Injury Epidemiology of Pickleball Players in South Korea
Article information
Abstract
PURPOSE
Pickleball is a racket sport that blends elements of tennis, badminton, and table tennis. As its global popularity has grown, research on the sport has also increased. However, little academic work has been done in South Korea, especially regarding injuries. This study aimed to investigate the prevalence and characteristics of injuries among recreational pickleball players in South Korea.
METHODS
A total of 165 adult players (57.6±9.1 years) who participated in the 1ST 2025 Oak Valley Pickleball Championship completed a cross-sectional injury survey. The questionnaire included items on demographic information, pickleball participation characteristics (e.g., frequency, weekly play hours, skill level), and injury-related experiences during pickleball over the past 12 months. Participants were asked to self-report the body regions, type, mechanism, and severity of injuries sustained during pickleball activity.
RESULTS
Among participants, 44.8% (n=74) reported at least one injury in the past 12 months. The most frequently injured sites were the knee (24.4%), elbow/forearm (18.3%), and ankle/foot (13.7%). The most commonly reported injuries were muscle or tendon injuries (49.5%), followed by joint injuries such as sprains and dislocations (29.5%). Overuse accounted for 58.0% of injuries. Most injuries occurred during play (71.6%), rather than before (1.4%) or after (27%) play. Notably, 22.5% of injured participants stopped activity for ≥1 month.
CONCLUSIONS
Recreational pickleball players exhibited a notable rate of lower limb injuries, particularly involving muscles, tendons, and joints, primarily sustained during play. This study provides foundational data on injury patterns among recreational pickleball players in South Korea, highlighting the need for future research to better understand the characteristics and potential risk factors of injuries in this growing population.
INTRODUCTION
Pickleball, a racket sport combining elements of badminton, tennis, and table tennis, was first introduced in the United States in 1965 [1]. It has rapidly evolved from the backyard game to a competitive sport. In recent years, pickleball has gained significant popularity, particularly among middle-aged and older adults. In the United States, the number of pickleball participants increased by 45.8% in 2024, with a cumulative three-year growth rate exceeding 300%, making it the fastest-growing sport for four consecutive years [1,2]. This rapid growth is attributed to factors such as a short learning curve, low cost, social engagement, and health benefits [3]. In South Korea, pickleball was first introduced in 2016 and has gained momentum following the establishment of the Korea Pickleball Association in 2018 [4]. Since then, the sport has continued to grow through the expansion of local clubs as well as the development of pickleball courts and the hosting of major tournaments such as the Korea Open Pickleball Championship and the World Pickleball Championship, one of the largest international competitions in Asia [5]. Notably, this growth has been largely driven by participation from middle-aged to older adults, typically in their 40s to 60s and beyond, reflecting the sport's particular popularity among aging populations in South Korea [6,7], reflecting the sport's popularity among aging populations.
As pickleball has continued to grow its popularity, research on pickleball has also conducted, addressing topics such as motivation, health benefits, psychological functioning, and social connection [8-12]. However, epidemiological studies focusing on injuries among pickleball players remain limited. Given the large number of older adults playing pickleball, injuries in this population may lead to complications and delayed recovery [13]. This highlights the need for foundational research to better understand the injury patterns in pickleball.
Several studies from the United States have attempted to characterize pickleball-related injuries. For example, Forrester [14] analyzed 300 injury cases using data from the National Electronic Injury Surveillance Sys-tem (NEISS) between 2001 and 2017 and found that 90.9% of the injuries occurred in individuals aged over 50. The most affected body parts were the lower extremities (32%), upper extremities (25.4%), and trunk (21.4%). The most common injuries were sprains and strains (28.7%), fractures (27.7%), and contusions or abrasions (11.9%). Subsequent research by Weiss et al. [15] using the same data source from 2010 to 2019 reported an estimated 29,000 pickleball-related injuries among adults aged over 60, with 63.3% attributed to slips or fails. The most common injuries were sprains and strains (33.2%) and fractures (28.1%). However, as these findings are limited to emergency setting and may not fully reflected the range of injuries experienced by pickleball participants.
