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Treating Pickleball Athletes
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Treating Pickleball Athletes
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Upload Date:
2025-04-20T03:05:31.2572110Z
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Language: EN.
Segment:0 .
VOICEOVER: Welcome to HSS Presents, the PODCAST of Hospital for Special Surgery.
ANIL NANDKUMAR: Welcome to HSS Presents, the PODCAST for the Hospital for Special Surgery. Our podcast is your trusted source for educational conversations on advances in musculoskeletal science and health, and best practices in patient care.
ANIL NANDKUMAR: My name is Anil Nandkumar. I'm an advanced clinician and board certified physical therapist at HSS and the host of this episode. I am here with Doctor Jessie Charnoff, an attending physiatrist at HSS specializing in the care of acute and chronic musculoskeletal sports and spine conditions. Today, we're here to discuss treating pickleball athletes.
ANIL NANDKUMAR: Let's get to it. How are you doing, Doctor Charnoff?
JESSE N. CHARNOFF: I'm great. Excited to be here.
ANIL NANDKUMAR: Great. So, you know, basically, let's just get right to it. The elephant in the room. What's the difference between tennis and pickleball? What would you say?
JESSE N. CHARNOFF: I think of pickleball more like a ping pong type thought process when I play. It's a smaller court. It's less of an, I'd say it's a lower speed game even though it's getting faster and faster now. There's still start and stop component but for me, as an ex tennis player, when I play pickleball, I think of it more in a smaller, almost like a mini tennis type setup and have more of like a ping pong strategy
ANIL NANDKUMAR: personally.} You know, that's interesting because I feel like there's like a constant feud between, you know, standalone tennis players and then now people transitioning to pickleball and it's interesting you're saying that because I never really thought of it that way of like, don't play pickleball like you're playing tennis. Play it as if you're playing ping pong or whatnot. And so with that being said, like how have you seen injuries kind of. blossom from pickleball now Are they similar to tennis injuries?
ANIL NANDKUMAR: Are they more along like a ping pong type injury or a general racquet sport injury? What would you say?
JESSE N. CHARNOFF: I'm definitely seeing a lot of tennis like injuries, particularly with just the fact that it's a new sport that so many young and older patients are playing, and the nature of the sport is that it can be very addictive. So there's a lot of patients who haven't been super active for a long period of time, and then they find this sport that's great socially and physically, and they want to play it.
JESSE N. CHARNOFF: And it's not such an aggressive athletic activity that you can't play it every day so it kind of lends itself to the overuse injuries. And then what I have found is a lot of these people aren't training to accommodate for that increased use and then we get a lot of acute injuries that are similar to the tennis world.
ANIL NANDKUMAR: Yeah and I think, you know, something you said is so profound, it's like you have to train for your sport
ANIL NANDKUMAR: and a lot of times with the boom of pickleball, we found that, people are like, oh, wow, this is really fun. Let me go out and try to play but if you've never learned how to start and stop or how to move laterally or something's in front of you, you're going to chase, chase it down like, one of the balls there. It can lead to some traumatic incidences that happen. And so, you know, what would you say are some of the most common traumatic injuries that have arose?
JESSE N. CHARNOFF: Yeah so we do see a lot of tennis leg injuries, which is going to be like a gastroc pull or a muscle tear in the calf and also Achilles ruptures. A lot of start to stop or stop to start movements that can be explosive and if not, you know, prepared can cause an acute injury. It's still, you know, there's going to be the occasional shoulder injury because it is an overhead sport
JESSE N. CHARNOFF: and there are even though not serves, there's overhead smashes. But I'd say the most common acute severe injuries are lower body, whether it's like an ankle sprain, an Achilles or a gastroc.
ANIL NANDKUMAR: Yeah. So kind of a lot of that quick start stop motion, quick of like loading to the ground and then explosion, which, again, you know, sometimes it's tough seeing your patient come in the clinic where, they may have never done those types of explosive movements before.
ANIL NANDKUMAR: So I guess like how do you start treating them or how do you start, you know, I guess your initial visit for someone who may have never done this before and then now has to go through a strenuous, maybe either treatment or something to kind of overcome that?
JESSE N. CHARNOFF: Yeah. I mean, the first thing I try to get a grip of is how often they're playing and what their frequency is. Also, what is their baseline exercise so you can get a feel for the exercise tolerance.
JESSE N. CHARNOFF: If a patient's coming in for a tennis elbow or golfer's elbow, where it's just an overuse, we can obviously dissect the injury, look at equipment and try to pinpoint why it happened but I'll take a broader view of, you know, looking at how much you're playing you're at high risk for these lower body injuries. Let's work on stabilization, strengthening dynamic warm ups to try to avoid these acute things that we see from even ever taking place.
ANIL NANDKUMAR: Yeah and, you know, it's so interesting because both you and I have grown up playing competitive tennis and, you know, I, I'm very familiar with the motions that, that go into pickleball. But when I started playing I developed a lot of wrist and hand injuries that I never got in tennis. And it's so humbling because it's just like one little tendon has flared up and it's just like, almost like now I'm shocked, like I'm traumatized.
ANIL NANDKUMAR: So, you know, even from your most high skilled, trained athletes, it's still a different motion, still a lot more flick of the wrist getting down low to get those dinks and things like that. And, you know, we've both covered a good amount of tournaments for pickleball. I'm just so I guess excited to see how competitive it is and how much fun it is. It kind of especially from the team aspect for different leagues.
ANIL NANDKUMAR: I kind of like associated it to like playing college tennis or high school tennis again, where everyone's involved, everyone's rooting for someone. But you know, if you could just speak a little bit about, the competition as it's grown and, you know, as it compares to, you know, some of the other racquet sports.
