Joey Wahler (Host): It's America's fastest growing sport, so we're discussing pickleball injuries and their treatment. Our guests, Dr. Robert Nickerson and Dr. Dwan Perry. They're physical medicine and rehabilitation physicians with a focus on sports injuries at UK HealthCare.

Host: This is UK HealthCast, a podcast from UK HealthCare. Thanks for listening. I'm Joey Wahler. Doctors, thanks for joining us.

Dr Robert Nickerson: Thank you.

Dr Dwan Perry: Thank you for having us.

Host: Great to have you. So first for you, Dr. Nickerson, for those still unfamiliar and I would imagine there are some, what is pickle ball in a nutshell?

Dr Robert Nickerson: Pickleball is a racket sport that's played on a hard surface. You can think of it as like standing and playing ping-pong. It has a ball. You hit it back and forth to each other. And there are some unusual rules, but it is the fastest growing sport in America for all ages actually.

Host: In terms of comparison, I guess you can also compare it to sort of a miniature version of tennis as well, right?

Dr Robert Nickerson: It would be similar. The ping-pong analogy is because the racket is solid and it doesn't have strings on it. So, there's a little difference in the ball. It's more of what most people think of as a wiffle ball. It's a hard ball. Some have larger holes, some have smaller holes. But the difference is that, when you hit it, it doesn't have quite the speed of a typical tennis ball.

Host: Gotcha. So, Dr. Perry, why do you think pickleball's popularity is exploding so much?

Dr Dwan Perry: Overall. I think that the population that is gaining the most use of pickleball would be some over the age of 40s to 50s. It's kind of easy to pick up. It has fairly simple rules. It's something that can be done in numerous venues, so it just can be done as something somewhere as simple as the YMCA. There are also pickleball courts. But I think it's very easy to pick up. It's easy for people to learn. You don't have to cover a lot of ground, and it's fun to play.

Host: Yeah. As a matter of fact, I know that just recently it was announced that in New York City in Central Park where the famous Wollman rink is, where there's ice skating available during the winter months, they're turning that into pickleball courts during the warmer weather. How about that?

Dr Dwan Perry: Oh, I think it's a great thing. I think it's a great thing. It gets people active. It's something, to keep people moving. So, it is great that they can get use out of a wintertime venue.

Host: So back to you, Dr. Nickerson. What are the most common pickleball-related injuries?

Dr Robert Nickerson: The most common injuries would be sprains and strains, then followed by probably fractures, believe it or not, where people stumble and fall. And then, contusions would be up there. Those are, you know, bruises or abrasions when you fall and hit the ground. Those are the top three areas of injuries, but there are lots of other injuries that I've seen over the years that pickleball has been growing. And there are about, I don't know, maybe between 19,000 to 20,000 injuries per year by a recent article. But that's probably even underestimating because not everybody who gets injured goes to the emergency room, right? And so, it's probably underdocumented and underestimated. So, it can be a sport that can give you some injuries. And it's important to know what they are and how to treat them.

Host: And speaking of treatment for you, Dr. Perry, what are some of the treatments for those injuries that Dr. Nickerson just mentioned?

Dr Dwan Perry: So, I think it depends on the injury itself. If we're looking at something that's not too serious, if we're thinking of a simple strain or a strain, using some of the very common modalities that you can do at home, such as rest, ice, compression, kind of elevating the area, that should be fairly simple for most people to do at home. Maybe try a little bit of anti-inflammatory medication as well. Of course, if those symptoms don't really improve, that's when we would suggest to seek medical attention to make sure there's not something more sinister going on. So, that may include getting some x-rays or trying some other treatments including prescription medication or injections. If it's a fracture, of course, that may need some additional types of treatments that may need to be seen by an orthopedic surgeon if it's unstable or maybe casting or immobilization of some other sort.

Host: Now, I've seen some pickleball, not a lot. But it seems like because there's so relatively little court to cover, you would think that something like a broken bone would be quite rare. But I guess, Dr. Nickerson, that's not the case, huh?

