Learn to Fall Before You Learn the Erne

Ask around your courts about pickleball injuries and you’ll hear about elbows. Somebody’s wearing a brace, somebody just got a cortisone shot, somebody switched to a 16mm paddle and won’t shut up about it. Tennis elbow is the injury everybody talks about.

The emergency room sees something else. The person who ends up there usually chased a lob and went over backward, or stepped on a stray ball, or lunged for a dink they were never going to reach. They put a hand down, and the hand lost.

What the ER actually sees

In June, the Journal of Orthopaedic Experience & Innovation published a 10-year look at pickleball arm injuries using federal emergency department data from 2014 through 2023. Out of an estimated 66,350 pickleball injuries, 14,916 involved the shoulder, arm, wrist or hand. Here’s what those looked like:

58.6% were fractures. Tennis: 36.1%.
8.1% of patients were admitted to the hospital, double the tennis rate of 4.0%.
83.1% were over 60, and the average age was 67.
Falls were the leading cause.
For women, 71.7% of these injuries were fractures. For men, 39.8%.

An earlier study presented at the 2024 AAOS meeting pulled every pickleball fracture out of the same database and found the same pattern. Falls caused 92% of them. Women accounted for 69%, the average age was 66.4, two-thirds of the breaks were in the upper body, and 19% of patients were admitted.

Back in July we wrote about a survey of 1,758 players where overuse was the biggest injury category, at 41%. These studies don’t contradict each other. They’re looking through different doors. A cranky shoulder walks into a physical therapist’s office sometime in May. A broken wrist gets driven to the ER at 10:30 on a Tuesday morning. Surveys catch the slow injuries. Emergency data catches the fast ones, and the fast ones are mostly a body meeting a court.

There’s one piece of good news in there. The rate of these arm injuries per 100,000 players peaked at 62.74 in 2021 and fell to 30.60 in 2022. That’s probably the sport getting younger: millions of new players showed up, and most of them weren’t 67. The raw count keeps climbing because the sport keeps growing, but the risk isn’t spread around evenly. It sits on one group of players, and if you’re in it, you should know.

Why pickleball breaks bones that tennis doesn’t

Some of it is who’s playing. The Bone Health and Osteoporosis Foundation estimates that about one in two women and up to one in four men over 50 will break a bone because of osteoporosis. Pickleball took a lot of those people and put them on hard courts, moving quickly, four mornings a week. The AAOS researchers pinned the fracture pattern on “the bone health of this postmenopausal population.” The 2026 paper adds less arm muscle, slower reaction times and weaker protective reflexes to the list.

Some of it is the game. Rec tennis players spend most of a point around the baseline, moving side to side. Pickleball parks four people at the kitchen line, about 14 feet apart, leaning forward on their toes. Then a lob goes up and somebody has to reverse direction instantly. Moving backward is the clumsiest thing humans do (we’ve said it before and we’ll keep saying it), and the kitchen line is where every lob starts.

And some of it is the sport’s own sales pitch. “Small court, light ball, anyone can play” gets people off the couch, which is wonderful. It also tells them there’s nothing to worry about. Nobody pictures getting hurt on a court that’s 20 feet wide.

One more number from the AAOS study matters this time of year. Winter produced the most fractures, 36% of them. Summer produced the fewest, 16%. We can only guess at why. Winter is when snowbirds pack the Sun Belt courts and everyone up north moves onto slick gym floors. Whatever the reason, fracture season is the one we’re walking into.

Four ways you’re going to hit the ground

Most pickleball falls come out of the same handful of situations. None of the fixes require any athletic talent.

The lob backpedal. The ball goes over your head and you shuffle backward on your heels, eyes on the sky, feet crossing. That’s how people end up flat on their backs. Turn your hips, run back, and let the ball bounce if you need the time. If you’re not sure you can get there safely, it’s your partner’s ball or nobody’s. A 3.5 overhead doesn’t come with a trophy.

The stray ball. A ball from the next court rolls under your foot at the worst possible moment. Anybody can stop play by yelling “Ball!” A stray ball is a hinder and the rally gets replayed, so use it and don’t feel bad about it. Clear loose balls off your own court between points, and stop parking the spare against the net post where somebody will back into it. In October, add wet leaves, acorns and morning dew on outdoor courts to the list.

The partner tangle. You both go for the same middle ball, or you both chase the same lob, and somebody’s shoulder ends up in somebody’s ribs. Settle it before the game: who takes middles, who covers lobs, and one word for each.

The hopeless reach. The ball’s already past you, and your competitive lizard brain sends you diving anyway. Let it go. A diving get looks great on Instagram. At open play it mostly costs you a wrist.

Yes, you can learn to fall

This part sounds a little silly until you see the research. In 2017, Yaejin Moon and Jacob Sosnoff reviewed 13 studies on landing strategies and found that nearly all of them reduced the force of a fall. Which one worked best depended on which way you were going down.

Falling forward, the winner was bending your elbows so they give when you land. A locked, straight arm sends everything through your wrist, which is exactly how a fall turns into a distal radius fracture. Falling sideways, rolling worked best, and martial-arts-style rolling had the biggest effect of anything in the review by a wide margin. Falling backward, squatting as you go down helped most, because you land on your butt from a lower height instead of toppling the full length of your body.

There’s a catch. Most of those studies used young adults doing falls they knew were coming. That’s a long way from a 68-year-old getting surprised by a lob. Older adults can learn these techniques, but they learn them more slowly, and slower reactions make it harder to pick the right move mid-fall. So this is a practice thing, not a reading thing.

Don’t practice on a court. A physical therapist who does fall training is the safest option. A beginner judo or aikido class works too, since both spend the first weeks teaching people to hit the mat safely. Go slow, and if you know you have osteoporosis, ask your doctor first. You want your body to tuck and roll when you go down for real, instead of throwing a stiff hand at the concrete.

Make the bone harder to break

You can’t prevent every fall, but you have some say in what happens when you land.

The U.S. Preventive Services Task Force recommends bone density screening, a DXA scan, for every woman 65 and older and for younger postmenopausal women with risk factors. The evidence on screening men is thinner, but if you’re a man who broke something in a minor fall, mention it to your doctor anyway. And if you’re a woman over 65 who plays four days a week and has never had a DXA scan, book one before you buy another paddle.

The 2026 paper’s authors also recommend resistance training, balance work, and calcium and vitamin D, with the doses up to your doctor. Lifting strengthens the muscles that catch you and helps hold onto the bone underneath them. Balance training keeps you from going down in the first place, so if you haven’t tried our 30-second balance test yet, do it tonight.

And wear court shoes. Running shoes are built to roll you forward, and the last thing you need is help rolling.

The bottom line

Pickleball mostly earns its gentle reputation. You’re far more likely to leave the court with sore calves than with a cast. But “low impact” describes the swing, not the ground, and ten years of ER data says the ground is where the serious injuries happen.

So turn and run for lobs instead of backpedaling, yell “Ball!” without apologizing, and let the hopeless ones go. Get the scan if you’re due. Spend a few Saturdays learning to fall on a mat. Learn to fall before you learn the erne. The erne gets you a highlight. The fall gets you an X-ray.