JESSE N. CHARNOFF: Yeah so we cover Major League pickleball and HSS is an official sponsor.
JESSE N. CHARNOFF: And I do think they do a great job of making it a team environment. It's two men, two women on each team for Major League, for Major League pickleball. And I would say that is unique when you look at compared to tennis, I mean, there's things like the Davis Cup that are not as popular, I'd say, even though they're great activities and tournaments. But when we're looking at it at the professional level, that even the injury profile, I'd say is a lot different, just the aggression and the speed that they're playing at is a little bit different.
JESSE N. CHARNOFF: A lot of those players, I'd say the vast majority, are ex-high level tennis players so they're also accustomed to kind of that, that training and repetitive playing to avoid the overuse injuries but it still occurs nonetheless. Yeah. But yeah, no so I do think that Major League pickleball has a lot of things to offer and it's a great viewing activity and sport.
JESSE N. CHARNOFF: It'll be interesting to see how big it gets.
ANIL NANDKUMAR: Yeah, I think, you know, just like you said, it's such a team approach when we're at those tournaments, you know, treating both the staff and the players, you know, I think we have a multitude of disciplines there. We kind of all work together and I think that's one of the biggest things about treating these athletes, these pickle-ballers. It's not just one approach.
ANIL NANDKUMAR: You know, I found it's like, you know, sometimes you may need to shut them down completely, work on some basic things. Sometimes you just need to patch them up really quick so they can play their match. So I think the higher level that they get, you know, you have to really take into account what the athlete needs as well too. So, you know, a lot of times I'll say, especially for some of my patients who are a little bit more novice, maybe don't fight through the pain you know
ANIL NANDKUMAR: especially if you're just learning it and you're just learning the moves and dynamic stuff. So, you know, I guess, what would you say to one of your patients coming to the clinic as well? Like, you know, they're addicted to the game now. They, they can't stop. They play a couple times a week, but they really love playing. Like, would you have them shut it down as well, or would you kind of tell them to keep going?
JESSE N. CHARNOFF: Yeah I mean I'd say it's definitely dependent on the injury type. For tendon injuries, I typically try to explain that a low level of discomfort is OK and we want to load the tendon. So we want to try to strengthen in between playing and it may be OK to say no pain, no gain. But for other things like joints where we're talking about arthritis or even some meniscus or other issues.
JESSE N. CHARNOFF: Typically, your body is giving you feedback of pain because there's something that it's not liking or something has gone awry. I don't like when especially a novice is pushing through that type of discomfort, because you're often going to pay for it on the back end and maybe doing more damage than good. So I try to differentiate what I think the main problem is and try to teach the patients to like this is pain that you can work through, and it's good versus you really need to listen and kind of take a step out.
ANIL NANDKUMAR: Sure and you know, I think speaking of that, a lot of people aren't used to having what we call, like you know, for those out there, a longer lever arm, right? [Yeah]. And they're not used to holding something that increases the distance of whatever a point of contact that they have to the rest of their body, so that now using a paddle out there, like, you know, if you can speak a little bit about the equipment and how pickleballers can kind of either get back into the game by certain equipment, things like that.
JESSE N. CHARNOFF: I would look at whatever the patient's history in terms of, what are they most prone for injury wise, or what are they coming in with? If someone who comes in, let's just say with a tennis elbow, I'm going to look at their hand size and what's their grip size, because that's kind of low hanging fruit in terms of things you can change, whether it's put in over grip, something to make it a little bit wider so that you tend to not squeeze as hard, that can help decrease both tennis elbow and golfer's elbow.
JESSE N. CHARNOFF: The weight of the paddle.
JESSE N. CHARNOFF: So someone who struggles with that may do better with a lighter paddle, focusing on training to help load those tendons so they're a little bit more accustomed to it. Talking about in general, when we think about tennis, we have the opportunity to play on some courts that are a little bit more forgiving, which is another thing that I've seen a lot of patients struggle with is I have tennis players who haven't played on hard courts for, you know, 20 years, and now they're only doing hard courts because that's what pickleball tends to be.
JESSE N. CHARNOFF: Yeah so it's all those factors that we think about but I definitely see a variety of issues that are popping up regardless of the changes that we make.
ANIL NANDKUMAR: So are you saying that, you know, we should petition Wimbledon to throw in a pickleball court there?
JESSE N. CHARNOFF: I want to see grass. I want to see a grass pickleball championship.
ANIL NANDKUMAR: You know, Roland Garros, you know, with the clay court.
ANIL NANDKUMAR: That would be cool. Definitely and, you know, speaking of, I think maybe that's where the game is going and we might see other injuries arise from different court surfaces. But you know, I think with the paddle itself, it's so interesting because to me it is very different than a tennis racket. And for those like myself that transitioned from playing tennis with the strings with the different types of rackets and the technology that it's grown, then moving to a paddle that it's to me it seemed a little, you know, less forgiving, and it seemed like a lot of shock on my hand there
ANIL NANDKUMAR: so something that I have to now train myself. So how would you again, I guess this is advice for me, but how would you like, you know, kind of educate your tennis player going to pickleball and they start having those risks in hand?
JESSE N. CHARNOFF: Yeah I mean, I think the tendency for a tennis player is try to get as much spin as possible and the reality is like it's hard to get spin because it's just a paddle
JESSE N. CHARNOFF: and there is not that string that gives you that little bit of bite. Yeah. So some people overcompensate with a lot of extreme wrist movement. So it comes down to strategy to a degree. I think there's not as much of that in the professional. It's a little bit more a to b. There's a couple players who have a lot of spin, but in general, I think spin is taken out to a degree with, you know, the more you play and the transition away from tennis.
JESSE N. CHARNOFF: But yeah, it's about just trying to find your groove of a swing that works is competitive, but you're not putting that overload on your joints where it's going to take, you know, months or a year or so to get accustomed to the repetitive movement, like it took years for you to get used to your tennis swing.
