Ortho on the go
Ortho on the go
Pickleball injuries
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Welcome back to the Ortho on the Go podcast. My name is Chuck Dowell, the host of the podcast. This is an educational orthopedic podcast focused on discussing both clinical and functional orthopedics. We will discuss a variety of topics within the field of orthopedics, including reviewing interesting cases, hearing from different professionals throughout the orthopedic profession, and discussing common musculoskeletal injuries and complaints. This podcast is meant for anyone that wants a better understanding of orthopedics, including all levels of practitioners, coaches, parents, and athletes themselves. My name's Chuck Dow. I'm one of the physician assistants here at Colorado Springs Orthopedia Group in the Express Care. Today I have the pleasure of uh speaking with Darren Yantis, the physic physical therapy supervisor for both the north and east location, right? Correct. All right. So we thought it would be good to do an episode regarding pickleball injuries. We know that pickleball is one of the fastest growing sports in the U.S. Uh there's an estimated five million people participating in pickleball. And then as the sport has grown, we've seen a lot of injuries. I know I personally have seen a lot of injuries in the expression care clinic.
SPEAKER_00I'm assuming a lot various sprains, strains, ligaments, and everything in between.
SPEAKER_01Yeah, so that's the good thing. I think with a lot of the pickleball injuries, um, they're mostly low-level injuries, as Darren said, mostly sprains and strains. I have seen some fractures from some falls, some concussions, and that type of stuff. Because it's growing and because we're seeing more of these injuries, we thought it would be good to do an episode regarding possibly injury prevention, um, mentioning some of the injuries that we commonly see, and then Darren's going to give us some exercises to uh do for injury prevention and also some warm-up exercises to do uh to help reduce the risk of injury, right? Correct. Perfect. So you mentioned already what are some of the common things. So you said sprains and strains, like what body parts do you most commonly see affected?
SPEAKER_00Lately we've been seeing a lot of hip injuries. So anything from glutamate to a bursitis on the lateral hip. So it's typically kind of a pain out towards that towards the edge of the hip. Got it. Um I've also seen some Achilles injuries. Yep. More of kind of a tightness, a tendonitis type of issue, probably due to lack of adequate warm-up.
SPEAKER_01Yeah. I think that's one of the big things. So as he was mentioning, I I think some of the literature shows that um, you know, a majority of the people participating in pickleball are over the age of 50, and we think 25 plus percent are over the age of 65. And one of the recent literatures or studies that came out show that 80% of the injuries from pickleball are lower extremity injuries. So as you mentioned, I think in the express care clinic, what we often see, as he mentioned, are sprains and strains of the hip. I see a lot of aggravation of underlying knee arthritis, and then, as you mentioned, a lot of calf injuries, gastroc injuries, Achilles tendonitis, Achilles injuries. And then I do see a lot of shoulder injuries, underlying rotator cuff pathology that become symptomatic secondary to the pickleball, and even some lateral epochondylitis, similar to tennis type stuff.
SPEAKER_00Yeah. Been seeing a few of those lately also.
SPEAKER_01What do you think, I guess, in your thought process, is the reason for possibly the injuries that you commonly see?
SPEAKER_00I'd say people go from no activity, jump right into it, thinking, hey, everyone's doing this, let's try, without adequately warming up the tissues, um prepping them for any kind of strain or load. So some kind of dynamic warm-up is going to reduce that injury risk.
SPEAKER_01Yeah, and I think, you know, I I see said I agree with that. That's what a lot of the studies see. And, you know, pickleball is nice, and I think it's so popular because it's an easy sport to play. The rules are pretty simple. Um, it's a small court, you can play it as doubles, and you can almost kind of, you know, be a sedentary person. And as you said, your buddy says, hey, I'm gonna go play, and there's a lot of courts available throughout the our area and throughout the country as well that are free to play on, and you can just go out there and play. And a lot of the times if you go from this sedentary position to an active dynamic sport, these common soft tissue injuries can happen. You know, as we talked about, uh uh, Darren's gonna help to show us and talk through some of the common exercises. So I think there's two components to it. There's the strength component to it for injury prevention, so exercises that people can do to help maybe get them strong so they could participate in pickleball and maybe be better at it. And then there's the dynamic warm-up or the functional warm-up. What are some of the exercises they can do from a strength perspective, like an injury prevention perspective?
SPEAKER_00So I'd say with these exercises, something you could do at home um a couple times a week to kind of prep the body for going and doing an activity like pickleball. Um, a lot of hip strengthening stuff. We'll kind of go over those um with a theraband here in just a minute. Again, something you could do at home, not necessarily at the court. Um some equipment required, so we'll kind of go over those here in a minute.
SPEAKER_01Yeah, and I know a lot of the times when I didn't have stuff to do at home, I would just lift gallons of milk or you know, I would lift, you know, jugs uh that weighed five pounds just to use as that resistive weight if necessary. And if you have stairs at home, you could do something as simple as kind of going up and down the stairs just with correct form and position. Definitely.
