Pickleball Primer: An Overview of Common Injuries, Treatment, and Optimization Strategies in Pickleball Athlete

Pickleball is one of the fastest growing sports in the United States with millions of players nationwide. It is a relatively appealing sport because of its ease of access, low impact, and highly social atmosphere, allowing players of all ages to participate. As the number of players continues its dramatic increase, player injuries are certain to increase in turn. There is little to no orthopaedic research on pickleball-related injuries and a paucity of data regarding treatment and prevention strategies. This summary was designed to familiarize orthopaedic surgeons with the basics of the sport and highlight potential pickleball-related injuries they may encounter in practice.

Pickleball Participation and the Health and Well-Being of Adults-A Scoping Review

BACKGROUND

Pickleball has grown tremendously in recent years, yet little evidence exists regarding pickleball-related injuries. This scoping review extends current work on pickleball participation by identifying positive and negative health effects associated with the sport. We summarize how pickleball impacts the health and well-being of adult participants.

METHODS

Searches were conducted on MEDLINE, CINAHL, ProQuest Nursing, ERIC, SPORTDiscus, PsycINFO, Scopus, CBCA Complete, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ProQuest Dissertations and Theses. Selected studies considered aspects of health and/or well-being of adult pickleball participants. Using the population/concept/context framework, participants were healthy, able-bodied adults 18 years of age or over, who had played pickleball at least once. The positive and negative outcomes of pickleball on participants' health and well-being (concept) within the context of pickleball participation were examined. Full-text articles written in English since 2013 were included. Extracted data were tabulated, and a descriptive summary with thematic analysis was completed.

RESULTS

This scoping review comprised 27 articles that met the inclusion criteria. Pickleball is promising as an exercise intervention for all adults, and there is evidence of positive social and psychological effects, and health and fitness benefits to participating in pickleball by older adults.

CONCLUSIONS

Although we are still in the early stages of studying pickleball, there have been some documented health benefits of using the sport as a physical exercise intervention for adults. More research is needed on the types, prevalence, and severity of pickleball injuries and the sport's impact on younger players.

Validity and Reliability of Wearable Technology Devices during Simulated Pickleball Game Play

Pickleball is a popular sport. Also popular is wearable technology usage. Because the validity and reliability of wearable technology during pickleball is unknown, the purpose of this research was to evaluate the ability of common devices to return heart rate and estimated energy expenditure during pickleball activity. Twenty adult participants were outfitted with a portable metabolic unit and heart rate monitor (criterion measures). Experimental devices were a Garmin Instinct, Polar Vantage M2, Polar OH1, and Polar Verity Sense. Participants played simulated pickleball for 10 min. Validity measures included mean absolute percent error (MAPE) and Lin's Concordance Correlation Coefficient (CCC), whereas reliability measures included coefficient of variation (CV) and intraclass correlation coefficient (ICC). The heart rate returned lower than 10% MAPE across all devices (Instinct = 5.73-6.32%, Verity Sense = 2.92-2.97%, OH1 = 3.39-3.45%) and greater than 0.85 CCC (Instinct = 0.85-0.88, Verity Sense = 0.96-0.96, OH1 = 0.93-0.94). The CV was below 10% (Instinct = 9.30%, Verity Sense = 2.68%, OH1 = 5.01%), and ICC was above 0.7 (Instinct = 0.77, Verity Sense = 0.98, OH1 = 0.91). The energy expenditure MAPE was greater than 10% (Instinct = 27.67-28.08%, Vantage M2 = 18.87-23.38%) with CCC lower than 0.7 (Instinct = 0.47-0.49, Vantage M2 = 0.62-0.63). Reliability thresholds were met in the Vantage M2 (CV = 6%, ICC = 0.98) but not in the Instinct (CV = 15%, ICC = 0.86). The Instinct was neither valid nor reliable for estimated energy expenditure, while the Polar Vantage M2 was reliable but not valid. All devices returned valid and reliable heart rates during pickleball.

Maintaining Active Lifestyle Through Pickleball: A Qualitative Exploration of Older Pickleball Players

This study aimed to explore the experiences of older adults engaged in pickleball. In particular, we collected views from the USA Pickleball Association (USAPA) ambassadors to identify how their experiences facilitate successful aging. A qualitative case study was utilized to obtain naturalistic data. Purposive sampling was used to recruit a total of 15 USAPA ambassadors, all of whom were interviewed in person. Data were analyzed using interpretive thematic analysis, and four overarching themes were generated: (a) a new way to stay active, (b) pickleball is social, (c) an intergenerational pastime, and (d) reestablishing an identity through pickleball. The findings support the view that engaging in pickleball is a promising means of achieving a healthy life as a senior citizen. The participants maintained a physically and mentally active lifestyle through pickleball, and their commitment to this sport led to their engagement as ambassadors in their communities.