To address this limitation, Kim et al. [16] conducted a self-reported injury survey during the 2019 US Open Pickleball Championship among the participants aged over 50. The study found that 32.1% of participants had sustained at least one pickleball-related injury in the past year, with the majority affecting the lower extremities (57.9%), particularly muscles and tendons (61.8%) and ligaments or joints (44.3%). Unlike emergency-based data, the US Open dataset captures a wider range of injuries, including overuse and less acute cases that may not result in hospital visits. This broader perspective suggests that repetitive movements and swing mechanics of pickleball may contribute to injury patterns in this population [17]. These repetitive loading patterns may lead to cumulative fa-tigue, joint stress, and tendon inflammation, especially in middle-aged and older adults, resulting in chronic musculoskeletal conditions [18-20].
However, these previous studies were conducted in the U.S., where the pickleball environment may differ structurally and culturally from that of South Korea, including player experience, frequency, intensity, and ac-cess to training resources. Accordingly, it is necessary to establish con-text-specific baseline data for South Korea to support effective injury prevention and promote safer participation. Several studies have investigated the prevalence of sports injuries among amateur racket sport participants in Korea. For instance, research on male and female senior tennis players reported two-year prevalences of 38.2% and 31.2% respectively, with injuries commonly occurring in the knee, ankle and elbow [21,22]. Given that pickleball shares many biomechanical characteristics with tennis— such as rapid changes of direction, repetitive swinging motions, and high demands on lower extremity joints— pickleball players may be exposed to similar injury risks. Yet, no epidemiological research has investigated injury patterns among pickleball participants in South Korea.
Therefore, the purpose of this study was to investigate the prevalence, body regions, and tissue types of pickleball-related injuries among recreational players in South Korea, providing foundational data to guide future injury prevention and management strategies.
METHODS
1. Participants
This study was conducted using a cross-sectional survey design. Data were collected on-site during the 2025 1st Oak Valley Pickleball Championship hosted by the Korea Pickleball Association, held in Wonju, South Korea. Participants were included if they were pickleball players aged over 18 who participated in the event. Players were excluded if they had pre-existing injuries unrelated to pickleball or were unable to com-plete the survey due to personal reason. A convenience sampling method was used, targeting all eligible players who attended the tournament. Although randomization was not applied, this approach allowed the researchers to reach a concentrated group of active pickleball players during an official competition setting, enhancing the ecological validity of the data collection [23]. All participants received a detailed explanation of the study's purpose and procedures and provided written informed consent. The survey responses were collected anonymously to ensure confidentiality. This study was approved by the Institutional Review Board (IRB) of Sungkyunkwan University (IRB No. SKKU 2025-03-039).