SPEAKER_00Body weight is a I mean makes it easy to work on strength. If you just put in the correct position, you can use the body weight and gravity to work on a lot of strength aspect.
SPEAKER_01Yeah. And I think the biggest thing is that with pickleball, because it's a dynamic sport, it's such a cutting and pivoting sport, you want your body to have some acclimation to being able to do those activities. And so maybe if you play pickleball once or twice a week, once or twice a week doing some of these simple bodyweight exercises, just so your body is ready for those dynamic activities, and that will help significantly reduce possible injuries.
SPEAKER_00100%, definitely.
SPEAKER_01It's so as we mentioned, a lot of the injuries we see are commonly sprains and strains, which is nice. From a treatment perspective, let's say somebody is playing pickleball and they have an injury, what is your recommendation as far as when to be seen? Because that's, I mean, we're all stubborn patients. I'm as stubborn as anybody else. I don't like to go in and be seen, and nobody likes to come in and see us. But from your perspective, if like a friend calls and says, Hey, I hurt myself a couple days ago, what would you tell them as an advice? Hey, should I come be seen by a physical therapist? Should I come to the express care clinic and get x-rays or be checked out?
SPEAKER_00So a couple things kind of lead into that. I'd say something that's more of a six out of ten pain or greater is something I'd say go in and get checked out for in the express care. Yep. Um if it's that high level of a pain, there might be some kind of uh deeper trauma to the tissue that maybe you need to go get checked out right away.
SPEAKER_01Okay.
SPEAKER_00Otherwise, for my rehab perspective, I like to let that acute phase settle just a little bit. Um a lot of times you might tweak something, and your body naturally just takes care of it. A little bit of rest a day. Sometimes the next day you wake up, I feel better.
SPEAKER_01Yep.
SPEAKER_00Um so I'd say outside of that acute phase, maybe five days to a week after injury, if it's still there, then maybe it's worth coming in, getting looked at, see if it's something that might need some further looking at. You know, maybe a visit over to Express Care or MRI x-ray, something like that. Yeah. Um, but a lot of stuff will subside if you give it a day or two.
SPEAKER_01Yeah. And I think that's the same advice I give a lot of patients that come in or friends that call me. I think you know, the acute inflammatory phase in the body is typically, you know, two to three days. So we know that kind of you injure yourself on Sunday, Monday, you're not too bad, Tuesday, Wednesday, you're pretty painful. Uh, in my advice, if it lasts for more than three to five days, I typically recommend you come in and get evaluated. As you said, I think if you're have pain with weight bearing, if you have pain more than a six out of ten, it's not improving with anti-inflammatory medications, ice, and rest, then I think it's worth coming in to get evaluated just to make sure that it's not something more complicated like we've mentioned, a possible fracture somewhere from a tw a sprained ankle or a fall on an outstretched arm and maybe a wrist injury. So I think from that perspective, that's when I would advise somebody to come in and get looked at. Um we talked about the exercise perspective. What if a patient says, hey, I'm not super familiar with exercises. I, you know, I can read what you wrote or or I could see the videos that you're going to show regarding the exercises, but what if I want some more one-on-one attention for that? I think we talked about this before. What I like to do is I send patients just for one or two physical therapy visits, and I think you guys can show them the appropriate form and the appropriate exercise to do, and then they can kind of take it over and do it on their own. Definitely.
SPEAKER_00I like one visit initially to kind of get a routine down, let them work on it for maybe a week, two weeks. Yeah. And then one follow-up just to make sure they're doing them correctly.
SPEAKER_01Yeah.
SPEAKER_00If we're doing them incorrectly at home, then it could even cause more damage than good. Yep. So a second follow-up just to make sure they're doing a thing appropriately. Maybe they need progressed a little bit if some of them were too easy. Just a second follow-up to kind of go over that. So one to two visits just to kind of work on a home exercise program. So adequate.
SPEAKER_01If somebody wanted to do that, they wanted to come in and work with you guys, how would they do that? Do they need an order from us to do it? Can they come in and just, you know, call the office and get in for a screening visit?
SPEAKER_00It really depends on insurance. Yeah. But unfortunately. Um but they can get a referral sent over from the primary care provider. They can come see you. Yeah. You can put in a referral. Um, they can see one of the docs upstairs and they can send down a referral. Um, and then we can get them in that way for eval and then one follow-up visit. Perfect.
SPEAKER_01Yeah, and so that's one of the benefits of the express care is it's a walk-in clinic. Um, and so you can walk in if you're having an injury that you think exceeds the level of kind of what you can tolerate, or as we talked about, lasts for more than a few days, or a pain level of six out of ten. We can evaluate you, we can do x-rays, and then you know, if we think it's something that physical therapy would benefit from, we can send them to see you and we can put the referral in. Um so that's I think very helpful for patients. And the last thing we mentioned, which I think um is quite helpful, is the warmup. So I'm just as guilty as everybody else. We exercise together and we've been uh you know to the gym together. I I I walk in, I put my shoes on, and I go exercise. And I know that I'm terrible patient because of that, but that's just you know, we're all terrible patients, I think. Um so from your perspective, how important is the warmup and what type of warm up would you recommend for somebody that's gonna go play pickleball?