ANIL NANDKUMAR: Sure, absolutely. And, you know, you covering a bunch of these tournaments. As far as just the classic injuries that you've spelled out for us,
ANIL NANDKUMAR: what are some things that maybe you found that as people are starting to get more competitive? You know, what are other things that maybe you've seen? I think I heard a story where, you know, you were treating someone that may have collapsed on court, you know, like things like that, that I think people need to understand of, like it is a pretty intense sport once you start ramping up your competitive level.
ANIL NANDKUMAR: And you need to stay hydrated and proper nutrition, so I guess if you can speak a little bit about those overarching things.
JESSE N. CHARNOFF: Sure. One thing I would say that is definitely underrated is if you're playing a tournament, even if it's a local, you know, 4-0, 4-5, 3-5, whatever it is, you're playing a lot of matches in one day, which is kind of different from how we do tennis tournaments, where it may be more spread out unless it's kind of Round Robin setup.
JESSE N. CHARNOFF: So I do think that people maybe not understanding the repetition and the length of time on court that you're actually having. I covered a tournament that was outside in a really warm climate, and a player was having some GI issues and suffered a heat attack secondary to just prolonged time on court and not being able to really properly hydrate. So it happens and it's one of those things where just like any sport, we got to be mindful of how much time we're out there, the temperature, our attire, all these things, changes in our diet.
JESSE N. CHARNOFF: These things can all make a factor in whether or not we're going to have a difficulty with recovery, as well as just playing to our max potential.
ANIL NANDKUMAR: Yeah, I think that's so important because again, right, that started with this casual, leisurely game and people moving from the couch to the court and then now as they become more addicted, they're going to get more intense but their, maybe their habits stay the same.
ANIL NANDKUMAR: So I think in treating the whole athlete, it has to be more of a holistic approach, like you were saying so absolutely. And as far as pickleball is going right now with the equipment, with the paddle, how about the ball? You know, do you do you find that hitting that type of ball that it also leads to certain injuries? Or, you know, how do you have to change your trajectory of your swing in order to really maximize your potential there?
JESSE N. CHARNOFF: Yeah, I mean, they're doing changes constantly to the ball so they're coming out with new balls I feel like every couple months.
ANIL NANDKUMAR: Sure. Yeah.
JESSE N. CHARNOFF: But in general, the ball is going to be a little bit harder. It has a little bit less of a give so you could get that kind of shock when you first do make contact. I still think it just comes down to making yourself acclimated to what that feels like, and the repetition in a safe way.
JESSE N. CHARNOFF: The more you do it, the more your tendons and muscles are going to be accustomed to that kind of shock feeling instead of the give way that you get with tennis, but it's all I'd say responsible practice that is going to be the critical piece. And just being aware that these injuries are looming, like with any repetition sport, you're going to have.
ANIL NANDKUMAR: Yeah so, you know, a lot of times I'll tell patients it's, you can't train for your sport by just doing your sport.
ANIL NANDKUMAR: Right so, you know, we talk about cross training or general physical therapy, maybe prehab or something along the lines of that but you know, what would you recommend for your patients in terms of just maybe either training for pickleball or getting ready to go back on court? You know, things of that nature.
JESSE N. CHARNOFF: Yeah I always say, you can't train by playing pickleball. You have to train for pickleball and not play pickleball to train.
JESSE N. CHARNOFF: OK so and I agree with your point completely, I'd say the number one thing that patients aren't doing and the hole in a lot of repertoire is just the lack of strength training. So especially with the older population, I'll hear, you know, I walk every day. I play pickleball three times a week. Like, that's a lot. I ride the bike.
JESSE N. CHARNOFF: But the reality is we need resistive strength training to really get those gains and the ability to be able to handle prolonged load on the tendons. So that's kind of the first thing that I always tell people is we have to work on strengthening and training for sport and not doing the sport to train, and then just describing really low hanging fruit exercises that are low risk for injury, but can definitely get those tendons involved.
ANIL NANDKUMAR: I see. Yeah. Yeah. You know, I think we've gotten a lot of catch phrases so far, you know, with the training. Here's one more. I usually tell patients it's like you because, you know, they'll say all the time they're like, I play pickleball three times a week. I walk 5 miles a day.
ANIL NANDKUMAR: All this stuff. Right? Why do I have this injury? Why does this hurt? And I sometimes say, you can be, you're probably grossly strong, but you're not specifically strong, right? The neuromuscular kind of component to that, you know, other things kind of compensate. So I think it's, you know, people sometimes have to take a step back and be like, all right, maybe I'll play pickleball twice a week and then strength train another day or, you know, work it in to maybe even their warm up or their down and, you know, kind of going to that.
ANIL NANDKUMAR: You know, I think we both would agree that, again, coming from our backgrounds of playing tennis, like a good warm up is almost 100% crucial to your performance and so, you know what how long should someone warm up? What should be in their warm up?
JESSE N. CHARNOFF: Yeah, so that's another similar to strength. That's kind of like the second most important thing that I tell people is I'd say the most common warm up is going to be a static, stretching warm up.
JESSE N. CHARNOFF: So one where you're just kind of pushing against resistance and trying to get some flexibility and what my recommendation would be, yes, you can have that as part of it but we definitely have to add majority of dynamic warm up. So moving around, getting the muscles and the tendons used to load, getting a little bit of a sweat going, and that's probably the number one thing
JESSE N. CHARNOFF: people are not doing and why there are so many of these acute explosive movement injuries. So depending on what the problem is, I'll definitely stress certain movements, whether it's just going onto your toes, hopping a little bit, high knees, but we got to get the blood flow going before the sport to kind of get maximal benefit and lower the risk of injury.
