Injuries and Return to Play in Elite Pickleball Players: A Review of the Professional Pickleball Association Tour

OBJECTIVE: To characterize the injury profile and return-to-play (RTP) timelines of elite pickleball players on the Professional Pickleball Association (PPA) Tour. DESIGN: Retrospective observational study. SETTING: Professional pickleball tournaments held on the PPA Tour or professional circuits between 2018 and 2025. PARTICIPANTS: One hundred thirteen elite pickleball players (48 male, 65 female), ranging in age from late teens to mid-40s (mean age ∼31 years). INTERVENTIONS OR ASSESSMENT OF RISK FACTORS OR INDEPENDENT VARIABLES: Descriptive analysis of publicly documented injury reports and RTP data. MAIN OUTCOME MEASURES: Injury type, location, mechanism, competition withdrawal, and RTP duration. RESULTS: Seventy-five injuries were recorded in 52 players (46%) during the 7-year period. Lower extremity injuries were most common (49%), particularly ankle sprains (13) and knee injuries (8), along with Achilles ruptures and Anterior Cruciate Ligament (ACL) tears. Head and face injuries (13%) were often from paddle or ball impacts and included concussions. Upper extremity injuries (12%), such as wrist ligament tears and elbow tendinopathies, were less frequent. Approximately 68% of injuries led to at least 1 tournament withdrawal. Return to play varied: 35% returned within days, 15% in weeks, and ∼19% required multiple months. Several severe injuries, including ACL tears and Achilles ruptures, were season ending. CONCLUSIONS: Elite pickleball players sustain a diverse array of injuries, with lower extremity sprains being the most prevalent. Although many athletes return quickly, others experience prolonged recovery. These results highlight the need for enhanced injury prevention efforts, centralized injury surveillance, and targeted conditioning programs to support player health as the sport continues to grow. CLINICAL RELEVANCE: These findings can inform injury prevention strategies and medical monitoring for professional pickleball players.