2. Data collection
Data were collected using a questionnaire developed based on previous research and expert consultation [16]. Although the questionnaire has not undergone formal psychometric validation, its prior use in a similar research context supports its contextual relevance and practical utility for injury surveillance. The questionnaire included three main sections: demographic characteristics, play characteristics, and injury experience within the past 12 months. Demographic variables included sex, age, and body mass index (BMI), which was calculated by dividing body weight (kg) by height squared (m2). BMI categories were defined according to the Korean Society for the Study of Obesity as underweight (<18.5 kg/m2), normal (18.5-22.9 kg/m2), overweight (23.0-24.9 kg/m2), class I obese (25.0-29.9 kg/m2), and class II obese (≥30 kg/m2) [24]. Play characteristics included self-reported skill level based on the Korea Pickleball Association's classification: “ unknown,” “ below 3.0,” “3.0,” “3.5,” “4.0,” “4.5,” and “5.0 or above.” This system aligns with the skill-level rating of the USA Pickleball Association [25]. Participants also reported their weekly frequency of play, weekly play hours, and length of pickleball experience (months). Additionally, participants who reported performing warm-up activities provided details on their warm-up routines by selecting both the types of activities performed (e.g., stretching, walking, cycling, jog-ging, or drill practice; multiple responses allowed) and the overall duration of warm-up (e.g., <5 minutes, 5-10 minutes, 10-20 minutes, 20-30 minutes, or >30 minutes). Participants were also asked whether they had sustained any injuries over the past 12 months. Self-reported injury data are frequently used in epidemiologic studies, particularly when medical records are unavailable or impractical to collect [26]. In this study, a self-reported injury was defined as any physical harm or musculoskeletal complaint sustained during pickleball participation within the past 12 months, as reported by the participant. This operational definition was adapted from a previous validation study, which demonstrated that injuries meeting these criteria were more reliably recalled in self-reported data [26,27]. For those who reported an injury, follow-up questions were collected, including the body regions of injury using a modified Nordic body chart [28], and the injury type (e.g., muscle, tendon, or joint). Multiple responses were allowed for both injury type and body region, as participants could report more than one injury or injury site. Because multiple responses were allowed for both injury type and body region, the total number of responses may differ between items. To capture overall injury trends, each item was analyzed independently and not paired by individ-ual injuries or anatomical sites. Injuries were also categorized as either traumatic (resulting from a specific identifiable event) or overuse (resulting from gradual onset), based on their subjective judgment. The timing of injury was reported as occurring before, during, or after play, referring to any pickleball-related activity conducted in both competitive and non-competitive settings. Finally, participants who had been injured were asked to report the duration of activity cessation following injury to estimate the extent to which injuries disrupted regular participation. Based on the previous literatures [29,30], a cessation period exceeding 28 days was operationally defined as indicative of a long-term effect on participation. Participants selected from the following options: “1-2 days,” “ less than 1 week,” “1-2 weeks,” “2-4 weeks,” and “ more than 1 month.”
3. Statistical analysis
All continuous variables were presented as means and standard deviations (SD), while categorical variables were reported as frequencies (n) and percentages (%). Chi-square test was used to compare variables related to demographic, play characteristics, and self-reported injuries. For items that allowed multiple responses, analyses were conducted based on the total number of responses rather than the number of participants. All statistical analyses were performed using R software (version 4.3.1).
RESULTS
1. Demographic characteristics
Table 1 provides the demographic characteristics of the participants. Participants (n=165) comprised 119 males (72.1%) and 45 females (27.9%). By age group, participants in their 50s comprised the largest proportion (34.1%), followed by those in their 40s (21.3%), and 60s or older (20.2%), indicating that middle-aged and older adults were the most frequent participants in the tournament. Based on the classification of the Korean Society for the Study of Obesity, 32.1% were categorized as overweight (23.0-24.9 kg/m2), 30.2% as normal weight (18.5-22.9 kg/m2), 29.6% as class I obese (25.0-29.9 kg/m2). A significant difference was found in BMI distribution between male and female participants (p<.001).
Descriptive summary of demographics
2. Playing characteristics
Table 2 presents the playing characteristics of the participants. The average weekly frequency of play was 3.6 times per week, with 31.1% playing three times and 21.3% four times per week. The average total weekly play hours were 9.8 hours, with most players falling into the “7-14 hours” (52.2%) and “ less than 7 hours” (31.0%) categories. The average pickleball experience was 18.3 months, and more than half had been participating for less than two years, particularly in the “ less than 1 year” (35.8%) and “1-2 years” (32.1%) ranges. The average skill level was 3.3, with the most frequent responses being “3.0” (35.1%) and “3.5” (24.1%), which correspond to intermediate-level skills. Of the 165 participants, 136 (82.4%) reported performing warm-up activities prior to pickleball play. These participants reported a total of 161 warm-up activities, as multiple responses were allowed. Stretching was the most frequently reported (71.4%), followed by drill practice (18.0%), walking (5.0%), run-ning (4.3%), cycling (0.6%), and other activities (0.6%). Regarding the duration of warm up, 136 participants reported durations of 5-10 minutes (37.5%) or less than 5 minutes (32.4%), with smaller proportions reporting durations of 10-20 minutes (24.3%), 20-30 minutes (4.4%), and more than 30 minutes (1.5%).
