Lower Extremity Injuries in Adult Pickleball Players: A Systematic Review of Injury Types, Mechanisms, and Risk Factors.

Pickleball is one of the fastest-growing sports in the United States, particularly among adults aged 50 and older. As participation has increased, so have reports of musculoskeletal injuries, with the lower extremity frequently identified as the most commonly affected region. Despite growing clinical awareness, no systematic review has comprehensively examined the types, mechanisms, and risk factors of lower extremity injuries among adult pickleball players. A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, MEDLINE, EMBASE, and Google Scholar were searched for peer-reviewed articles published between January 2004 and March 2025 using terms and Boolean combinations related to pickleball and lower extremity injuries. Studies were included if they reported pickleball-specific injury data in adults aged 18 years or older, addressed lower extremity injuries, and discussed injury types, mechanisms, or risk factors. Fifteen studies met the inclusion criteria and were independently reviewed by all authors. Sprains, strains, and fractures were the most commonly reported injury types, with Achilles tendon rupture also notably represented. Falls were the leading mechanism of injury, followed by running or lunging forward and foot or ankle inversion. Older age was a consistent risk factor across studies. Age 50 years or older was a consistent risk factor across nearly all studies. Gender-based trends were mixed: males were more frequently injured overall, but females were disproportionately affected by fractures (p < 0.001). Lower extremity injuries in pickleball are common, predominantly involve sprains and strains and fractures, and disproportionately affect older adults. Falls and rapid directional movements are the primary injury mechanisms. Clinicians, community organizations, and facility operators should prioritize implementation of structured injury prevention programs that include dynamic warm-up, proprioceptive training, sex-specific safety messaging, sport-specific footwear guidance, and routine court surface inspection.