Facilitators and constraints to adult sports participation: A systematic review

Despite the well-documented health, social and economic benefits of sports participation, adults' participation in organised sport declines as age increases. To date, no review has summarised the multi-level factors that influence adults' decisions to participate in sport. Therefore, this systematic literature review aimed to: 1) determine the facilitators, constraints and negotiated constraints to adults' (25-64 years) sport participation, and 2) summarise these factors according to the multiple levels of the social-ecological model. A total of 91 articles were identified following an extensive literature search conducted according to the PRISMA guidelines. Studies were published over four decades (1983-2023), predominantly located in North America (n = 45; 49.5%), ranged from 5 to 10,646 participants, examined mainly middle-aged adults (Mrange = 35-44 years; n = 52; 48.6%), included more males (61.6%) than females (38.1%), and were conducted in primarily single sport contexts (n = 63; 69.2%). Overall, more unique facilitators (55 items) were identified than constraints (35 items) and negotiated constraints (13 items). The desire for improved health and enjoyment were the most frequently reported facilitators, and the main constraints were injury or illness and family commitments. Constraint negotiation strategies largely included individual (e.g., implementing financial strategies) and interpersonal factors (e.g., encouraging others to participate). This review highlighted the expansive multi-level factors that influence adults' sports participation, reiterated the complexity of developing appropriate sport offerings, and identified a lack of studies examining non-sport participants. Strategies to support adult sport participation should focus on enjoyment, consider co-designed sport modifications to alleviate perceived constraints and integrate behaviour change theory to foster positive sport participation habits.

Treating Geriatric Sports Injury Among Pickleball Players: A Narrative Review of an Exercise Craze Among Seniors

The sudden and enormous popularity of pickleball has included a surprising and large contingent of geriatric players. Similar to tennis and badminton, pickleball is a game with a short learning curve that offers low-impact cardiovascular benefits. Unlike tennis, most injuries in pickleball are sustained by older rather than younger players. In fact, pickleball-related injuries increase with increasing age. Such injuries include strains, sprains, joint pain, falls, and fractures. The most affected joints are the wrists, shoulders, knees, and ankles. Clinicians can advise their older pickleball patients on strategies and tips to minimize the risk of injury. This may be particularly important because many older individuals playing pickleball today were previously sedentary. Older people may be attracted to pickleball because it is an inclusive sport with a high socialization factor. Nevertheless, pickleball can deliver an excellent cardiovascular workout and it may be an example of a successful way to promote exercise among older people and those who resist exercise.

Static and dynamic resting-state brain activity patterns of table tennis players in 7-Tesla MRI

Table tennis involves quick and accurate motor responses during training and competition. Multiple studies have reported considerably faster visuomotor responses and expertise-related intrinsic brain activity changes among table tennis players compared with matched controls. However, the underlying neural mechanisms remain unclear. Herein, we performed static and dynamic resting-state functional magnetic resonance imaging (rs-fMRI) analyses of 20 table tennis players and 21 control subjects using 7T ultra-high field imaging. We calculated the static and dynamic amplitude of low-frequency fluctuations (ALFF) of the two groups. The results revealed that table tennis players exhibited decreased static ALFF in the left inferior temporal gyrus (lITG) compared with the control group. Voxel-wised static functional connectivity (sFC) and dynamic functional connectivity (dFC) analyses using lITG as the seed region afforded complementary and overlapping results. The table tennis players exhibited decreased sFC in the right middle temporal gyrus and left inferior parietal gyrus. Conversely, they displayed increased dFC from the lITG to prefrontal cortex, particularly the left middle frontal gyrus, left superior frontal gyrus-medial, and left superior frontal gyrus-dorsolateral. These findings suggest that table tennis players demonstrate altered visuomotor transformation and executive function pathways. Both pathways involve the lITG, which is a vital node in the ventral visual stream. These static and dynamic analyses provide complementary and overlapping results, which may help us better understand the neural mechanisms underlying the changes in intrinsic brain activity and network organization induced by long-term table tennis skill training.

