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  • Writer's pictureDr. Patrick Thompson, PT, DPT, OCS, Dip. Osteopractic

Shoulder Pain and Pickleball

Pickleball Shoulder Pain Rotator Cuff Injury The Woodlands, TX
Shoulder Pain and Pickleball - Why are these injuries so common?

It is safe to say that Pickleball is here to stay! Sure, the game began to make waves over a decade ago - but most people wrote it off as a passing fad or a sport for “old people.” But years have gone by, and Pickleball has only grown in popularity and continues to be the fastest growing sport in the country. 

This is likely due to the fact that Pickleball can be enjoyed by people of all ages, athletic abilities, and skill levels - thus making the game accessible to all. It is great for active outings with friends and provides a great full body workout! 

However, with this increase in popularity and participation, comes the introduction of athletic injuries to Pickleballers across the country. The addictiveness of the sport, ironically, can lead to many athletes attempting to play through nagging injuries - ultimately leading to more severe injuries or overuse injuries. 

Of particular interest to Pickleballers, are shoulder injuries. It is easy to understand how long days of Pickleballing can lead to shoulder pain - whether it be from hours of swinging your paddle or a powerful overhead smash.  

The shoulder is a complex joint in the body and is susceptible to injury when repetitive overhead motions are performed - before we take a closer look at Pickleball-induced shoulder pain, let's take a closer look at the shoulder itself. 

Anatomy of the Shoulder

The shoulder is a ball and socket joint. The “ball” is the head of the humerus (arm bone) and the “socket” is the glenoid of the scapula (shoulder blade). A ball and socket joint  is a special type of joint in the body - along with the hip joint - that allows for maximal movement in many directions. This shape is the reason the shoulder has so many degrees of freedom compared to a hinge joint such as the elbow. And while the amount of movement allowed at the shoulder has many advantages, the shoulder joint is inherently unstable to allow this motion. Because of this, the muscles of the shoulder girdle play a large role in providing dynamic stability to the joint. (The shoulder does, of course, have ligaments that provide static stability which can play a role in an injury - but that is a different blog topic).

This is one of the reasons that after a Pickleball Tournament or weeks of consistent Pickleballing with friends, that a variety of shoulder diagnoses can arise due to a muscular imbalance from fatigue or overuse injury. 

Next, let’s take a closer look at a few of the common Pickleball injuries affecting the shoulder. 

Common Sources of Shoulder Pain due to Pickleball

Rotator Cuff Strain/Tendonitis

  • Ahh the infamous Rotator Cuff Injury - one of the most misunderstood injuries and commonly misdiagnosed by “Street MDs” and “Dr. Google.” To keep it brief the rotator cuff is a series of 4 muscles in the shoulder that assist the shoulder with both rotation and keeping the “ball in the socket” of the shoulder with overhead activities. Being that many repeated rotational movements and overhead movements occur in Pickleball, the tendons of the rotator cuff muscles can become inflamed and irritated, thus causing pain.


  • Impingement can occur when one of the muscles of the rotator cuff gets inflamed and subsequently gets pinched up against a part of the Scapula. Impingement can present as a sharp “stab” at the front of the shoulder with overhead motions or when reaching across your body. 


  • Bursitis can occur when one of the bursae in the shoulder gets inflamed from sudden overuse or direct trauma. There are many bursae in the body, mostly at points of high friction near and around joints. I like to visualize a bursa as an empty water balloon (barely filled with water) that reduces friction during movement. When a bursa gets inflamed, the “water balloon fills up with water” and becomes painful to touch and negatively impacts movement and strength.

Labrum Injury/FOOSH Injury

  • Since the ball and joint socket is so shallow - much like a golf ball sitting on a golf tee - the joint needs a little extra depth to assist in stability. This stability comes in the form of the shoulder labrum. Think of it as an extra rim on the outside edge of a golf tee to help the golf ball sit a little easier. The labrum does have muscular attachments and can be injured with forceful movements and direct trauma. Direct trauma to the shoulder can occur during a FOOSH injury (Falling On an OutStretched Hand) where the ball jams into the socket when you fall onto your hand/elbow/shoulder. 

How to Prevent Shoulder Injuries while playing Pickleball

Cross Training/Routine Exercise

  • Staying and being active every day is not only encouraged, but is a staple of a healthy lifestyle; however, it can also be a recipe for overuse injuries if the same structures/muscles/tendons are repeatedly stressed. The easiest, and most exciting way to prevent an overuse injury is to cross train with a variety of styles of exercise and activities. 

Dynamic Warm Up

  • Regardless of age, priming your muscles and joints for exercise is key to muscular health and injury free activity. So before you start your first game of the day, take extra time to perform a full body dynamic warm up to set yourself up for success. 

Hydrate, Hydrate, Hydrate

  • While this seems like an obvious statement because we all know we should be drinking water throughout the day to stay hydrated, the importance as this relates specifically to tendon/muscular health is often understated. There are countless studies that highlight the mechanical changes that occur within the tendon when a person is hydrated versus dehydrated. To stay brief, the less water content (dehydrated) a tendon has, the stiffer a tendon is, thus leading to a higher incidence of injuries. 

Proper Technique/Understanding Pickleball before going all in

  • It is tempting to jump right into playing Pickleball without learning the movement patterns necessary; however, learning the game first - to familiarize yourself with the movements and rules to prevent unnecessary injury - can pay off in the long run. 

What do I do if I already have Shoulder Pain and still want to play Pickleball?

If you are reading this and are already struggling with shoulder pain that is affecting your ability to play Pickleball, then the next step is a fast and accurate diagnosis of the cause of your pain. 

And no, this does not mean wasting time and money for an expensive MRI which may or may not show the actual issue. This means utilizing direct access Physical Therapy services to have a thorough initial assessment to then have a custom treatment plan designed for you.

This is exactly what we do at Flow Physical Therapy and Wellness in The Woodlands, TX. Our Osteopractic Physical Therapist is Fellowship trained and a Board Certified Orthopaedic Clinical Specialist. We will spend 60 minutes to look beyond the obvious shoulder symptoms to determine exactly which structures are involved and limiting your ability to play Pickleball. 

Once the source of your pain is identified, then a custom treatment program can be designed based on whether your symptoms are muscular, joint related, nerve related, or many other potential concerns. This treatment plan may include techniques such as dry needling, joint mobilizations, massage, cupping/scraping, manipulations, and of course functional exercises to tie everything together so we can get you back on the Pickleball court. 

So if you are currently struggling with shoulder pain that is affecting your ability to play Pickleball, or you are looking to avoid shoulder pain while you continue to play, click the button below to get started with your custom program for shoulder pain!

Dr. Patrick Thompson, PT, DPT, OCS, Dip. Osteopractic

Owner of Flow Physical Therapy and Wellness


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