Dr Robert Nickerson: That is true. And the reason is twofold. Number one, the ball does not bounce very high, and so you find yourself leaning over. And if you're not careful, you will get your center of gravity what I call over your ski tips and you will fall forward. And when you fall forward, you tend to want to put your arm out in front of you. And so, it's very easy to end up with a fractured wrist or a fractured finger bone. I've seen people actually fractured their ankles because they lost their balance and fall forward. So, there are a little higher incidence of what I would consider, you know, a significant injury because of the type of the bounce of the ball and the center of gravity changes a little bit. And so, a lot of times people who are older, their center of gravity is not as well adjusted, and so they tend to fall. And so, it can really be a problem, and that's why it's important to probably take some lessons and get proper equipment and watch and get some tips from people who know how to play it so you don't end up injuring yourself.

Host: Indeed, that sounds like a great tip to go out and get some tips. So, let me also ask you, Dr. Nickerson, how about the fact that the sport is still so relatively new, especially at the popularity level we're seeing now. Do you think that's part of why we're seeing so many injuries, because maybe some that are participating or taking it a little bit lightly are aren't properly prepared?

Dr Robert Nickerson: That could be possible. I will say that the data that's available shows that about 90% of the injuries occur in people over 50. So, it's a very social event. And so, a lot of people and they're over 50s, 60s, 70s, they love to get out and do it as a group activity. And those are the people who tend to fall. Typically, the 20-year-olds, the 30-year-olds, they're more athletic. They've been doing things and they don't have much in the way of problems. But when you get a little older, your tendons and ligaments get a little stiffer and you lose your balance a little easier. And so, that tends to be where most of the injuries occur, is in that over 50 age group.

Host: Understood. So back to you, Dr. Perry. How about the fact that just in general, people often tend to overdo it when exercising, especially when trying something for the first time, when returning to something that they haven't done for a while, maybe they've been kicking back during the winter months. It warms up and now they want to do everything all at once. How much of that do you think contributes not just to pickleball injuries, but sports injuries in general among your "amateurs"?

Dr Dwan Perry: So, I think that's a great point. I think we've all fallen culprit to that really where we're trying to get into activities that we've done previously or activities that we've done in the kind of either the remote past like you put it, or even in something that's most more recent as, say, over the wintertime and you're just getting back into activities. And not having that ample amount of warmup, stretching, and you just think you can go out and do what you have been doing previously. For instance, if you were an athlete and you think, "Well, you know, I was able to run five miles when I was 25. And now, I'm 42, maybe I can go do the same thing again." But our tissues are usually little bit different than they were. And just as Dr. Nickerson mentioned, getting back into those activities with an older body may not react as well as it did when you were a younger person. So, not having that kind of foundational body structure and tissue readiness can sometimes lead us to be more prone for injury. So, making sure we get back into a slow pace and kind of ramp our activity up to where we want it to be is probably the best way to go. Kind of let your body be your guide if you find yourself overdoing it.

Host: Sure. It's definitely, I know from personal experience, so much more important and wise to listen to your body more as you get a little bit older. Couple of other things. Dr. Nickerson, so many of us, speaking of which, don't stretch enough before exercising. How much does stretching help to avoid injury in pickleball as well as in any other physical activities?

Dr Robert Nickerson: I think one of the most important things people can do before they start any activity, including pickleball, is learn how to do what we call a functional warmup. And what I mean by that is you just don't go out and start stretching your hamstrings or stretching your Achilles tendons, that you really need to do something that warms the muscle and the tissue up. That can be light jogging in place, that can be swinging your leg back and forth, out to the side and inside. It can be moving your arms in circular motions, wrist up and down, elbows in and out. So, you want to do a functional warmup to get the tissues primed before you actually do what is called a static stretch. You should only really do that after maybe five to 10 minutes of what I call a functional warmup. And that should be done each and every time before you go out and begin any activity, including pickleball. So, you really want to give yourself about a five or 10-minute warmup before you try any activity on any given day, because you want to limit those sprains and strains, and that's the best way to do it.