Pickleball and mental health in adults: A systematic review

Introduction

Physical activity has been extensively studied and numerous mental health benefits have been found. Pickleball is an emerging racquet sport, which is characterized by its accessibility to all audiences and has become especially popular in the United States among the elderly. It is a novel team game and its inclusive nature is innovative for health improvement. The purpose of this systematic review was to review and evaluate existing studies that have examined the effects of pickleball on the mental and psychological health of individuals.

Methods

A systematic review was conducted on articles found in Scopus, PubMed, Elsevier, Web of Science (WoS), PsyINFO, Dialnet, and Elton B. Stephens Company (EBESCO) from 1975 to the present. The keywords used was a five combination between "Pickleball" joint with different terms by the connector AND, the second part of the combo could be "mental disorder" OR "anxiety" OR "depression" OR "psychological health" OR "mental health." Eligibility criteria included: papers focused on pickleball, in English or Spanish, on mental health variables, without establishing an age range. We excluded duplicate works, without access or that did not address the objective of this study.

Results

The search resulted in 63 papers, of which 13 were selected. A total of 90.74% of the population were people over 50 years of age. The results show significant improvements in the different psychological variables measured in pickleball practitioners: personal wellbeing, life satisfaction, depression, stress, happiness, etc., pickleball shows potential as a new tool to work and improve people's mental health.

Conclusions

The pickleball is displayed as an inclusive sport that does not need adaptations, resulting of great interest to be worked in different populations with mental problems.

Physical Activity Intensity of Singles and Doubles Pickleball in Older Adults

The purpose of this study was to measure heart rate, activity intensity, and steps in recreational singles and doubles pickleball players. We collected data in 22 singles and 31 doubles players (62.1 ± 9.7 years of age) using Garmin Fenix 5 watches (Garmin International, Inc.) and ActiGraph GT3X+ (ActiGraph LLC) accelerometers. Mean heart rates during singles and doubles were 111.6 ± 13.5 and 111.5 ± 16.2 beats/min (70.3% and 71.2% of predicted maximum heart rate), respectively. Over 70% of singles and doubles playing time was categorized in moderate to vigorous heart rate zones whereas 80.5% of singles time and 50.4% of doubles time were moderate based on Freedson accelerometer cut-points. Steps per hour were higher in singles versus doubles (3,322 ± 493 vs. 2,791 ± 359), t(51) = 4.540, p < .001. Singles and doubles pickleball are moderate- to vigorous-intensity activities that can contribute substantially toward older adults meeting physical activity guidelines.

Play Badminton Forever: A Systematic Review of Health Benefits

Regular physical activity (PA) engagement has multiple benefits for individual general health at all ages and life stages. The present work focuses on badminton, which is one of the most popular sports worldwide. The aim was to conduct a systematic review focused on examining and analysing this sport and the benefits it brings to the health of those who engage in it. Examination was conducted from the viewpoint of overall health and provides an overview of the current state-of-the-art as presented in published scientific literature. PRISMA 2020 guidelines were adhered to. An exhaustive search was conducted of four electronic databases or search engines: Web of Science, Scopus, MEDLINE and Google Scholar. The search terms used were "badminton AND health" and "badminton AND benefits". In total, 27 studies were eligible for inclusion in the systematic review. After analysing the results, it was concluded that badminton engagement may lead to an improvement in all areas, the most studied being those related to physical health, in particular the improvement of cardiac and pulmonary functions and the development of basic physical capacities.

Marketing Up the Wrong Tree? Organisational Perspectives on Attracting and/or Retaining Older Adults in Sport

Community sport is seen as a suitable setting for physical activity for different population groups. Older adults (aged 50+ years) are a rapidly growing population group. Physical activity is critical for healthy ageing, however sport participation rates for older adults are very low. The aim of this study was to investigate how sporting organisations perceive sport for older adults. This cross-sectional study surveyed 171 representatives from Australian National and State Sporting Organisations. Descriptive statistics were used to summarise the results and the three sporting organisation categories' (high, medium, and low participation) responses were compared using non-parametric statistics. Contextualised in the perspective of organisational change, a framework for marketing to the ageing consumer was used to interpret the results. Older adults are not a high priority group for most sporting organisations, however the benefits of engaging older adults were recognised, particularly in context of increasing participation numbers. A lack of age-appropriate programmes was perceived to be a major barrier of engaging older adults. This lack of programmes stems from older adults being deemed as a less attractive segment than other age groups for sporting organisations. Modifications that sports felt they could make to attract and/or retain older adults included specific marketing and age appropriate opportunities. There was widespread consensus across sporting organisations, suggesting that perceptions of older adult sport participation were comparable across the sector, such as increasing participation numbers and engaging their older fan base. In the context of attracting, and retaining, older adults in sport clubs, it was concluded that most sporting organisations are not (yet) ready to build “age friendly” sporting environments. There is very limited literature on the organisational perspective of older adults and sport, meaning this study is unique in the field. Although sport policy encourages organisations to grow their participation, most organisations do not actively and strategically engage older adults. This research provides an understanding of why this untapped market is not a priority target and provides comprehensive insights for policy makers to better engage with this population group.

