Two racket sports that are brilliant fun, surprisingly competitive and rather more athletic than they first appear. Here’s how to enjoy them without your knees paying the price.
By Mr Nev Davies, Consultant Trauma & Orthopaedic Surgeon
The short answer: are padel and pickleball bad for your knees?
No. Neither sport is inherently bad for your knees. Both can be excellent ways to keep active, improve fitness and enjoy a bit of healthy competition.
But there are a few things worth knowing:
Padel involves repeated lunging, rapid direction changes, twisting and stopping. Muscle and tendon problems are common, and knees and ankles can take a fair bit of punishment.
Pickleball may look gentler, but short bursts, reaching, backpedalling and sudden changes of direction can catch people out. Falls and fractures are a particular concern in older players.
Neither sport requires you to have perfect knees. What matters is your strength, balance, experience, current symptoms and how quickly you increase the amount you play.
The big trap? Both games are easy to start enjoying before your body has had time to adapt to playing them enthusiastically.
Trying both games at Club La Santa. Great fun, but the legs have to keep up with the enthusiasm.
I recently had the chance to play both padel and pickleball at Club La Santa in Lanzarote. Great courts, a bit of family competition and, predictably, a reminder that the brain learns a new sport considerably faster than the muscles, tendons and knees adapt to it.
I now see a steady stream of racket-sport-related knee complaints in clinic. Most do not need surgery. They need a good explanation, a sensible rehabilitation plan and, occasionally, a gentle reminder that being able to hit a winning shot is not the same as being conditioned to chase every ball.
These sports deserve to be enjoyed, not feared. So what should you know before your next game?
Padel and pickleball: what’s the difference for your knees?
Padel
The stop, twist and chase game
Played in an enclosed court with glass walls, a solid perforated racket and a tennis-style ball. The rallies create lots of accelerations, decelerations, side steps, reaches and turning movements. Your quadriceps, glutes, calf muscles and tendons are working remarkably hard, even when you are having too much fun to notice.
Pickleball
The deceptively quick game
Played on a smaller open court with a flat paddle and a lightweight perforated plastic ball. It can be very accessible, including for older players, but doubles rallies still demand quick reactions, short lunges, lateral movement and sometimes moving backwards. It is not just ‘gentle tennis’.
My take: Padel often tests your brakes and your ability to change direction. Pickleball can expose balance, reaction and movement limitations, especially when a player starts chasing a ball they probably should have left alone.
That is a practical distinction rather than a claim that one game is categorically more dangerous. The research on both sports is still developing, and there are plenty of young, athletic pickleball players and older, very capable padel players.
What injuries do I see, and what does the research say?
Padel: tendons, muscles and the occasional twist
Published reviews of padel injuries describe a lot of muscle and tendon problems. Across the whole body, the elbow is frequently reported as an injury site, with knee and ankle problems also featuring prominently. The exact pattern varies between studies and playing levels.
Around the knee, problems worth recognising include:
Pain around the kneecap, often linked to suddenly increasing the amount of lunging, squatting and braking you do.
Patellar or quadriceps tendon irritation, particularly when training load increases faster than the tissues adapt.
Calf or Achilles problems, sometimes mistaken at first for ‘just a tight calf’.
Meniscal or ligament injury, including more serious injury after an awkward twist or landing. Thankfully, not every click or twinge means a torn meniscus.
There is no need to panic every time a knee feels sore after a match. A stiff or achy knee following a new type of exercise is not necessarily a damaged knee. The key is whether the symptoms settle as you recover or become increasingly painful, swollen and limiting.
Pickleball: falls, strains and sudden changes of direction
The most useful warning from the pickleball research is not that the sport itself is bad for you. It is that different age groups are injured in different ways.
US emergency department studies report substantial numbers of slips, trips and falls, with fractures particularly prominent among older players. Younger players also sustain sprains and strains from lunging and sudden stops.
A note of caution: emergency department studies tell us which injuries reach hospital. They do not tell us the injury rate of every person who plays, and they cannot by themselves prove that pickleball is riskier than padel.