ANIL NANDKUMAR: I think those days have gone where high school, college,
ANIL NANDKUMAR: we could just go out there and play a little mini tennis, you know, move up to the baseline and start warming up. You know, now, I'm getting a full sweat before I even get on court there. You know, just because it's so important. I think that's what happens when we get these traumatic injuries. You have, you know, these cold tendons that are now doing explosive activity and therefore just can't handle it at that point in time.
ANIL NANDKUMAR: And, you know, I think similarly to a nice cool down is important too, because again, the body is moving the entire time. You need something to gradually bring you down a little bit. So I guess, what are some tips that you would give, you know, your patients and your athletes to kind of cool down a bit?
JESSE N. CHARNOFF: Yeah, I mean, I'll generally try to warn people not to just play a really aggressive couple of games of pickleball and then hop in the car and drive for a couple hours.
JESSE N. CHARNOFF: But people do stuff like that just because that's life. But I'll try to encourage, you know, walking around a little bit. Again, similar movements to how we start, but just some basic movements to let some of those muscles and tendons kind of relax and get back into your normal everyday movement pattern.
ANIL NANDKUMAR: Yeah and I think as people start to play and, and start to understand their form and their bodies, they start to realize where their problem areas lie, right?
ANIL NANDKUMAR: If your hamstrings always bother you after you play. All right, let me spend a little extra time, warm up those hamstrings, cool down those hamstrings, things like that. So yeah, I think it's just knowing yourself and how to handle it and you know. During your practice, I, I've also heard that you're starting to potentially do a study in regards to pickleball and racquet sports.
ANIL NANDKUMAR: Can you speak about that?
JESSE N. CHARNOFF: Yeah so we have a study currently open for any patients or listeners on pickleball injuries and we're trying to find associations between playing habits, equipment and most common injuries that we see so we're about halfway through that study and hopefully, we get some participants from this podcast and we get closer to publishing.
JESSE N. CHARNOFF: But I think there's not enough data on these things. We have a lot of just initial data, and we're seeing a lot of more like billing and money stories out there on how much pickleball is costing, because there's some Medicare data that shows it's a high risk for injury sport. But it'd be interesting to get a little bit more into the details and really figure out how we can make adjustments to reduce risk. So one thing that I would say I see a lot is that when people get injured, even if it's a really severe injury, that hurts a lot.
JESSE N. CHARNOFF: I'm not seeing a lot of patients respect the injury, and I think maybe it's because it's pickleball and it's not such. They don't frame it as an extreme activity, but I'm seeing a lot of people get whether it's like a strain of the gastroc or, you know, the beginnings of tennis elbow, they're not taking the appropriate time or action. They're kind of just blasting through it and trying to play through it, as we said.
JESSE N. CHARNOFF: Yeah and ultimately, it becomes a chronic issue and, you know, even with guidance, they're having trouble kind of backing away.
ANIL NANDKUMAR: And why do you think that's happening?
JESSE N. CHARNOFF: I think it's a sport that lends itself where you can still participate at a certain level, even injured with not such a big drop off. And I think there's just a big social component to it and that's why
JESSE N. CHARNOFF: so many people love it, that people don't want to give up, that, you know, connection. But it's still important to realize when there's a legitimate injury that requires intervention and time off and giving yourself that amount of time to do so.
ANIL NANDKUMAR: Yeah, I think that's what the beauty. I always go back to my roots. I always bring it back to tennis. But I think that's the beauty of what tennis was or is,
ANIL NANDKUMAR: excuse me in the sense of like it's was a globally great exercise for cardiovascular. You know, it, it started to build your mental health and mental strength there, a social component by, you know, either playing with another person or playing doubles and whatnot and then now we're seeing that same thing with pickleball as well. And even more so because the court is shorter
ANIL NANDKUMAR: so you can definitely talk through some points there. And so I think you're right, I think the fact that people are really loving it and they're starting to ignore their injuries, that then these things start to happen. Maybe it was just a little oh, my calf is a little tight, and then I decided to go play and something bad happened. So I think, you know, I would love to talk about a little bit of something that, we call red flags, you know, what are some red flags that, that you can identify right away for, for patients, something easy for them to digest so they can say, you know what, I don't think I got it today OK.
JESSE N. CHARNOFF: I mean, if you had a concerning tendon or muscle injury, I would say keep an eye on it for the next day or two. If you're noticing a lot of bruising, that typically implies that there was some tearing of the muscle or tendon. And in general, I would take that a little bit more serious than if it just hurts a little but after a day or two kind of resolves. That implies that there was some anatomical damage that we should potentially be assessed by a doctor.
JESSE N. CHARNOFF: Other things would be if there's some sort of deformity that you notice after an injury, beyond that swelling of a joint. Difficulty with strength, so if you're noticing acute strength deficit or tingling, pins and needles, those are things that shouldn't typically happen from just your average overuse injury and may require some further attention.
ANIL NANDKUMAR: Yeah and I think, you know, in layman's terms that I like to tell patients too.
ANIL NANDKUMAR: It's like if it alters the way that you normally do something, there's something probably wrong. And that's more than just, you know, kind of doing that Frankenstein walk after you've had a tough workout, right. It's more of like, oh, I'm limping. Oh, something is whatever is sending off those alarm bells in your own head, I think that's when you start to get it checked out.
ANIL NANDKUMAR: And so, you know, from a standpoint, you know, definitely assessing the whole body, the movement, looking at different special tests, really diving into potential injuries that might happen. We isolate certain areas and work on different strength, range of motion and whatnot to get a patient better and of course, bring down their symptoms but from the medical side of things, what are some interventions conventions that you may recommend or you have done for these athletes?