Psychosocial Aspects of Participation in Competitive Sports Among Older Athletes: A Scoping Review

BACKGROUND AND OBJECTIVES

In the last decade, sport has been considered a tool in active aging to maintain physical fitness, improve mental wellbeing and form social relationships among older people. However, a thorough psychosocial understanding of the phenomenon of older athletes competing in sports events is lacking. Most research has focused on competitive sports participation in the young population. This study analyzes the general state of knowledge of competitive sports participation among athletes aged 50 years and older from a psychosocial perspective.

RESEARCH DESIGN AND METHODS

We followed the five-step process outlined by Arksey and O'Malley (2005) and expanded by Levac and colleagues (2010). After the search in four electronic databases, 69 peer-reviewed articles met the inclusion criteria.

RESULTS

The findings indicate that psychosocial research into older people's participation in competitive sports has grown moderately in the last decade. While intrapersonal and interpersonal aspects have dominated the academic psychosocial discourse on older athletes' competitive sports participation, aspects related to the environment/community and policy have largely been overlooked.

DISCUSSION AND IMPLICATIONS

We identified several critical gaps in the literature, classified into conceptual (e.g., lesser attention to personality, emotional and cognitive aspects), methodological (e.g., longitudinal studies almost absent), and diverse aspects (e.g., focus on a wide indiscriminate age range; few comparisons between types of sports; underrepresentation of some nation or world regions as well as few cross-national comparative studies). These research gaps hint at opportunities that future research on older people's participation in competitive sports should address.

Non-fatal senior pickleball and tennis-related injuries treated in United States emergency departments, 2010-2019

BACKGROUND

Pickleball is growing rapidly with a passionate senior following. Understanding and comparing players' injury experience through analysis of a nationally representative hospital emergency department sample helps inform senior injury prevention and fitness goals.

METHODS

A cross-sectional descriptive study was performed using 2010 to 2019 data from the U.S. Consumer Product Safety Commission's (CPSC) National Electronic Injury Surveillance System (NEISS). Tennis was selected for comparison purposes because of the similarity of play, occasional competition for the same court space, and because many seniors play both sports. Non-fatal pickleball and tennis-related cases were identified, examined, recoded, and separated by injury versus non-injury conditions. Since over 85% of the pickleball injury-related cases were to players ≥60 years of age, we mostly focused on this older age group. Analyses consisted of descriptive statistics, injury frequency, type and trends over time, and comparative measures of risk.

RESULTS

Among players ≥60 years of age, non-injuries (i.e., cardiovascular events) accounted for 11.1 and 21.5% of the pickleball and tennis-related cases, respectively. With non-injuries removed for seniors (≥60 years), the NEISS contained a weighted total of 28,984 pickleball injuries (95% confidence interval [CI] = 19,463-43,163) and 58,836 tennis injuries (95% CI = 44,861-77,164). Pickleball-related injuries grew rapidly over the study period, and by 2018 the annual number of senior pickleball injuries reached parity with senior tennis-related injuries. Pickleball-related Slip/Trip/Fall/Dive injury mechanisms predominated (63.3, 95% CI = 57.7-69.5%). The leading pickleball-related diagnoses were strains/sprains (33.2, 95% CI = 27.8-39.5%), fractures (28.1, 95% CI = 24.3-32.4%) and contusions (10.6, 95% CI = 8.0-14.1%). Senior males were three-and-a-half times more likely than females to suffer a pickleball-related strain or sprain (Odds Ratio [OR] 3.5, 95% CI = 2.2-5.6) whereas women were over three-and-a-half times more likely to suffer a fracture (OR 3.7, 95% CI = 2.3-5.7) compared to men and nine times more likely to suffer a wrist fracture (OR 9.3 95% CI = 3.6-23.9). Patterns of senior tennis and pickleball injuries were mostly similar.

