Pickleball Injuries in Brooklyn: Tennis Elbow, Shoulder Strain, and How Shockwave Speeds Recovery

Pickleball injuries in Brooklyn are filling up chiropractic clinics, and the elbow is taking the worst of it. I see two or three new pickleball players a month now, mostly coming from McCarren Park or the Brooklyn Bridge Park courts, gripping their paddle arm and wincing when they try to shake my hand. The backhand flick that makes pickleball fun is the same motion that shreds the tendons on the outside of your elbow. That’s lateral epicondylitis, and if you’ve been playing through it, you already know something’s wrong.

Why Pickleball Wrecks Your Elbow

Lateral epicondylitis is an overuse injury of the extensor tendons that attach to the bony bump on the outside of your elbow. Every time you snap a backhand or absorb a dink at the net, those tendons take the hit. Pickleball makes it worse than tennis for a specific reason: the court is smaller, so rallies are longer and more repetitive. You’re hitting 3x more shots per minute than a tennis player, and each one sends vibration straight up the paddle into your forearm.

A 2025 epidemiological study in the Journal of Sports Sciences found pickleball extremity injuries increased by 3,650% over the past decade [1]. Upper extremity injuries account for roughly 41% of all recreational pickleball injuries, with the elbow and forearm topping the list at 18.1% [2].

The grip is part of it too. Players who death-grip their paddle (and almost everyone does when the point gets competitive) load the wrist extensors even harder. Add a cheap paddle with poor vibration dampening and you’re basically running a jackhammer into your lateral epicondyle for 90 minutes.

The Most Common Pickleball Injuries in Brooklyn

Elbow gets all the attention, but it’s not the only thing that breaks down. Here’s what walks through my door at our Greenpoint clinic.

1. Lateral Epicondylitis (Pickleball Elbow)

Pain on the outside of your elbow that gets worse when you grip, twist a doorknob, or try to pour coffee. Starts as a dull ache after playing. Then it shows up during games. Then it’s there when you wake up. The classic pattern is someone who played 4 days in a row at McCarren Park and now can’t open a jar. Tendons don’t heal on their own once they hit the degenerative stage. You need targeted treatment, not rest alone.

2. Shoulder Impingement

Overhead smashes and high volleys put your rotator cuff in a bad position, especially if your thoracic spine is stiff from desk work. The supraspinatus tendon gets pinched under the acromion, and you get a sharp catch when you raise your arm overhead. Patient last month could serve fine but winced every time she reached for the kitchen cabinet. That’s impingement. If you also have shoulder pain outside of pickleball, the sport is accelerating something that was already brewing.

3. Low Back Strain

The ready position in pickleball is a sustained forward lean with rotation. Your lumbar erectors and QL are working nonstop. Players who don’t warm up properly (which is most of them) go from sitting in a car to explosive lateral movement in about 30 seconds. I see this more in the 45+ crowd, players who are athletic enough to compete but whose spines aren’t conditioned for rapid direction changes.

4. Wrist Pain (De Quervain’s and Extensor Tendinitis)

Spin shots load the wrist in ways that straight drives don’t. The tendons on the thumb side of your wrist get irritated from repeated flicking, and some players develop De Quervain’s tenosynovitis. Pain at the base of the thumb that gets worse when you grip the paddle. Less common than elbow but harder to shake once it sets in.

How Shockwave Therapy Fixes Pickleball Elbow

This is where I tell every pickleball player to pay attention. If you’ve been dealing with elbow pain for more than 6 weeks and braces, ice, and ibuprofen aren’t cutting it, shockwave therapy for tennis elbow is the treatment that actually changes the trajectory.

Radial shockwave (ESWT) sends acoustic pressure waves into the damaged tendon. It does three things: breaks up calcified scar tissue that’s blocking healing, triggers neovascularization (new blood vessel growth into tissue that gets almost no blood supply on its own), and resets the pain signaling in the area. A 2019 systematic review found that ESWT delivers an average 60% pain reduction, with 89% of patients reporting sustained improvement at one year [3].

