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

Inj Epidemiol. 2021 May 3;8(1):34. doi: 10.1186/s40621-021-00327-9.


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.

Keywords: Emergency department; Falls; Fractures; Injury; NEISS; Physical activity; Pickleball; Seniors; Sports and recreation; Tennis.