There was no actual sound of an Achilles tendon rupturing, but I could feel the anguish wash over my pickleball partner's soul as he crumpled to the ground in a confused, muscular heap.
Aaron is 35 and super fit, a natural athlete who had just attempted to reach a softly fluttering ball near the net. Now he was lying on his back near the baseline, wrapping his left arm around his face as if to shield his dazed eyes from a brutal reality. Aaron was processing why his left calf seemed to have been struck by a rubber bullet.
"What just happened?" he asked incredulously.
I had heard of this dreaded injury, one of the most likely to strike those new to the country's fastest growing sport -- headed toward 20 million of us pickle junkies, by recent estimates. I had tried to leverage that fear to inspire my own warm-up for the activity that had overtaken so many early mornings of my mid-life existence the past two years.
But to watch someone accustomed to extreme amounts of daily physical exertion -- Aaron hikes, bikes, surfs, lifts weights and had just recently picked up pickleball -- lose this delightfully life-affirming activity, along with all the rest, for the better part of a year was the visceral gut check I'd been needing. I was immediately sure my lazy version of pre-pickle stretching couldn't protect me from an equally soul-wrenching fate.
In need of a pickleball intervention, I rang Stanford Medicine orthopaedic guru Michael Fredericson, MD, someone I knew had been closely tracking not just the increasing number of pickleball-related injuries but also their diverse nature. (According to one recent estimate, there were some 19,000 injuries totaling $500 million in medical costs in 2023 alone.)
If anyone could save me from myself -- and this peculiar obsession for rifling Wiffle balls at the torsos and feet of friends and strangers with a joy I hadn't felt since I was a giddy 9-year-old whizzing dodgeballs across the blacktop during recess -- it was Fredericson. I knew he too had sampled the tantalizing fruits of pickleball's allure -- physical enough for a good workout, social enough for a mental health booster -- and would understand my plight.
We talked about all the common maladies that affect young and old who suddenly venture into the world of tennis-meets-table tennis, squash-meets-racquetball, badminton-meets-Smashball. Elbow and wrist trauma, knee and ankle joint tweaks, eye injuries. (Those balls whiz fast...and often unintentionally high. Eye protection is highly recommended.)
But I had come to Fredericson -- one of Team USA's doctors at the Tokyo Olympics in 2021 -- mostly to address the specifics of my own personal haunting. How do I not end up like my friend Aaron? How do I keep my Achilles tendons firmly attached to my heel bones? The good doctor had some food for thought.
More than its name
This is something I often hear from experts like Fredericson: Pickleball isn't as dainty as it might appear. The stops and starts and quick changes of direction needed to excel at this sneakily explosive sport aren't immediately clear to someone watching it for the first time.
"People aren't thinking about injury when they first see it because it just looks so fun," Fredericson said.
Perhaps the game's frivolous name started all this. (Pickles was the dog owned by one of the sport's originators in Bainbridge Island, Washington, back in 1965 -- accounting for one version of the name's origin.) But the sized-down courts and plastic balls resembling those batted around in backyard games of Home Run Derby are also to blame for its sense of cute Americana more than killer instincts.
Make no mistake: Killer instincts, wherever they were honed earlier in life, from bowling alleys to kickball fields to Monopoly boards, will re-emerge on the pickleball court. And, when they do, your joints and muscles and tendons must be ready to support them.
Right prep, right shoes
All potential lower body injuries -- particularly injuries to the calf or Achilles -- begin with a lack of proper stretching and strengthening exercises. Five minutes of dynamic stretching movements that elongate the key muscles and tendons in motion rather than statically, while also getting the body warm, are what Fredericson recommends as a starter.
An easy jog around the court, standing or walking lunges, movements that require some bounding and help activate the calves, hamstrings and hip flexors (leg swings, power skips and box jumps are a few).
Then comes an even more important few minutes before picking up a paddle. Movements that strengthen the lower body are even more injury protective than stretches, Fredericson says. One easy way is to find a step and use it to do a combination of calf raises (straight leg, bent knee and eccentric).
The more traditional static stretches where you put strain on the calf muscle and Achilles for an extended period (think of the runner's stretch or the yoga pose Downward Dog) are best saved for after play when the body is warm and "tissues are more pliable," Fredericson said. Prolonged static stretching beforehand can actually reduce power and explosiveness of the muscle, he said.
As important as mimicking the motions your feet will soon attempt is what you put on them. Running shoes are the biggest no-no. They are made to go north and south, while pickleball requires north, south, east west and every little diagonal in between.
"A good pair of court shoes -- designed for tennis or pickleball -- is a must for all the stopping, starting and cutting you're going to do," Fredericson said.
I have gravitated toward the minimalist barefoot shoes (with an orthotic insole for better arch support) because, as a lifelong surfer, flip-flop wearer and sand walker, my feet are accustomed to breathing and touching the earth. Having a big sole makes me feel disengaged from the earth and susceptible to ankle twists.
Know your foot muscles
Did you know the human foot has 29 muscles, 19 intrinsic to the foot and 10 extrinsic that originate outside the foot but cross the ankle joint to act on the foot? Fredericson recommends getting to know as many as you can because their proper functioning is crucial to the health of not just your foot, but all the ligaments and tendons that extend from there up into your calves, hamstrings and glutes.
"People tend to know about the importance of core strength in your body -- well, there's also the core of the foot," he said. "If you're wearing shoes all the time, those muscles tend to atrophy. A good way to feel this is to take a barefoot walk in the sand, where you must keep all those muscles engaged."
There are good exercises for strengthening the foot's core -- from toe yoga that focuses on vertical flexibility to "doming" of the foot muscles that activate the foot's arch to toe movements that work on spreading their flexibility laterally.
"Foot strength is incredibly important in court sports like pickleball," Fredericson said.
Beginner beware
I told Fredericson that I now know three relatively young, fit humans who blew out their Achilles in the last year. The common theme: Each was new to the game, learning completely new biodynamics on the fly.
While hardcore pickleball studies are slow to roll out, Fredericson said that the "new player" hypothesis seems to match up with the anecdotal evidence. People who haven't been performing explosive movements, possibly for years or even decades, suddenly turn up giddy and ready to explode in all directions.
I was one of them for sure. In my first pickleball forays, I slammed into a few fences and took a few head-first tumbles that I luckily survived with nothing more than a few scrapes and audible gasps. But my body and mind had no sense of what I could and could not do at first. I was going on instincts from other times and playing fields. Gradually I adapted and now I feel far less injury prone.
I slammed into a few fences and took a few head-first tumbles that I luckily survived with nothing more than a few scrapes and audible gasps.
But I'm still hyper aware of staying loose, limber and low to the ground -- especially since I love nothing more than scrapping for wayward balls all over the court. Between points, I obsessively touch my toes, perform calf raises, do some walking on my heels, knowing that my junkyard dog instincts are sure to ground me eventually if I don't.
And as easy as it is to get sucked straight into action and warm up on the fly, I'm getting better about developing a pre-pickle stretch-and-strengthen program. I've learned that, despite the cutesy name and low-key vibe, this game isn't one to be taken lightly. Just ask my friend Aaron, who unfortunately found out the hard way and is now entrenched in the slow climb back to the activities he lives for.
"I like to tell people that you don't run to stay fit, you stay fit to run," said Fredericson, who is also head physician for the Stanford track & field team. "It's the same with pickleball."
Illustration: Emily Moskal