CONCLUSIONS

NEISS is a valuable data source for describing the epidemiology of recreational injuries. However, careful case definitions are necessary when examining records involving older populations as non-injury conditions related to the activity/product codes of interest are frequent. As pickleball gains in popularity among active seniors, it is becoming an increasingly important cause of injury. Identifying and describing the most common types of injuries may can help inform prevention and safety measures.

Pickleball: Review and Clinical Recommendations for this Fast-growing Sport

Pickleball is a single or doubles volley sport played with paddles and ball on a hardcourt. Growing in popularity in recent years, injuries can occur similar to racquet sports; however, there is a scarcity of references in the literature for sports medicine providers encountering these athletes and injuries. This review provides clinicians treating pickleball athletes with an overview of the sport, a case study demonstrating the significant injuries that can occur in pickleball, and a review of the available literature. We provide a discussion on common pickleball injuries, injury prevention strategies, and event coverage recommendations to better equip sports medicine providers with a base of knowledge and a clinical approach to treat these athletes, or "picklers," who enjoy this fast-growing sport.

Motivational climate of group exercise sessions in nursing homes

Background

Motivational climate in exercise group environments would have an impact on adherence, effort and enjoyment. We examined the motivational climate among nursing home residents who were involved in group exercise sessions.

Methods

This cross-sectional study was conducted in 10 nursing homes of Liège area that offer group exercise sessions. Sociodemographic data (age, sex, body mass index), cognitive status (by the Mini Mental State Examination) and independence in activities of daily living (by the Katz Scale) were retrieved in the medical records. The “Abbreviated-Perceived Motivational Climate in Exercise Questionnaire” was translated into French and then administered face to face with a clinical researcher. This is composed of 6 ego-involving climate items (corresponding to rivalry, comparison and favoritism) and 6 task-involving climate items (corresponding to valorization, individual efforts, self-improvement and cooperation). Each item is ranged on a 5-point Likert scale ranging from 1 (not at all focused on ego or task) to 5 (totally focused on ego or task). Each subscale has a total score expressed as an average.

Results

A total of 102 subjects of exercise group sessions were included (84.3 ± 7.7 years and 83 (81.4%) women). The mean score of task-involving and ego-evolving motivational climate was respectively 3.57 (SD = 0.67) and 1.52 (SD = 0.49), suggesting that the motivational climate was more focused on the task-involving climate than on ego-involving climate. Some items results were of particular interest: 55.9% of the respondents found that the instructor doesn’t remark/reward when they try hard, 63.7% said that the instructor doesn’t encourage mutual aid and 38.2% found that instructor doesn’t encourage to do new exercises.

Conclusions

Participants tended to perceive motivational climate as more task-involving than ego-involving. The absence of individual positive feedback, new exercises and mutual aid were also highlighted.

Senior physical activity contests in nursing homes: a feasibility study

BACKGROUND

Competition has been shown to improve motivation and physical performance in young people. This method has been rarely studied in older people.

AIMS

To evaluate the feasibility of senior physical activity (PA) contests between two nursing homes and to assess changes in the motivational level and physical performance of the residents over time.

METHODS

Residents from two Belgian nursing homes were invited to participate in PA contests. A pretest and three contest sessions were organized over a period of 3 months. The activities proposed were body balance, gait speed, sit-to-stand performance, arm curl and address tests. Feasibility was measured by contest session adherence (expected score > 80%), difficulty scores (expected score < 40%) and appreciation scores (expected score > 80%). Motivational questionnaires were administered: the BREQ-2 (assessing amotivation, introjected regulation, identified regulation, intrinsic motivation and external motivation) and the A-PMCEQ (assessing ego- and task-involving climates). Friedman's analysis of variance was performed to evaluate the changes in physical performance and motivational levels.

RESULTS

Of the 24 participants, seven did not complete all sessions because of medical or personal reasons not related to the study. During the three sessions, the adherence was 86%, the mean difficulty score was 30.8% and the satisfaction score was 87%. After three sessions, residents experienced a significant decrease ranged from 3 to 0 point for amotivation (p = 0.03), 1 to 0 point for external motivation (p = 0.03) and 2.5 to 2 points for ego-involving climate (p = 0.02) and a significant improvement ranged from 0.7 to 0.9 m/s for gait speed (p < 0.001), 18.5 to 15.6 s for sit-to-stand performance (p < 0.001) and 11.5 to 15 curls for arm curl scores (p < 0.001).

CONCLUSIONS

In nursing home settings, senior PA contests are feasible and may improve the motivational climate and physical performance.