of these as a lunge plus! These just get you moving a little bit more…but they require a lot more stability, and eccentric work. I LOVE these!
If you are flat footed you are already beat in pickleball today. You need to be able to stay on your toes and control your movement. This works on both of those!
Even one day of targeted strength work per week is meaningfully better than none, and the benefits extend well beyond the court.
3. Warm Up Properly
A real warm-up is not breaking a light sweat. It's not hitting three dinks and declaring yourself ready. It's preparing your body, and your brain, for the demands you're about to place on them.
I'll be the first to admit, we have all done this, you show up to the court, they need a fourth, and suddenly you're in the middle of a game with cold muscles. That's exactly when injuries happen.
Don’t skip this part! Get your joints moving, activate the muscles you'll be relying on, get your brain ready for what you're about to do. It makes a real difference.
That’s exactly why I put together this Pickleball Warm-Up Guide. Download it, save it to your phone, and keep it with you for court days.
A few minutes before play can make a big difference.
When to Seek Further Attention
As a general rule, see a physician if you experience:
- Unusual clicking, popping, snapping, or locking sensations
- Significant feelings of instability or giving way
- Substantial swelling
For more general soreness, discomfort, or pain without those red flags, seeing your athletic trainer is a great first step. A good rehab program can get you back on the court faster.
Need Help With Knee Pain From Pickleball?
If you're in the Redondo Beach or South Bay area and:
your knee pain keeps coming back
you're unsure whether it’s strength, load, protection patterns, or something else
you want to stay on the court longer
Learn more about my Athlete Rehab and Sports Injury Prevention
This isn’t a quick screen.
It’s a deep dive into movement, protection patterns, strength, load tolerance, and how your body is functioning so you can move better and keep playing.