Descriptive summary of playing characteristics
3. Injury prevalence and characteristics
Table 3 summarizes injury experience, mechanism, and playtime lost due to injury over the past 12 months. Among all participants, 44.8% (n=74) reported at least one pickleball-related injury within the past year. Overuse injuries (58.0%) were more prevalent than traumatic injuries (42.0%). Most injuries occurred during play (71.6%), followed by after play (27%), and before play (1.4%). The severity of these injuries, based on the duration of activity cessation, varied. The most frequently reported period was 1-2 weeks (26.8%), followed by more than one month (22.5%), less than 1 week (21.1%), 2-4 weeks (16.9%), and 1-2 days (12.7%).
Descriptive summary of self-reported injuries
Fig. 1 and 2 present the reported body regions and affected tissue types, respectively. A total of 131 responses were collected for body region (Fig. 1) and 95 for affected tissue type (Fig. 2), as participants were allowed to report multiple injuries or injury sites. For example, the same tissue type (e.g., muscle/tendon) could be selected for different regions (e.g., knee and ankle), resulting in fewer tissue type responses. Fig. 1 shows that lower extremity injuries (48.8%) were more prevalent than upper extremity injuries (38.0%). Specifically, the most common sites were the knee (24.4%) and ankle/foot (13.7%) in the lower extremities, and the elbow/forearm (18.3%) and shoulder/arm (11.5%) in the upper limbs. As illustrated in Fig. 2, the most frequently affected tissue types were muscles and tendons (49.5%), followed by joints (29.5%) and muscle cramps (12.6%).
Self-reported injuries by body regions from the 1st 2025 Oak Valley Pickleball Championship
Self-reported injuries by tissue types from the 1st 2025 Oak Valley Pickleball Championship
DISCUSSION
The present study found that 44.8% of participants reported an injury within the past year, which is higher than the 32.1% reported in a previous study of US Open Pickleball Championship participants [16] and 39.4% reported in a study of tennis players [18]. This discrepency may stem not only from differences in sample size but also from variations in demographic factors (e.g., age, sex, BMI) and playing characteristics (e,g., frequency, weekly play hours, playing experience). However, this study did not analyze the associations between these variables and injury prevalence. Future studies are needed to quantitatively assess these relationships using a longitudinal design.
Similar to findings in previous studies on racket sports, such as tennis and badminton, the lower extremities— particularly the knee and ankle/foot— were the most commonly affected body regions in this study. These findings may be associated with the biomechanical characteristics of pickleball, which involve repetitive short-distance direction changes, lateral and forward-backward movements, and lunges [17]. Similarly, Kim et al. [16] reported that 57.9% of self-reported injuries occurred in the lower extremities, and Changstrom et al. [31] found that more than 34% of injuries in racket and paddle sports occurred in this region, sug-gesting a consistent trend across similar sports. In the present study, a relatively high proportion of upper extremity injuries was observed compared to previous studies. However, no statistical analysis was performed to evaluate the relationship between skill level and upper extremity injuries. Therefore, no direct association can be inferred from our data. Nonetheless, previous research on recreational racket sports, such as tennis, has suggested that poor technique and slower reaction times may increase the risk of upper limb injuries [32]. Further studies are needed to explore whether similar mechanisms apply in the context of pickleball.