From a knee point of view, an awkward change of direction can irritate a previously quiet arthritic joint or produce a meniscal or ligament injury. For some older players, though, the bigger issue is not their cartilage at all. It is being able to stop, turn and recover their balance safely.
The court is inviting. The first few games are often when enthusiasm gets ahead of conditioning.
The problem isn’t the game. It’s the gap between enthusiasm and conditioning.
I think this is the most important part of the whole conversation.
You can become competitive at padel or pickleball quite quickly. Within a few games you know where to stand, how to find an angle and exactly which shot your opponent hates.
Your brain may be ready for the local league. Your calf tendons may not even have received the WhatsApp invitation.
And the knee has to cope with all the extra braking, lunging and sideways movement that comes with your new-found enthusiasm.
That is why I am much more interested in load versus capacity than simply telling people a sport is good or bad.
Your brain learns the game faster than your body adapts
- Enthusiasm and skill: increase quickly
- Strength and tissue capacity: build gradually
- The gap, where niggles often start
If you gradually build the strength and movement capacity to tolerate what you ask of your knees, the sport becomes much more enjoyable. If you go from a relatively sedentary week to three fiercely competitive matches on Saturday, the tissues may object.
Five things I’d do before the next game
1. Warm up properly, not just with three practice serves
Give yourself five to ten minutes to gradually raise your heart rate, move through the ranges you will need and prepare for side stepping and changes of direction. Start with brisk walking or jogging, then add controlled lunges, calf raises, gentle lateral shuffles and a few progressive practice movements.
Long, aggressive static stretches immediately before explosive play are not a substitute for a dynamic warm-up.
2. Build up your playing time gradually
If you are new to the sport, start with manageable sessions and leave time to recover. Avoid suddenly adding multiple extra matches in the same week. There is no magic number of hours that works for everyone, so use your fitness, previous injuries and how your knees respond over the next day to guide your progression.
3. Strength train twice a week
Twenty minutes, twice a week, can make a real difference to how prepared your legs feel. It does not need to be complicated.
Try a mixture of squats or sit-to-stands, step-ups, split squats, calf raises and controlled single-leg balance work, adapted to your ability. Progress the difficulty as you become stronger. If you have a specific knee condition, your physiotherapist can help tailor the exercises.
This is also a reason I love working collaboratively with physios. A good strength and movement programme is often far more useful than a scan.
4. Practise stopping, turning and recovering your balance
Good footwork is a skill. Small steps, controlled deceleration and learning when not to chase an impossible ball are all worth practising. For players who feel less steady, balance training and a few coaching sessions can be just as valuable as extra court time.
5. Choose appropriate shoes and listen to the knee afterwards
Wear comfortable footwear suited to the court surface and lateral movements. The right amount of traction matters, but there is no single magic shoe that prevents knee injuries.
A little muscular soreness after an unfamiliar session can be normal. A knee that repeatedly swells, becomes increasingly painful, feels unstable or stays significantly worse the next day is asking you to change something.
Can I play with knee arthritis?
Often, yes. A diagnosis of knee osteoarthritis is not an automatic ban on doing the things you enjoy.
I prefer to treat the person and the symptoms, rather than frightening somebody with the wording of an X-ray report. Movement and appropriate strengthening can be hugely valuable for people with arthritis.
If your knee tolerates a comfortable game and settles afterwards, that is useful information. If every session produces significant swelling and pain for the next two days, we should look at the volume and intensity of play, your strength and whether there are better ways to manage the symptoms.
You may find that shorter doubles games, longer recovery between matches and a sensible strengthening programme let you carry on enjoying the sport.
That does not mean ignoring persistent pain or instability. It means finding a version of the activity that works for you.
What if I’ve had a knee replacement?
This question is becoming more common, especially as more people want to stay active in their 60s, 70s and beyond.
Many patients do return to racket sports after joint replacement. Encouraging research has reported successful returns, but the long-term evidence for frequent twisting and more demanding racket sports after knee replacement remains limited. Studies often combine different joints and sports, so they should not be read as a blanket guarantee.
