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Rehabbing for Pickleball: A Sports Medicine Approach to Returning to Play

by msk-direct | 19 Nov, 2024 | Others | 0 Comments

In this episode of the *Talking Rehab Podcast*, I dive into a unique case from this week: helping a patient with a knee injury, some underlying arthritis, and a degenerative meniscus tear get back to playing pickleball. For this patient, pickleball is more than just a sport; it’s their main form of exercise and their favorite way to stay active. As both a sports medicine physician and an amateur pickleball player myself, I was excited to craft a safe, step-by-step rehab plan to guide their return to the court.

The Appeal of Pickleball (and Its Risks)

Pickleball’s popularity comes in part from its accessibility—people of all ages and fitness levels can enjoy it. Unlike tennis, it doesn’t require as much power or speed to get into position, making it easier on the joints. The smaller court size means players can cover the court with fewer steps, which makes the game fun without demanding high-impact sprinting or sudden stops. However, the ease and appeal of the game often lead to another common scenario: people playing for hours without breaks, which can increase the risk of injury, especially for those new to regular physical activity.

The Challenge of Knee Rehab for Pickleball

Racket sports like pickleball require multi-directional movement, which can be demanding on the knees, especially with underlying arthritis or previous injuries. For this patient, knee pain and limited confidence in their joint stability were the main challenges. The ultimate goal was to regain confidence and build the strength and stability required for the quick stops, lateral shuffles, and occasional twisting involved in pickleball.

Step-By-Step Rehab Plan: From Ping Pong to Pickleball

My rehab approach for this patient was progressive, focusing on movements and skills that would let them ease back into pickleball. Here’s how I broke it down:

#1. **Start with Ping Pong for Lateral Movement**

   – Ping pong uses similar paddle and ball-control skills to pickleball but doesn’t require as much movement or stress on the knees. Playing ping pong allows the patient to work on hand-eye coordination and lateral footwork without the risks associated with larger court coverage.

   – This phase was intended to help the patient get used to moving side-to-side with stability while avoiding twisting or lunging, which could strain the knee.

#2. **Introduce a 80/20 Ping Pong-to-Pickleball Ratio**

   – After practicing with ping pong for most of their play time, I advised them to gradually add in short pickleball sessions. The initial goal was 80% ping pong, 20% pickleball, allowing the knee to adapt to the more demanding movements in pickleball without overloading it.

   – During these initial pickleball sessions, I encouraged the patient to stay close to the net, focusing on short, reactionary shots that don’t require extensive forward, backward, or lateral movement.

#3. **Progress to a 50/50 Ratio and Expand the Range of Motion**

   – As the patient’s confidence and knee stability improve, they can transition to a 50/50 split between ping pong and pickleball, gradually moving into a more “normal” pickleball game.

   – At this stage, the focus would be on covering more of the pickleball court with controlled movements, including more forward and backward play and stopping to test the knee’s tolerance and stability. 

#4. **Gradual Introduction of Twisting Movements**

   – Once the patient is comfortable with forward, backward, and lateral movements, twisting motions can be added. By this point, they should have built the necessary stability and confidence in their knee to handle the demands of changing directions and reacting to unexpected shots.

   – This step essentially rounds out the final movements necessary for full pickleball play.

Practical Tips for Safe Pickleball Play

Pickleball is an addictive, high-energy game, but that enthusiasm can sometimes lead to injuries from jumping back in too quickly. I’ve seen everything from overuse injuries to sprains and strains, particularly among players who dive into long sessions without proper conditioning. The key to staying safe on the court is to:

   – **Warm up thoroughly** to prepare the muscles and joints for dynamic movement.

   – **Gradually increase play time** rather than jumping into long, high-intensity sessions right away.

   – **Use good-quality equipment** that provides the right amount of grip, support, and stability for quick movements.

Why Rehab Programs Should Be Fun

One of the reasons pickleball is such a fantastic option is that it’s inherently enjoyable—people are likely to stick with it. And that’s an important factor for any rehab program: it should be fun. If patients look forward to their rehab activities, they’ll stick with the program, and their recovery will be smoother and more effective. This patient’s love of paddle sports is what motivated me to find a rehab approach that kept them connected to the game they love while respecting the limitations of their knee.

Final Thoughts

Pickleball’s popularity doesn’t seem to be slowing down anytime soon, and as more people embrace it, we’re seeing a greater need for safe, sport-specific rehab strategies. This case was a great reminder of how adaptable rehabilitation can be, even for high-energy sports like pickleball.