JESSE N. CHARNOFF: Sure, I mean, it's similar to other overuse injuries. So, you know, when we're talking about beyond physical therapy, we have a gamut of options, which include steroid injections. We try to shy away from that, particularly with tendons, just because we have some better options now and there are some downside to doing steroids. PRP is something that we use a lot with tendon or overuse injuries, and that's platelet rich plasma.
JESSE N. CHARNOFF: There's some mixed data on the efficacy, but for certain things like tennis elbow, it's been well proven that it does provide benefit and there's not really a high risk associated with it. We sometimes will do something called shockwave therapy, which is a non-invasive treatment for tendons and muscle injuries. And it's an in-season treatment so it's something that people can play with even while receiving treatment.
JESSE N. CHARNOFF: And obviously for really severe injuries, there can be surgical intervention.
ANIL NANDKUMAR: Yeah if you could just speak a little bit more about shockwave,
ANIL NANDKUMAR: I think that's becoming quite the rage right now, especially just like you said, you can do it while still doing your activity, not having to shut yourself down for a good amount. What is shockwave and how do you, how do you usually do it?
JESSE N. CHARNOFF: Yeah so it's using energy ultrasound energy high amount to cause some small microtrauma.
JESSE N. CHARNOFF: It creates a change in the local environment and it's under the umbrella of regenerative medicine although it's not been proven to actually cause regrowth of tendon and completely resolve the issue. Like, how we think of what a stem cell should be, but it has been proven to have an analgesic effect and help change that environment to a less inflammatory or painful environment.
ANIL NANDKUMAR: OK. Yeah.
ANIL NANDKUMAR: You know, I've had shockwave myself. I'm sure you've had it. The only thing is that it can be quite uncomfortable, you know. And so, you know, when dosing something like an intervention that can be uncomfortable, like how do you educate, you know, your athletes to bear with it, you know, and potentially this might lead to something better.
JESSE N. CHARNOFF: Yeah, I'd say during the treatment itself, it definitely, you know, we were looking for anywhere from a 4 to 7 out of pain, out of 10 for pain.
JESSE N. CHARNOFF: But typically day of or even the following days it should feel better after shock wave, but you do tell them there's always the chance, because we are kind of bringing up the immune system and causing an acute reaction that if it does hurt, beyond that, we want to pull back on the sport. We want to try to treat it with different modalities and just give them the full range of potential things they may encounter, so they're not scared if anything goes off script.
ANIL NANDKUMAR: Sure. You know, this has been a fantastic conversation. And, you know, I think what we've learned is that there it's a multimodal approach in order to treating pickleball athletes, athletes in general. You know, I really feel like pickleball is booming and it's going to continue to boom because just like you said, people love the sport because it's a social aspect. It's a physical aspect.
ANIL NANDKUMAR: It's just something that you can do to, you know, keep yourself going, keep yourself out there and moving. And so, you know, I think injuries will arise. But I think, like you said, as you've collected your data, as we see how it moves, we can then start treating these players a little bit more specifically. And, you know, using a specific method for, you know, good protocol to treat everyone.
JESSE N. CHARNOFF: So I have a question for you.
ANIL NANDKUMAR: Yes, please.
JESSE N. CHARNOFF: So do you find that pickleball messes up your tennis game?
ANIL NANDKUMAR: Absolutely. In what way? So basically I've found that playing tennis, you can then translate that ability to playing other racquet sports or paddle based sports and you can pick it up quite quickly. But going the other way, I've found it to not ruin my game, but I have to change my mindset.
ANIL NANDKUMAR: Kind of like what you said before in the sense of, you know, you can't play pickleball like you're playing tennis. It's a different motion, different stroke. And for me, I've always been a player that really gets used to their equipment and so therefore if I change equipment, it takes me a while to then, you know, change it back or, you know, and so for that aspect I found it
ANIL NANDKUMAR: but what translates directly is just timing. I think like after I play pickleball, I'm way better, you know, timing wise on the tennis court, my feet are set, my hands are more alive. I can play doubles at the net just a lot quicker and I've always struggled with that. So that's definitely helped. So I think, you know, it's something that these two can kind of help each other.
ANIL NANDKUMAR: If you are a player like myself who was reluctant to start playing pickleball, there's definitely some benefits back and forth. But, you know, I still think I need to separate the two a little bit better. And how about yourself?
JESSE N. CHARNOFF: For me, it's more the mindset that you kind of touched on it, but it's more the strategy. OK so the strokes for me feel different.
JESSE N. CHARNOFF: I don't feel like it has a negative impact because I feel like I'm playing more of a ping pong type. It's my style for ping pong, but what I get messed up with is the strategy. Like, I'll have a short ball in tennis and I'll just do like a little dink and then just get smashed at me. I see and I see you like just mentally have that, you forget, like you try to get behind someone like you would with pickleball.
JESSE N. CHARNOFF: Yeah, but they can just come up to the net and smash it. So it's like that quick, you know, split moment decision that where if I play tennis right after pickleball, I'll get kind of catched up.
ANIL NANDKUMAR: Yeah, but like you said, I think the strategy with tennis is at least the modern game now is like, you're going to unleash all your skills at the baseline, you know, and then you might move into the net to finish the point,
ANIL NANDKUMAR: whereas pickleball, you rush the net almost immediately any, any chance you get. So you're right, I think the strategy is the biggest thing for sure. And, you know, I think as the sport grows and, you know, people are going to be moving around to different sports, it'll be a little bit of an adjustment but you know, I think really overarching theme that I think for all treating these athletes is, you know, to potentially just cross train, prepare yourself, understand what your body is doing and understand, all right, maybe something is wrong.
ANIL NANDKUMAR: You know, and know when to kind of reach out to get help. And here at HSS, I really think that we're pushing the envelope to being like the first to really start to look at these things and, and really start to analyze, like how, how can we treat these pickleball athletes as a separate subgroup and really treat them specifically.
