Warming up, cooling down advisable, as in other racket sports

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

Pickleball is considered a social sport that's good exercise and easy to learn, but with the sport's increasing popularity comes a rise in potential injury. Here with me to discuss common pickleball injuries and how to avoid them is Dr. Eric Bellinger. He's an assistant professor of orthopedic surgery at Upstate.

Welcome to "The Informed Patient," Dr. Bellinger.

Eric Bellinger, MD: Thanks for having me.

Host Amber Smith: Well, I'd like to talk about specific lower- and upper-extremity injuries, but before we do, can you tell us if most pickleball injuries are from overuse or do you see players with acute injuries?

Eric Bellinger, MD: So we see a combination of both. So there are a subset of patients that will come in with an ankle sprain or an Achilles injury or a rotator cuff issue. That's more of an acute nature, but there's also a fair share of patients that will come in with a more chronic, tendinitis type of issue or something along those lines.

Either way, we're more than adept at treating those, but the treatment algorithms can change depending on what the nature of the injury is.

Host Amber Smith: Well, let's go over then, let's start with the lower-extremity injuries that you see that are most common and how you typically treat them.

Calf strains or tears: Do you see that?

Eric Bellinger, MD: Yeah, so occasionally we'll see some calf strains. Tearing really is essentially synonymous with strains. Strains are just kind of on the lower end of a lower-grade tear of a calf muscle, and generally speaking, that can be treated with getting over the initial point of the injury, the RICE: rest, ice, compression, elevation, anti-inflammatories, if medically you're allowed to take those. Those are all good things to kind of treat the initial. And then typically we'll start you, once your pain is at a more controlled level, we'll initiate physical therapy at that point.

Host Amber Smith: Do you ever see people with a flare-up from knee arthritis caused by playing pickleball?

Eric Bellinger, MD: Yeah, so that's another common one that we'll see. Patients that have pre-existing knee arthritis, the side-to-side motion of pickleball can set off, quote unquote the knee arthritis, and you can get a flare-up of the arthritis pain as well.

It's kind of treated similar to the calf strain initially: the rest, ice, elevation compression, anti-inflammatories. Those kinds of things are generally a good first go-to for these types of injuries. And then, again, depending on the nature of it and how long it's been going on, a short course of physical therapy might be helpful as well.

Host Amber Smith: Do you see plantar fasciitis that's caused by pickleball?

Eric Bellinger, MD: Plantar fasciitis is not often caused by pickleball. It can be exacerbated, so if you had plantar fasciitis or were predisposed to plantar fasciitis, the pickleball can aggravate it. But pickleball doesn't typically cause plantar fasciitis itself.

That's more of a degenerative one that usually there's some sort of underlying issue that is the case versus the pickleball actually causing it.

Host Amber Smith: And so that would be like pain in the foot.

Eric Bellinger, MD: That's more pain along the bottom of your foot at the heel.

Host Amber Smith: OK. Hamstrings, because I hear about hamstring injuries, that is the upper part of the leg?

Eric Bellinger, MD: Yep, that's the back of your thigh. Hamstring injuries are something that we see commonly with pickleball. The side-to-side motion, the quick stop-start -- those are things that can cause a hamstring pull or strain, and that can usually be prevented if you're good about stretching before and after the pickleball.

Host Amber Smith: That's good to know. Now what about ankle injuries, ankle sprains or Achilles types of injuries? Do you see a lot in that area?

Eric Bellinger, MD: Yep. So the most common thing that we see is an ankle sprain, and that's typically a misstep with the side-to-side motion in pickleball causes somebody to turn their ankle, so that's probably the most common thing that we'll see.

Achilles injuries we will see. Now, Achilles injuries is a little bit more severe in that, depending on the nature of the Achilles injury, if it's a complete rupture of your Achilles, then we're having a discussion about potential surgery versus more of a long course of a recovery there.

Host Amber Smith: Do you ever see people with back injuries from pickleball?

Eric Bellinger, MD: Yep. We'll see back injuries. usually people have underlying back issues to begin with and the pickleball will kind of exacerbate it. It usually is not something where we're seeing somebody that's never had back issues before and now has back issues because of the pickleball.

But if you are predisposed to having back issues beforehand, it can certainly flare it up.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith.

I'm talking to orthopedic surgeon Eric Bellinger about injuries that may occur from playing pickleball.

We talked about lower extremities, so I want to ask you about upper-extremity injuries that might happen, things such as what's called tennis elbow.

Eric Bellinger, MD: Yep. So tennis elbow is a common, probably one of the more common, upper-extremity injuries that we see with pickleball. As the name would suggest, racket sports very often will lead to a tennis elbow, or lateral epicondylitis is the medical term for that.

And that's an inflammation in one of the main extensor tendons of your forearm at the elbow level, and similar to some of the injuries in the lower extremity, rest, ice compression, elevation are the first line with some anti-inflammatories. Physical therapy -- this injury responds particularly well to physical therapy.

Almost everybody that does the physical therapy and the exercises associated with it will get better with time, and that's usually where we would start first line for that. Very rarely do we have to go much further past that.

Host Amber Smith: What about shoulder or rotator cuff injuries? Are those common?

