Heather Harlan plays pickleball about four days a week at Columbia's Activity and Recreation Center.
Harlan, 74, started playing in 2019 to help manage her weight and have fun. But an ankle injury last year, unrelated to pickleball, forced her to take a break. She has since returned to the court with limited mobility.
Even so, Harlan said pickleball gives her a reason to stay active and has helped her cope with grief after the death of her son several years ago.
“Pickleball can be helpful for me to keep me in the moment,” Harlan said. “A lot of times our minds squirrel off on what's happened in the past or what's coming down the road, and very seldom do we find things that get us to camp out on that razor-thin edge of right now.”
Pickleball continues to grow in Mid-Missouri
In Columbia, the sport shows little sign of slowing down.
The city recently added 10 pickleball courts at Albert-Oakland Park. The Show-Me Pickleball Club in Columbia now has 475 members and draws players from nearby Centralia, Boonville and Jefferson City.
Club president Kay Barbee said the increase in injuries needs to be considered alongside the rapid growth in participation.
“Pickleball injuries may have increased, but that's because the participation has exploded,” Barbee said.
Pickleball is one of the fastest-growing recreational sports in the United States, drawing millions of players to courts across the country. But as participation has picked up, so have hospital visits.
About 24 million Americans play pickleball each year, according to the Sports & Fitness Industry Association. A recent analysis by ValuePenguin, a consumer finance and insurance research firm, looked at data from US Consumer Product Safety Commission
and found the estimated number of pickleball-related injuries treated in U.S. emergency rooms nearly quadrupled from about 8,300 in 2018 to more than 31,000 in 2025.
Rob Bhatt, a research analyst at ValuePenguin, said the increase in injuries stood out because of how quickly it happened.
“That's a pretty substantial increase in a short amount of time,” Bhatt said. “We know anecdotally that pickleball is growing with phenomenal popularity, but we were surprised to see the number of injuries go up by so much over this relatively short period of time.”
Falls, trips and slips accounted for nearly half of the injuries analyzed by ValuePenguin.
Older adults makes up a big portion
Pickleball combines elements of tennis, badminton and table tennis. Its smaller court, lighter paddles and relatively short games have helped make the sport accessible to people of different ages and abilities.
That accessibility has made the sport especially popular among older adults, who also account for the majority of pickleball-related emergency room visits. Adults 50 and older accounted for an estimated 125,000 pickleball-related ER visits between 2018 and 2025, or more than four of every five visits during that period, according to the ValuePenguin analysis. And half of those visits were by players 65 and older.
But the same characteristics that make pickleball appealing to people who may not regularly participate in other forms of exercise can also make some players more vulnerable to injury, said Dr. Steven DeFroda, an orthopedic doctor with MU Health Care.
DeFroda said many of the pickleball players he sees are older adults. While he encourages older people to stay active, he said some may be at greater risk of injury if they aren't accustomed to the physical demands of sports.
The most common injuries he sees are relatively minor, including soreness and overuse injuries, as well as flare-ups of existing conditions such as arthritis or plantar fasciitis. Players also can experience sprains and strains involving the ankles, knees and other joints.
“Ankle sprains are very common if someone lands inappropriately,” DeFroda said.
More serious injuries are less common but can include Achilles tendon tears, ACL tears and injuries to the upper extremities, including the rotator cuff. Falls also can lead to injuries, particularly when players lose their balance or land awkwardly.
DeFroda recommends that players warm up before playing, understand their physical limitations and pay attention to pain.
“Regardless of the activity, whether it's pickleball, biking, swimming, running, et cetera, be respectful of your own kind of physical limitations,” DeFroda said. “Try to stay within yourself.”
He said players can increase their risk of injury by jumping into a game without adequately warming up or stretching.
“And then also just kind of listen to your body,” he said.
For players who do get injured, DeFroda said physical therapy and rehabilitation can help them safely return to activity.
“Because obviously we want people to remain active, to remain cardiovascularly fit. Those are all very important things. But doing it safely in a way to protect the musculoskeletal system as well.”