Host: Right. So, your advice there is stretching is good, but don't get right to the stretching, warm the body up gradually, even before that, right?

Dr Robert Nickerson: That is correct.

Host: And again for you, Dr. Perry, any other tips you can provide for people on their own to avoid injury especially at the warm weather time of year when a lot of people, as we touched on, are getting back to it for the first time in a while.

Dr Dwan Perry: So, I think if you want to minimize kind of the risk of injury, some of the things we've mentioned previously, but setting some realistic expectations and goals. Don't assume that you're going to go out there and play for the pickleball championship the first time you get back out there. But like I say, listen to your body. Get yourself a good warmup and stretch as Dr. Nickerson mentioned. Again, don't think you have to go out there full speed. There are some rules, some areas on the court that are kind of no-go areas. So, people trying to get out there in full speed, as Dr. Nickerson says, they kind of get out over their skis and they kind of lose balance. So, sometimes you got to let the ball go to the wayside, so you can avoid a fall. So, really just being mindful of your activity.

This is a recreational sport, so make sure that you take care of yourself first. Of course, as we talked about the warm up, understand the fundamentals of the game and correct form, making sure that you're not going to have any overuse injuries or any risk that may increase your tendency to fall. Of course, after you play, make sure you get a good recovery. I try to tell people, this is just like the Tom Brady's, they have to have a good post activity recovery plan, so that may be cooling down and stretching, make sure you stay hydrated, make sure that you ice down areas if you need to.

Of course, make sure you have the proper equipment. If you need to get some new shoes, if you're going to start taking on a new sport, maybe make sure that you have the correct equipment. So if that's a new tennis shoes, if you have to get a new racket or something of that nature, anything that's going to help you reduce that risk of injury.

Host: Yeah, you mentioned Tom Brady. We've all marveled at what he's done over his extra long career. But I guess your point is we really don't know exactly what he was going through behind the scenes in order to make that happen, right?

Dr Dwan Perry: Correct. Yeah. I mean, there's a lot of behind the scenes, treatment and maintenance of his body. And I think, like you say, we marvel at what he's done on the field, but he does a lot of things on the beginning and the end of those games to really keep his body in optimal function.

Host: Absolutely. And final question for both of you. Dr. Perry, you just mentioned, don't think you're gonna go out and win the Pickleball Championship on day one. So, speaking of which, I going to ask you both, which of the two of you is the better pickleball player right now?

Dr Dwan Perry: Well, I'll give that to Dr. Nickerson because he's got so much experience with tennis. I probably will try my best, but he'll have me running all over the court probably.

Dr Robert Nickerson: Well, I'm at an unfair advantage. I started playing tennis when I was 12 years old, and I've been playing ever since. So, my racket sports is pretty good. Pickleball is a little different. But it is a lot of fun, it's a very social. If you haven't tried it, I would encourage people to get out and try it. It is a wonderful sport.

Host: And Dr. Perry, what's your sport of choice?

Dr Dwan Perry: Oh, right now, I like things that are less strenuous. So, meaning I would like to do more aerobic activities, so running, walking, biking, lifting weights. So, getting back and forth on the tennis corridor or the pickleball court is a lot. I end up being a little bit more sore than I plan on. But I'll get pickleball a try every once in a while.

Host: Plus you don't need an experienced guy like Dr. Nickerson playing all those angles and making you look bad, right?

Dr Dwan Perry: No, those guys are cutthroat. They're really good. They know how to make you run around more than you expected.

Host: Absolutely. Well, folks, we trust you are now more familiar with pickleball injuries and their treatment. Drs. Robert Nickerson and Dwan Perry, thanks so much again.

Dr Robert Nickerson: Thank you.

Dr Dwan Perry: Thank you.

Host: And for more information, please visit ukhealthcare.com. Again, that's ukhealthcare.com. Now, if you found this podcast helpful, please do share it on your social media. And thanks again for listening to UK HealthCast, a podcast from UK HealthCare. Hoping your health is good health. I'm Joey Wahler.