JESSE N. CHARNOFF: Yeah. It's exciting. I'm looking forward to the future.
ANIL NANDKUMAR: Well, thank you so much for sitting down with me. Thank you to HSS for the opportunity here at the podcast and we'll see you next time.
VOICEOVER: [MUSIC PLAYS] Thank you for listening to this podcast episode from HSS Presents. a ConveyMed production, and keep listening to HSS Presents for other offerings. The views expressed on this podcast are those of the interviewers and interviewees alone, and do not reflect the views of HSS.
VOICEOVER: Information relayed on the podcast is for informational and educational purposes. This information is not medical advice and should not be used for diagnosis or treatment. Listeners should seek advice from a licensed medical professional before making any personal health decisions. [VIDEO AND MUSIC ENDS]
Segment:0 .
VOICEOVER: Welcome to HSS Presents, the PODCAST of Hospital for Special Surgery.
ANIL NANDKUMAR: Welcome to HSS Presents, the PODCAST for the Hospital for Special Surgery. Our podcast is your trusted source for educational conversations on advances in musculoskeletal science and health, and best practices in patient care.
ANIL NANDKUMAR: My name is Anil Nandkumar. I'm an advanced clinician and board certified physical therapist at HSS and the host of this episode. I am here with Doctor Jessie Charnoff, an attending physiatrist at HSS specializing in the care of acute and chronic musculoskeletal sports and spine conditions. Today, we're here to discuss treating pickleball athletes.
ANIL NANDKUMAR: Let's get to it. How are you doing, Doctor Charnoff?
JESSE N. CHARNOFF: I'm great. Excited to be here.
ANIL NANDKUMAR: Great. So, you know, basically, let's just get right to it. The elephant in the room. What's the difference between tennis and pickleball? What would you say?
JESSE N. CHARNOFF: I think of pickleball more like a ping pong type thought process when I play. It's a smaller court. It's less of an, I'd say it's a lower speed game even though it's getting faster and faster now. There's still start and stop component but for me, as an ex tennis player, when I play pickleball, I think of it more in a smaller, almost like a mini tennis type setup and have more of like a ping pong strategy
ANIL NANDKUMAR: personally.} You know, that's interesting because I feel like there's like a constant feud between, you know, standalone tennis players and then now people transitioning to pickleball and it's interesting you're saying that because I never really thought of it that way of like, don't play pickleball like you're playing tennis. Play it as if you're playing ping pong or whatnot. And so with that being said, like how have you seen injuries kind of. blossom from pickleball now Are they similar to tennis injuries?
ANIL NANDKUMAR: Are they more along like a ping pong type injury or a general racquet sport injury? What would you say?
JESSE N. CHARNOFF: I'm definitely seeing a lot of tennis like injuries, particularly with just the fact that it's a new sport that so many young and older patients are playing, and the nature of the sport is that it can be very addictive. So there's a lot of patients who haven't been super active for a long period of time, and then they find this sport that's great socially and physically, and they want to play it.
JESSE N. CHARNOFF: And it's not such an aggressive athletic activity that you can't play it every day so it kind of lends itself to the overuse injuries. And then what I have found is a lot of these people aren't training to accommodate for that increased use and then we get a lot of acute injuries that are similar to the tennis world.
ANIL NANDKUMAR: Yeah and I think, you know, something you said is so profound, it's like you have to train for your sport
ANIL NANDKUMAR: and a lot of times with the boom of pickleball, we found that, people are like, oh, wow, this is really fun. Let me go out and try to play but if you've never learned how to start and stop or how to move laterally or something's in front of you, you're going to chase, chase it down like, one of the balls there. It can lead to some traumatic incidences that happen. And so, you know, what would you say are some of the most common traumatic injuries that have arose?
JESSE N. CHARNOFF: Yeah so we do see a lot of tennis leg injuries, which is going to be like a gastroc pull or a muscle tear in the calf and also Achilles ruptures. A lot of start to stop or stop to start movements that can be explosive and if not, you know, prepared can cause an acute injury. It's still, you know, there's going to be the occasional shoulder injury because it is an overhead sport
JESSE N. CHARNOFF: and there are even though not serves, there's overhead smashes. But I'd say the most common acute severe injuries are lower body, whether it's like an ankle sprain, an Achilles or a gastroc.
ANIL NANDKUMAR: Yeah. So kind of a lot of that quick start stop motion, quick of like loading to the ground and then explosion, which, again, you know, sometimes it's tough seeing your patient come in the clinic where, they may have never done those types of explosive movements before.
ANIL NANDKUMAR: So I guess like how do you start treating them or how do you start, you know, I guess your initial visit for someone who may have never done this before and then now has to go through a strenuous, maybe either treatment or something to kind of overcome that?
JESSE N. CHARNOFF: Yeah. I mean, the first thing I try to get a grip of is how often they're playing and what their frequency is. Also, what is their baseline exercise so you can get a feel for the exercise tolerance.
JESSE N. CHARNOFF: If a patient's coming in for a tennis elbow or golfer's elbow, where it's just an overuse, we can obviously dissect the injury, look at equipment and try to pinpoint why it happened but I'll take a broader view of, you know, looking at how much you're playing you're at high risk for these lower body injuries. Let's work on stabilization, strengthening dynamic warm ups to try to avoid these acute things that we see from even ever taking place.
ANIL NANDKUMAR: Yeah and, you know, it's so interesting because both you and I have grown up playing competitive tennis and, you know, I, I'm very familiar with the motions that, that go into pickleball. But when I started playing I developed a lot of wrist and hand injuries that I never got in tennis. And it's so humbling because it's just like one little tendon has flared up and it's just like, almost like now I'm shocked, like I'm traumatized.