The predominance of muscle/tendon and joint injuries is consistent with patterns observed in other amateur racket sports. Weiss et al. [15] found that sprains and strains accounted for 32.4% of injuries, while Kim et al. [16] reported muscle/tendon (61.8%) and ligament (44.3%) injuries as the most frequent in pickleball. Other racket sports show similar trends, with badminton reporting muscle/tendon injuries in 42.4% of cases [31,33] and squash/racquetball players showing a 33.8% prevalence of sprains and strains [19]. However, previous research reported a higher portion of bone injuries, particulary fracutres, whereas our data revealed that relatively fewer bone-related cases. This discrepency may be attributed to differences in reporting environments. Emergency data are more likely to reflect severe injuires requiring immediate medical attention, while self-reporteed surveys capture a wider spectrum of injury severity. However, the results of highest rate of strain and sprain injuries suggests shared biomechanical vulnerabilities across different populations and data sources.
Similarly, our study identified overuse injuries as more prevalent than traumatic ones. Although previous studies using NEISS data [14,15] primarily identified acute and traumatic injuries treated in emergency settings, the higher proportion of overuse injuries in our findings may reflect the characteristics of recreational play and the sensitivity of self-reported surveys in capturing gradual-onset injuries. These results may reflect the influence of cumulative loading and repetitive strain during recreational play, although no direct association was examined in this study. Further research is needed to clarify the role of overuse mechanisms in injury development. Additionally, 22.5% of injured participants ceased play for more than one month, indicating the possibility of long-term participation disruption. Similarly, Kim et al. [16] found that 28.9% of middle-aged and older pickleball players stopped playing for more than one month due to injury. Despite the perception of pickleball as a low-intensity sport, these findings suggest that injuries caused by repetitive stress may require significant recovery time.
This study has several limitations. First, its cross-sectional survey design limits the ability to determine causal relationships between and participant characteristics, including both demographic and play-related factors. Second, the reliance on self-reported data introduces the possibility of recall bias, as participants may not accurately remember past injuries, potentially affecting the reported prevalence and characteristics. These limitations should be considered when interpreting the findings. Future studies should adopt longitudinal designs to more clearly examine how demographic and play-related characteristics contribute to injury risk in pickleball. Another limitaion is that this study employed a convenience sampling method by surveying participants who attended the tournament, which may introduce selection bias and limit the generaliz-ability of the findings to the broader pickleball population in South Korea. Since the sample may overrepresent individuals who are more competitive or more likely to report injuries, future studies should consider random or stratified sampling methods to enhance representativeness. Lastly, although severral potential risk factors were collected, regression analysis to examine their associations with injury occurrence was not conducted due to the limited number of injury cases. Future studies with larger sample sizes are warranted to enable such inferential analysis.
Despite these limitations, this study, to our knowledge, is the first to examine the injury patterns among pickleball participants in South Korea, providing foundational data for future epidemiological studies and guide the development of locally relevant injury prevention strategies.
CONCLUSION
This descriptive study provides baseline epidemiological data on injury characteristics among recreational pickleball players in South Korea. Most injuries were attributed to overuse rather than trauma and frequently involved the muscles/tendons and joints of the knee, elbow/forearm, and ankle/foot. Notably, a considerable number of injured participants reported extended breaks from play, highlighting the potential im-pact of injuries on sustained participation. This is the first study to investigate the self-reported injury patterns among South Korean pickleball participants. These findings offer an overview of injury patterns in this population. Further studies using longitudinal designs are needed to clarify how demographic and playing characteristics contribute to injury risk in this population.
Notes
CONFLICT OF INTEREST
The authors declare no conflict of interest.
AUTHOR CONTRIBUTIONS
Conceptualization: KJ Lee, B Jeong, SH Nam, KM Kim; Data curation: KJ Lee, B Jeong, KM Kim; Formal analysis: KJ Lee, B Jeong, KM Kim; Methodology: KJ Lee, B Jeong, SH Nam, KM Kim; Project admin-istration: KJ Lee, B Jeong, SH Nam, KM Kim; Writing - original draft: KJ Lee, B Jeong, KM Kim; Writing - review & editing: KJ Lee, SH Nam, KM Kim