Pickleball Ankle Injuries: Quick Lateral Movements and Sprain Prevention

Pickleball has taken Malaysia by storm. Courts have sprung up across the Klang Valley, from dedicated facilities in Petaling Jaya and Subang Jaya to converted badminton halls and community centres throughout Selangor. The sport appeals to a wide demographic, attracting everyone from retirees looking for low-impact exercise to competitive athletes seeking a new challenge. However, the fast-paced lateral movements and sudden directional changes that make pickleball engaging also place significant demands on the ankle joint. At Kinesio Rehab in Putra Heights, we have seen a notable increase in pickleball-related ankle injuries over the past year, and understanding how to prevent and manage these injuries is essential for anyone who wants to enjoy the sport long-term.

Why Pickleball Demands So Much from Your Ankles

Unlike tennis or badminton, where the court is larger and rallies may involve more forward-and-back movement, pickleball is played on a compact court that favours quick lateral shuffles, sudden stops, and explosive starts. The kitchen or non-volley zone creates a unique dynamic where players frequently rush forward to the net and then retreat rapidly, often while reaching laterally for a dink or volley. These multi-directional movements place the ankle in vulnerable positions, particularly when a player is off-balance or fatigued.

The demographics of pickleball also contribute to injury risk. Many Malaysian players taking up the sport are in their 40s, 50s, or older, and may not have the baseline ankle strength, flexibility, or proprioception of younger athletes. Some are transitioning from less demanding activities or returning to sport after years of relative inactivity. Additionally, the social nature of pickleball means players often engage in extended sessions, sometimes playing for two or three hours in the Malaysian heat and humidity, which accelerates fatigue and reduces neuromuscular control.

How Ankle Sprains Occur in Pickleball

The lateral ankle sprain is the most common ankle injury in pickleball. It occurs when the foot rolls inward, stretching or tearing the ligaments on the outer side of the ankle. The anterior talofibular ligament is the most frequently injured, followed by the calcaneofibular ligament in more severe sprains. Several specific pickleball scenarios commonly lead to ankle sprains.

• Lateral lunging for a wide shot: Reaching sideways to return a ball while your body weight shifts over a planted foot can roll the ankle if the foot catches on the court surface or if ankle stability is inadequate.
• Backpedalling from the net: Moving backwards quickly to cover a lob can cause a misstep, particularly on outdoor courts where surface irregularities may exist.
• Pivoting during a volley exchange: Rapid changes of direction at the kitchen line demand quick foot repositioning, and a momentary loss of balance can roll the ankle.
• Stepping on a ball: Stray balls rolling onto the court from adjacent games are a surprisingly common cause of ankle injuries in multi-court facilities across the Klang Valley.

Court Surface and Footwear Considerations

The playing surface has a direct impact on ankle injury risk. In Malaysia, pickleball is played on a variety of surfaces including purpose-built acrylic courts, converted badminton courts with synthetic flooring, concrete outdoor courts, and even futsal turf that has been repurposed. Each surface offers different levels of grip, cushioning, and consistency. Outdoor concrete courts can become slippery when wet from the frequent tropical rain showers, while some indoor synthetic surfaces may be excessively grippy, causing the shoe to stick rather than slide and increasing rotational forces on the ankle.

Footwear selection is one of the most impactful injury prevention decisions a pickleball player can make. Court shoes designed for lateral movement sports, such as tennis shoes or dedicated pickleball shoes, provide the lateral support, cushioning, and sole patterns needed for the sport. Running shoes, which are designed exclusively for forward motion, offer inadequate lateral stability and are a significant risk factor for ankle sprains. Look for shoes with a wide, stable base, reinforced sidewalls, herringbone or modified herringbone tread patterns for multi-directional grip, and adequate cushioning in the forefoot and heel. Replace your court shoes when the outsole tread begins to wear smooth, as this compromises traction.

Proprioception Training and Ankle Strengthening

Proprioception, your body's ability to sense its position and movement in space, is the foundation of ankle stability. Research consistently shows that proprioceptive training is the single most effective intervention for preventing ankle sprains, reducing recurrence rates by up to 50 percent. This is particularly important for pickleball players who have experienced a previous sprain, as the ligament damage disrupts the proprioceptive nerve endings in the ankle, leaving it vulnerable to re-injury.

A comprehensive ankle injury prevention programme for pickleball should include the following components, performed at least three times per week.

• Single-leg balance progressions: Begin with standing on one foot on a firm surface for 30 seconds, then progress to a soft surface such as a folded towel or balance pad, and eventually add eyes-closed challenges and reaching tasks.
• Calf raises and heel drops: Perform three sets of 15 repetitions of double-leg and single-leg calf raises to strengthen the gastrocnemius and soleus muscles that provide dynamic ankle stability.
• Resistance band eversion and inversion: Using a resistance band wrapped around the foot, perform controlled inversion and eversion movements to target the peroneal muscles, which are the primary active stabilisers against ankle inversion sprains.
• Lateral agility drills: Controlled side-stepping, lateral shuffles over a line, and carioca drills build the neuromuscular patterns needed for safe court movement during play.

Taping vs Bracing: Which Is Better?

For players with a history of ankle sprains or those recovering from a recent injury, external ankle support can provide additional protection during play. Both taping and bracing are effective, but each has its advantages and limitations. Athletic taping using rigid sports tape can be moulded precisely to the ankle and provides excellent initial support. However, tape loosens significantly after 20 to 30 minutes of activity, losing up to 50 percent of its supportive capacity, and requires skill to apply correctly.

Semi-rigid ankle braces, such as lace-up braces with integrated stays, offer consistent support throughout a playing session and are easy for players to apply independently. Studies comparing taping and bracing have found similar reductions in ankle sprain rates, but braces are more practical for recreational players who may not have access to a physiotherapist or athletic trainer for tape application before every session. At Kinesio Rehab, we often recommend a semi-rigid brace for our pickleball patients during their return-to-sport phase and teach them to transition away from it as their ankle strength and proprioception improve.

Return-to-Play Timeline After an Ankle Sprain

The return-to-play timeline following an ankle sprain depends on the severity of the injury and the quality of rehabilitation. A mild grade I sprain with minimal ligament stretching may allow a return to gentle play within one to two weeks, provided that pain, swelling, and functional testing criteria are met. A moderate grade II sprain with partial ligament tearing typically requires four to six weeks of rehabilitation before a return to full competitive play. Severe grade III sprains involving complete ligament rupture may need eight to twelve weeks or longer.

Regardless of grade, rushing back to the court before the ankle has recovered adequate strength and proprioception is the most common cause of recurrent sprains. At Kinesio Rehab, we use objective functional tests including single-leg hop tests, the Star Excursion Balance Test, and sport-specific agility assessments to determine readiness. A structured return-to-play programme progresses from walking and light jogging to lateral movements, sport-specific drills, and finally full match play, with each stage completed without pain or instability before advancing.