ANIL NANDKUMAR: So, you know, even from your most high skilled, trained athletes, it's still a different motion, still a lot more flick of the wrist getting down low to get those dinks and things like that. And, you know, we've both covered a good amount of tournaments for pickleball. I'm just so I guess excited to see how competitive it is and how much fun it is. It kind of especially from the team aspect for different leagues.
ANIL NANDKUMAR: I kind of like associated it to like playing college tennis or high school tennis again, where everyone's involved, everyone's rooting for someone. But you know, if you could just speak a little bit about, the competition as it's grown and, you know, as it compares to, you know, some of the other racquet sports.
JESSE N. CHARNOFF: Yeah so we cover Major League pickleball and HSS is an official sponsor.
JESSE N. CHARNOFF: And I do think they do a great job of making it a team environment. It's two men, two women on each team for Major League, for Major League pickleball. And I would say that is unique when you look at compared to tennis, I mean, there's things like the Davis Cup that are not as popular, I'd say, even though they're great activities and tournaments. But when we're looking at it at the professional level, that even the injury profile, I'd say is a lot different, just the aggression and the speed that they're playing at is a little bit different.
JESSE N. CHARNOFF: A lot of those players, I'd say the vast majority, are ex-high level tennis players so they're also accustomed to kind of that, that training and repetitive playing to avoid the overuse injuries but it still occurs nonetheless. Yeah. But yeah, no so I do think that Major League pickleball has a lot of things to offer and it's a great viewing activity and sport.
JESSE N. CHARNOFF: It'll be interesting to see how big it gets.
ANIL NANDKUMAR: Yeah, I think, you know, just like you said, it's such a team approach when we're at those tournaments, you know, treating both the staff and the players, you know, I think we have a multitude of disciplines there. We kind of all work together and I think that's one of the biggest things about treating these athletes, these pickle-ballers. It's not just one approach.
ANIL NANDKUMAR: You know, I found it's like, you know, sometimes you may need to shut them down completely, work on some basic things. Sometimes you just need to patch them up really quick so they can play their match. So I think the higher level that they get, you know, you have to really take into account what the athlete needs as well too. So, you know, a lot of times I'll say, especially for some of my patients who are a little bit more novice, maybe don't fight through the pain you know
ANIL NANDKUMAR: especially if you're just learning it and you're just learning the moves and dynamic stuff. So, you know, I guess, what would you say to one of your patients coming to the clinic as well? Like, you know, they're addicted to the game now. They, they can't stop. They play a couple times a week, but they really love playing. Like, would you have them shut it down as well, or would you kind of tell them to keep going?
JESSE N. CHARNOFF: Yeah I mean I'd say it's definitely dependent on the injury type. For tendon injuries, I typically try to explain that a low level of discomfort is OK and we want to load the tendon. So we want to try to strengthen in between playing and it may be OK to say no pain, no gain. But for other things like joints where we're talking about arthritis or even some meniscus or other issues.
JESSE N. CHARNOFF: Typically, your body is giving you feedback of pain because there's something that it's not liking or something has gone awry. I don't like when especially a novice is pushing through that type of discomfort, because you're often going to pay for it on the back end and maybe doing more damage than good. So I try to differentiate what I think the main problem is and try to teach the patients to like this is pain that you can work through, and it's good versus you really need to listen and kind of take a step out.
ANIL NANDKUMAR: Sure and you know, I think speaking of that, a lot of people aren't used to having what we call, like you know, for those out there, a longer lever arm, right? [Yeah]. And they're not used to holding something that increases the distance of whatever a point of contact that they have to the rest of their body, so that now using a paddle out there, like, you know, if you can speak a little bit about the equipment and how pickleballers can kind of either get back into the game by certain equipment, things like that.
JESSE N. CHARNOFF: I would look at whatever the patient's history in terms of, what are they most prone for injury wise, or what are they coming in with? If someone who comes in, let's just say with a tennis elbow, I'm going to look at their hand size and what's their grip size, because that's kind of low hanging fruit in terms of things you can change, whether it's put in over grip, something to make it a little bit wider so that you tend to not squeeze as hard, that can help decrease both tennis elbow and golfer's elbow.
JESSE N. CHARNOFF: The weight of the paddle.
JESSE N. CHARNOFF: So someone who struggles with that may do better with a lighter paddle, focusing on training to help load those tendons so they're a little bit more accustomed to it. Talking about in general, when we think about tennis, we have the opportunity to play on some courts that are a little bit more forgiving, which is another thing that I've seen a lot of patients struggle with is I have tennis players who haven't played on hard courts for, you know, 20 years, and now they're only doing hard courts because that's what pickleball tends to be.
JESSE N. CHARNOFF: Yeah so it's all those factors that we think about but I definitely see a variety of issues that are popping up regardless of the changes that we make.
ANIL NANDKUMAR: So are you saying that, you know, we should petition Wimbledon to throw in a pickleball court there?
JESSE N. CHARNOFF: I want to see grass. I want to see a grass pickleball championship.
ANIL NANDKUMAR: You know, Roland Garros, you know, with the clay court.
ANIL NANDKUMAR: That would be cool. Definitely and, you know, speaking of, I think maybe that's where the game is going and we might see other injuries arise from different court surfaces. But you know, I think with the paddle itself, it's so interesting because to me it is very different than a tennis racket. And for those like myself that transitioned from playing tennis with the strings with the different types of rackets and the technology that it's grown, then moving to a paddle that it's to me it seemed a little, you know, less forgiving, and it seemed like a lot of shock on my hand there
ANIL NANDKUMAR: so something that I have to now train myself. So how would you again, I guess this is advice for me, but how would you like, you know, kind of educate your tennis player going to pickleball and they start having those risks in hand?
