Pickleball injury research: five studies of emergency visits, kept apart.

What NEISS can and cannot show

NEISS, the National Electronic Injury Surveillance System, is run by the US Consumer Product Safety Commission. It records patients from a sample of US hospital emergency departments, and researchers weight those cases to produce national estimates. Two limits run through every study below, and the Weiss and Yu authors state them:

• Only emergency visits. Injuries treated by a family doctor, an urgent-care clinic or a physiotherapist, or not treated at all, are not in the data, so the counts are lower than the true number of injuries.
• No players in the denominator. NEISS does not know how many people played pickleball, or for how long. A rising count can reflect more people playing as well as anything else, so these studies show trends and the pattern of injuries, not the risk to any one player. Yu and colleagues add that about 13% of mechanisms in their data were not specified.

The studies also overlap in years and use different case definitions. Their totals describe different slices of the same data and must not be added together or compared as rates.

The five studies side by side

Forrester, 2001 to 2017

This study could only be seen as a search-result excerpt of its abstract, so its details are unconfirmed. The excerpt describes 300 NEISS cases, a weighted estimate of 19,012 injuries, with patients aged 50 or older making up 90.9% of cases. Sprains or strains were 28.7% and fractures 27.7%, the lower extremity was involved in 32.0%, and 88.0% of patients were treated and released.

Weiss, Dougherty and DiMaggio: players aged 60 and over, 2010 to 2019

This cross-sectional study looked at adults aged 60 and over in both pickleball and tennis. It reported that more than 85% of all-age pickleball injury cases in its data were in players 60 or older. For senior pickleball players:

• Trend. 92.0% of the senior cases fell in 2015 to 2019, and by 2018 the yearly senior pickleball count had reached the senior tennis count.
• Diagnoses. Strains or sprains 31.0%, fractures 30.4%, contusions 11.1%.
• Body regions. Upper extremity 35.0%, lower extremity 27.6%, head and neck 18.1%, trunk 16.7%. Eye injuries were 0.5%.
• How. A slip, trip, fall or dive in 66.9%. Falls caused 75.5% of senior women's and 57.7% of senior men's injuries.
• Who. 46.2% women and 53.8% men, mean age 69.5; 7.4% were hospitalised.
• Women and men. Senior women had about 3.7 times the odds of a fracture, and 9.3 times the odds of a wrist fracture, of senior men; senior men had about 3.5 times the odds of a strain or sprain.
• Not counted as injuries. Cardiovascular events and fainting were 11.1% of senior pickleball cases and were removed from the injury figures.

The paper also gives all-age percentages (for example strains or sprains 33.2% and fractures 28.1%) that differ from the senior figures above, so each number belongs with its population.

Ghattas and colleagues: fractures, 2002 to 2022

• Trend. No pickleball fractures were recorded before 2005. Over the study period fractures rose roughly 90-fold; they roughly doubled from 2020 to 2021, and 2017 to 2022 was 349% higher than 2012 to 2017. In recent years about 90 fractures a year were recorded in NEISS, which the authors scaled to roughly 5,400 a year nationally.
• Who. Mean age 66.4. About 87% were over 60 (about 46% aged 60 to 69 and 41% aged 70 or older). About 69% were women and 31% men.
• Where. Upper extremity about 66%, lower extremity about 19%, trunk about 11%, head or neck about 4%. The radius was the bone most often fractured, then the humerus and the ulna.
• How and when. About 92% resulted from falls (the paper gives 365 falls in its abstract and 367 in its results). About 36% happened in December to February, the highest of any season.
• Admission. About 81% went home and about 19% were admitted. In a single-factor analysis the odds of admission were higher for age over 60 (odds ratio 2.27), male sex (2.31), trunk fractures (2.89) and lower-extremity fractures (13.8).

Yu and colleagues: all ages, 2013 to 2022

• Trend. Estimated yearly injuries rose from 611 in 2013 to 13,690 in 2022, about 22-fold. They fell 14% from 2019 to 2020 and rose 41% from 2020 to 2021.
• Who. Mean age 64, range 4 to 93. Ages 65 to 80 accounted for 61.1% of injuries and ages 35 to 64 for 31.3%. Women made up 50.6% of all injuries and 69.1% of fractures.
• How. Falls led overall at 65.5%. Being struck by a paddle was most common for ages 0 to 17, and twisting or inversion for ages 18 to 34.
• Diagnoses and sites. Fractures 32.7% and strains or sprains 30.8%. The wrist (12.7%), lower trunk (12.1%), lower leg (11.7%) and head (11.3%) were the most affected sites.
• Admission. About 6.9% were admitted. Among them the lower trunk, including the hip and pelvis, was the most common site (42.2%), and fracture the most common diagnosis (70.5%).

Lacher, Koc and Tsui: eye injuries, 2005 to 2024

This JAMA Ophthalmology study, published online on 16 October 2025, was not read in full; its figures come from Review of Optometry's report. It found 73 eye-injury cases from 2005 to 2024, 33 of them in 2024, a weighted estimate of 3,112 injuries, 1,262 of them in 2024. It estimated that eye injuries rose by about 405 cases a year from 2021 to 2024, and about 70% of cases were in people aged 50 or older. The injuries and the eyewear rules are covered on eye injuries and eyewear rules.

What the studies agree on, and what they cannot say

In the three studies whose figures on how injuries happened could be read in full (Weiss, Ghattas and Yu), falls were the leading cause, and in each of the five, older players made up most of the patients, by that study's own age bands. The four studies that report a trend found the counts rising across their years. None of them can say whether pickleball is more or less risky than another activity, or how risky it is for a given player, because none has a count of players or hours played. Anyone who has fallen, struck their head or eye, or felt unwell on court needs medical care.