SPEAKER_00So warm-up, warm-up really is the key. Like Tuck said, I used to go in, just grab a bar and start lifting. Yeah. Now that I've gotten older, warm-up is 100% the key. Yeah. Um, so I like to say a warm-up, do something that's gonna imitate what you're gonna be doing. I like it. So um we'll go over some stuff from ankles all the way up to shoulders, just to get those tissues warmed up, ready to play.
SPEAKER_01Yeah.
SPEAKER_00And it could be anywhere from five minutes, ten minutes if you really want to warm up, you know, various body parts, but it doesn't have to be long, doesn't have to be extensive. Yeah. Um, just something fairly quick to at least get the tissues ready.
SPEAKER_01Yeah, and I think as you mentioned, as I've gotten older as well, um, I I think more of these aches and pains tend to happen quite a bit. I've noticed that my body needs more of a warm-up to be able to participate in these sports and reduce the risk of injury. As we mentioned, we know that majority of the patients that are playing pickleball are over the age of 50 and 25% over the age of 65. So I think that warmup's important. It's important to show up 10 minutes earlier and just kind of do that functional specific warm-up, that activity-specific warm-up, just to kind of get the blood flowing, and that'll significantly help reduce a lot of these sprain strain risks.
SPEAKER_00Aaron Ross Powell Well, the courts are crowded now too. So getting there, waiting for your court to open up, correct, start your warm-up stuff.
SPEAKER_01Yeah. And that's another thing I think sometimes um, you know, you can warm up too early and then you'll cool back down before the court's available. So, you know, from your recommendation, what, maybe 15 minutes ahead of playing?
SPEAKER_00Yeah. At least, you know, get the heart rate up a little bit, 15 minutes, and then just stay moving.
SPEAKER_01Yeah.
SPEAKER_00It doesn't have to be anything extensive, but stay moving up to up to the time you go play.
SPEAKER_01And even just maybe doing a little light kind of walk around the courts a couple times, a gentle stretch while you're waiting for the court to open, and then maybe going to more of the functional specific dynamic warm-up once the court opens can be quite helpful. Yeah. And that'll significantly reduce the risks of injury. Do you play pickleball?
SPEAKER_00I've played a couple of times. Yeah.
SPEAKER_01Do you like it?
SPEAKER_00I do.
SPEAKER_01Yeah.
SPEAKER_00Yeah. I've played only outdoors over here.
SPEAKER_01Yeah.
SPEAKER_00Um, I'm looking to get into one of those indoor courts too.
SPEAKER_01Yeah, I think it's a fun sport. Um, I think it's nice because it's a sport that a lot of people can play. Um, and so, you know, uh, we just wanted to do an episode regarding possible injury prevention and or dynamic warmups to reduce the risk of injury regarding uh, you know, pickleball. But I think this can be functional across all kind of athletic activities, you know, tennis and any type of other sport that a lot of people are playing, even golf. Yeah. Um maybe we'll do one for that. We've played together. Yeah. So dynamic warm-up correlates to everything. Yeah. I'm I'm I park the car and I step onto the first T. So again, I'm a terrible patient. Uh anything else? Anything you want to add that you think is important?
SPEAKER_00Um, I think we covered it pretty good, but we'll go over that warm-up stuff.
SPEAKER_01So um, as we talked about, if at any point you feel like you're having an injury that's exceeding kind of your level of tolerance, as Darren mentioned, kind of six out of ten pain, maybe lasting more than three to five days, and you just want to get it checked out, I think the first stop is is to go into the express care clinic, a Colorado Springs orthopedic group. Again, it's a walk-in clinic open nine to five during the weekdays and eight to noon on Saturday. Uh, we can check you out, we can do x-rays. If we think there's a concern about a soft tissue injury, we can do an MRI on it if necessary. And if we think it's something that can be successful with physical therapy, we can do that. Um, and then as you said, it's not necessarily a huge commitment with the therapy. A lot of the times it's maybe one or two visits a couple weeks apart just to kind of show them how to do the exercises and give them an at-home program. Thank you for joining us uh on this episode. Uh, this was a great conversation between myself and Darren, uh, one of the physical therapists that works at the practice I work at. If you'd like to see Darren uh give a video demonstration regarding the pickleball exercises he recommends and the Theraband uh exercise he recommends, uh you can see this on the YouTube uh page, Ortho on the go YouTube uh page. Uh he has a section in this discussion where he actually will give you examples of the exact exercise to do regarding uh pickleball injury prevention and strengthening exercises. Thank you again for joining us. We appreciate your time and uh listening to the episode. Please feel free to follow us on social media, both Instagram and Facebook. Uh please feel free to reach out uh or comment regarding episodes you like, what you didn't like, and possible ideas regarding episodes in the future. Thank you and have a good day.