For somebody with a knee replacement, the discussion should be individual. I would consider the type of replacement, recovery, strength, balance, previous experience, symptoms and whether the intended game is relaxed doubles or full-on competition.
This is something to discuss with your own surgical team before returning. I would not give every knee replacement patient the same answer, nor pretend that a high-intensity padel match is the same thing as a gentle doubles game.
When should I get my knee checked?
Most racket-sport aches are not surgical problems. But I would arrange an assessment if your knee repeatedly swells after play, feels as though it gives way, catches or locks, or is not improving with sensible changes to your activity and rehabilitation.
Seek urgent assessment after an injury if you cannot bear weight, have a significant deformity, develop marked immediate swelling or cannot straighten the knee. A hot, very swollen joint with fever also needs urgent medical attention.
The earlier we understand what is going on, the easier it often is to develop a plan that keeps you playing.
If your knee isn’t settling, Debbie, my secretary and practice manager, can help arrange an appointment.
Ask Debbie about a consultation
So, should you give padel or pickleball a go?
Absolutely, if you fancy it.
They get people moving, laughing, competing and spending time together. They are also rather more athletic than they look, which is part of the appeal.
My message is not to play less. It is to prepare better, build up sensibly and keep your legs strong enough to enjoy the game.
Because the best racket sport is the one you can keep playing, not the one that earns you an appointment with me on Monday morning.
See you on court.
Nev
The padel courts at Club La Santa, Lanzarote.
Frequently asked questions
Is padel bad for your knees?
Not inherently. It involves plenty of stopping, twisting and lunging, which can aggravate symptoms or cause injury if you are underprepared. Strength, technique and gradual progression are important.
Is pickleball safer than padel?
Not necessarily. They have different movement patterns and different groups of players. Current studies do not allow a reliable, like-for-like comparison of their overall injury risk.
Can I play pickleball with knee osteoarthritis?
Often, yes, if your symptoms allow it. Try manageable sessions, build strength and adjust your playing time if the knee becomes painful or swollen. Persistent symptoms deserve an individual assessment.
Can I play padel or pickleball after a knee replacement?
Some people return successfully, but the decision depends on their recovery, strength, balance, experience and intensity of play. Discuss it with your own surgical team. Long-term evidence for more demanding racket sports after knee replacement remains limited.
What’s the best warm-up for padel or pickleball?
Five to ten minutes of progressive movement, starting with brisk walking, then gentle lunges, calf raises, lateral shuffles and practice direction changes. Aim to feel warm and ready, not exhausted.
Written by Mr Nev Davies FRCS (Tr.&Orth.)
Consultant Trauma & Orthopaedic Surgeon, specialising in adult knee surgery and children’s orthopaedics. He is passionate about helping people stay active, prevent injuries and get back to the sport they love.
This article provides general information and is not a substitute for personal medical advice. If you have persistent knee pain, swelling or instability, speak to a qualified healthcare professional. For appointments, visit Contact Nev.
Related reading
You may also find these helpful: Is running bad for your knees?, Why does my knee hurt going down stairs?, Why “wear and tear” is the wrong way to describe knee osteoarthritis, Get ski fit: a common-sense guide to knee injury prevention and ACL injury prevention. Or browse all blog articles.
Sources and further reading
Dahmen J, et al. Incidence, prevalence and nature of injuries in padel: a systematic review. BMJ Open Sport & Exercise Medicine, 2023.
Aguilar-Núñez D, et al. Epidemiology, incidence, prevalence, and treatment of injuries in padel: a scoping review. Applied Sciences, 2026.
Increasing incidence of pickleball injuries presenting to US emergency departments. Orthopaedic Journal of Sports Medicine, 2025.
Taylor AJ, et al. Can I pickle, doc? Return to pickleball and other racket sports after total joint arthroplasty. Journal of Arthroplasty, 2025.
Lester D, et al. Return to sport post-knee arthroplasty: an umbrella review for consensus guidelines. Bone & Joint Open, 2022.
World Health Organization. WHO guidelines on physical activity and sedentary behaviour. 2020.