Compare that to cortisone, which a 2024 study showed often worsens long-term outcomes despite short-term relief [4].

At BCC, a typical course is 4 to 6 sessions spaced one week apart. Each session takes about 15 minutes. Most players notice a real difference by session 3. You don’t need to stop playing entirely during treatment, but you do need to dial back intensity. I’ll give you specific guidelines based on where your tendon is in the healing process.

We treat all the major tendon conditions with shockwave therapy at our Greenpoint clinic. Plantar fasciitis, Achilles, rotator cuff. But tennis elbow from pickleball is becoming the fastest-growing reason people call us for it.

What Treatment Looks Like at BCC

First visit is a full assessment. I need to figure out which structures are involved, because it’s rarely just the elbow. A stiff thoracic spine changes how your shoulder moves, which changes your arm slot, which overloads your elbow. I check your cervical spine too. Referred pain from C5-C6 can mimic lateral epicondylitis, and I’ve caught that more than once.

Treatment plan depends on what I find:

• Chiropractic adjustments to restore mobility in the thoracic spine, shoulder, and wrist. If the joints above and below the elbow aren’t moving right, the elbow compensates.
• Soft tissue work on the forearm extensors, rotator cuff, and upper traps. Active release, instrument-assisted, whatever the tissue responds to.
• Shockwave therapy for chronic tendon pain that hasn’t responded to conservative care. This is the accelerator.
• Rehab exercises you do at home. Eccentric wrist curls, shoulder stability work, thoracic mobility drills. I’ll show you exactly what to do and how often.

Most pickleball players I treat are back to full play in 4 to 8 weeks. Some faster, some longer. Depends on how long you waited before coming in.

How to Keep Playing Without Breaking Down

You don’t have to quit pickleball to save your joints. But you do need to be smarter about it.

1. Warm up your forearms before you play. 2 minutes of wrist circles, forearm stretches with elbow straight, and light paddle swings. Nobody does this. Everyone should.
2. Check your grip pressure. On a scale of 1 to 10, you should be at a 3 or 4 during rallies. Most people play at an 8. Loosen up. The paddle isn’t going anywhere.
3. Upgrade your paddle if it’s cheap. Carbon fiber faces and polymer cores absorb more vibration than wood or basic composite. It’s a $100-150 investment that saves your tendons.
4. Limit consecutive play days. Your tendons need 48 hours to recover from repetitive load. Three days on, one day off is a reasonable minimum. Back-to-back doubles tournaments are where most injuries start.
5. Do eccentric wrist curls 3x per week. Hold a light dumbbell (2-3 lbs), rest your forearm on your knee palm-down, and slowly lower the weight over 5 seconds. 3 sets of 15. This builds tendon resilience better than any brace.

When to Stop Playing and Get Checked

Some pain you can play through. Some you shouldn’t. Here’s the line.

See a chiropractor if:

• Elbow or shoulder pain persists more than 2 weeks after resting
• You feel sharp pain during the swing, not just after
• Grip strength is noticeably weaker on your paddle side
• Numbness or tingling runs down your forearm into your fingers
• You’re compensating by changing your swing (this creates new problems)

Go to urgent care or an ER if:

• You hear a pop followed by sudden swelling and inability to move the joint
• You fell and can’t bear weight or move your wrist/shoulder
• There’s visible deformity after an impact

The players who do best are the ones who come in early. A fresh tendinopathy responds to treatment in 2 to 3 weeks. A chronic one that’s been grinding for 6 months takes 6 to 8 weeks and often needs shockwave to break through. Don’t be the person who waits until they can’t hold a coffee mug.

If you’re playing at McCarren Park, Brooklyn Bridge Park, or any of the growing number of courts across Brooklyn, your body is absorbing more repetitive load than you think. Sports chiropractic exists for exactly this. Get assessed before a minor strain becomes a chronic problem.