Eric Bellinger, MD: Yep. Rotator cuff strains or tears are probably a close second to the lateral epicondylitis or tennis elbow, in terms of injuries that we see. That almost always is, something that we will get you into physical therapy pretty quickly because physical therapy will significantly help speed that along in terms of your overall recovery from that.

Host Amber Smith: So all of the injuries that we've talked about so far, it doesn't sound like they're unique to pickleball.

Do you see them with tennis and racquetball and other sports that use rackets?

Eric Bellinger, MD: Yes. So the rotator cuff injuries and the tennis elbow, racket sports and overhead sports, generally you'll see those types of injuries.

Host Amber Smith: So in order to prevent or to minimize the risk of injury, you did talk about stretching beforehand to help hamstrings.

Is there other advice you have that would help prevent some of these other injuries as well?

Eric Bellinger, MD: Yep. So just like the lower extremities, stretching out your upper extremities, there's certain stretches that you can do, and anything that you can do beforehand to warm up is helping prevent these injuries.

Host Amber Smith: Do you recommend people run or jog, or is it just stretching? Are there specific exercises that they should do beforehand?

Eric Bellinger, MD: For lower extremities, it is always nice to do like a light jog or something like that to get the blood flowing in your lower extremities.

And then you couple that with your stretching exercises after you've got the blood flowing in your lower extremities. stretching's going to work best if the muscles are warmed up. If you're just kind of coming out of the car cold, and go right into the stretching, the stretching's not going to be as effective.

So any type of way that you can get the blood pumping in those muscles before you start stretching is a good rule of thumb, whether the lower extremity or the upper extremity.

Host Amber Smith: Now what about afterward? Is a cooldown helpful for helping prevent injuries?

Eric Bellinger, MD: Cooldown is just as important as the warm-up in preventing, soreness afterwards or an injury down the line. Cooldown stretching is something that we always will push our patients to do as well.

Host Amber Smith: In terms of equipment, do you have any recommendations or any concerns about choosing a racket or choosing shoes?

Eric Bellinger, MD: Yeah, not so much in terms of the racket; whatever is more comfortable to you. But in terms of, some of the lower-extremity stuff, that, for sure, a good pair of, running shoes is going to be paramount to helping prevent some injuries. If you are particularly prone to ankle sprains, sometimes a brace can be helpful.

Those are kind of the preventative things, at least in the lower extremity, that I would recommend, in addition to the stretching we already talked about.

Host Amber Smith: If someone gets hurt playing pickleball, do you have any advice for how to determine whether they need to go to the emergency department or to call their primary care doctor or to wait it out and see if they feel better the next morning?

How does a person determine what they need?

Eric Bellinger, MD: For lower-extremity injuries, one of the good rules of thumb is, if you can't walk on it, that's something that probably should be seen sooner rather than later. Anytime anybody can't weight-bear, so to speak, on their affected side, that's usually a good indication that that's probably something that you want to have looked at. In terms of the upper extremity, certainly any deformity, but that's relatively rare in this instance, but an excessive amount of swelling or bruising, something that's certainly something that you could certainly, want to be seen sooner rather than later for.

Host Amber Smith: Is there any sort of first aid that may help for the person until they do get care?

Eric Bellinger, MD: It's never a bad idea to, wrap an Ace wrap around an injured extremity to just provide a little bit of compression. Anti-inflammatories, if you're able to take them and don't have a medical reason that you can't, those are always helpful to bring some of the inflammation down, and then icing.

Host Amber Smith: Now pickleball is a sport that seems to be attracting, an older population. Are there special concerns, or do you treat patients differently if they're in their 50s or 60s or sixties versus if they're in their 20s and 30s?

Eric Bellinger, MD: The injuries that tend to occur in the younger population tend to be different than the injuries that occur in the older population. So I would say it doesn't necessarily mean if you have the exact same diagnosis the treatment's different, but I would tell you in different demographs of patients, we tend to see different injuries.

So I guess the treatment would differ based on what the actual injury is.

What types of injuries are you more likely to see in the older patients versus the injuries that you would see in the younger people?

Eric Bellinger, MD: So, in the upper extremity, for example, the older population tends to have more issues with their rotator cuff, where the younger population tends to be more of a tennis elbow.

That's not exclusive, but that's generally what we see.

Eric Bellinger, MD: In the lower extremity, obviously any of the pre-existing arthritis in the older population, so exacerbations of those arthritis (related problems), that's going to be something in the older population.That's kind of the differentiation there.

Host Amber Smith: Now, how do appointments work for Upstate Orthopedics, where you work? Are people able to get a same-day appointment, do you know?

Eric Bellinger, MD: Yeah, so we have a walk-in clinic here, so patients that have an injury, whether confirmed or suspected, are able to walk in and see a provider, whether that's a midlevel or a doctor, the same day. So we have a pretty good walk-in clinic readily available to take patients that have these types of injuries.

Host Amber Smith: And that is at the Bone and Joint Center at 6620 Fly Road (East Syracuse).

Well, Dr. Bellinger, I want to thank you so much for making time for this interview.

Eric Bellinger, MD: Thanks so much. I appreciate it.

Host Amber Smith: My guest has been Dr. Eric Bellinger. He's an assistant professor of orthopedic surgery at Upstate.

"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe.

Find our archive of previous episodes at upstate.edu/informed.

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