JESSE N. CHARNOFF: Yeah I mean, I think the tendency for a tennis player is try to get as much spin as possible and the reality is like it's hard to get spin because it's just a paddle
JESSE N. CHARNOFF: and there is not that string that gives you that little bit of bite. Yeah. So some people overcompensate with a lot of extreme wrist movement. So it comes down to strategy to a degree. I think there's not as much of that in the professional. It's a little bit more a to b. There's a couple players who have a lot of spin, but in general, I think spin is taken out to a degree with, you know, the more you play and the transition away from tennis.
JESSE N. CHARNOFF: But yeah, it's about just trying to find your groove of a swing that works is competitive, but you're not putting that overload on your joints where it's going to take, you know, months or a year or so to get accustomed to the repetitive movement, like it took years for you to get used to your tennis swing.
ANIL NANDKUMAR: Sure, absolutely. And, you know, you covering a bunch of these tournaments. As far as just the classic injuries that you've spelled out for us,
ANIL NANDKUMAR: what are some things that maybe you found that as people are starting to get more competitive? You know, what are other things that maybe you've seen? I think I heard a story where, you know, you were treating someone that may have collapsed on court, you know, like things like that, that I think people need to understand of, like it is a pretty intense sport once you start ramping up your competitive level.
ANIL NANDKUMAR: And you need to stay hydrated and proper nutrition, so I guess if you can speak a little bit about those overarching things.
JESSE N. CHARNOFF: Sure. One thing I would say that is definitely underrated is if you're playing a tournament, even if it's a local, you know, 4-0, 4-5, 3-5, whatever it is, you're playing a lot of matches in one day, which is kind of different from how we do tennis tournaments, where it may be more spread out unless it's kind of Round Robin setup.
JESSE N. CHARNOFF: So I do think that people maybe not understanding the repetition and the length of time on court that you're actually having. I covered a tournament that was outside in a really warm climate, and a player was having some GI issues and suffered a heat attack secondary to just prolonged time on court and not being able to really properly hydrate. So it happens and it's one of those things where just like any sport, we got to be mindful of how much time we're out there, the temperature, our attire, all these things, changes in our diet.
JESSE N. CHARNOFF: These things can all make a factor in whether or not we're going to have a difficulty with recovery, as well as just playing to our max potential.
ANIL NANDKUMAR: Yeah, I think that's so important because again, right, that started with this casual, leisurely game and people moving from the couch to the court and then now as they become more addicted, they're going to get more intense but their, maybe their habits stay the same.
ANIL NANDKUMAR: So I think in treating the whole athlete, it has to be more of a holistic approach, like you were saying so absolutely. And as far as pickleball is going right now with the equipment, with the paddle, how about the ball? You know, do you do you find that hitting that type of ball that it also leads to certain injuries? Or, you know, how do you have to change your trajectory of your swing in order to really maximize your potential there?
JESSE N. CHARNOFF: Yeah, I mean, they're doing changes constantly to the ball so they're coming out with new balls I feel like every couple months.
ANIL NANDKUMAR: Sure. Yeah.
JESSE N. CHARNOFF: But in general, the ball is going to be a little bit harder. It has a little bit less of a give so you could get that kind of shock when you first do make contact. I still think it just comes down to making yourself acclimated to what that feels like, and the repetition in a safe way.
JESSE N. CHARNOFF: The more you do it, the more your tendons and muscles are going to be accustomed to that kind of shock feeling instead of the give way that you get with tennis, but it's all I'd say responsible practice that is going to be the critical piece. And just being aware that these injuries are looming, like with any repetition sport, you're going to have.
ANIL NANDKUMAR: Yeah so, you know, a lot of times I'll tell patients it's, you can't train for your sport by just doing your sport.
ANIL NANDKUMAR: Right so, you know, we talk about cross training or general physical therapy, maybe prehab or something along the lines of that but you know, what would you recommend for your patients in terms of just maybe either training for pickleball or getting ready to go back on court? You know, things of that nature.
JESSE N. CHARNOFF: Yeah I always say, you can't train by playing pickleball. You have to train for pickleball and not play pickleball to train.
JESSE N. CHARNOFF: OK so and I agree with your point completely, I'd say the number one thing that patients aren't doing and the hole in a lot of repertoire is just the lack of strength training. So especially with the older population, I'll hear, you know, I walk every day. I play pickleball three times a week. Like, that's a lot. I ride the bike.
JESSE N. CHARNOFF: But the reality is we need resistive strength training to really get those gains and the ability to be able to handle prolonged load on the tendons. So that's kind of the first thing that I always tell people is we have to work on strengthening and training for sport and not doing the sport to train, and then just describing really low hanging fruit exercises that are low risk for injury, but can definitely get those tendons involved.
ANIL NANDKUMAR: I see. Yeah. Yeah. You know, I think we've gotten a lot of catch phrases so far, you know, with the training. Here's one more. I usually tell patients it's like you because, you know, they'll say all the time they're like, I play pickleball three times a week. I walk 5 miles a day.
ANIL NANDKUMAR: All this stuff. Right? Why do I have this injury? Why does this hurt? And I sometimes say, you can be, you're probably grossly strong, but you're not specifically strong, right? The neuromuscular kind of component to that, you know, other things kind of compensate. So I think it's, you know, people sometimes have to take a step back and be like, all right, maybe I'll play pickleball twice a week and then strength train another day or, you know, work it in to maybe even their warm up or their down and, you know, kind of going to that.
ANIL NANDKUMAR: You know, I think we both would agree that, again, coming from our backgrounds of playing tennis, like a good warm up is almost 100% crucial to your performance and so, you know what how long should someone warm up? What should be in their warm up?
JESSE N. CHARNOFF: Yeah, so that's another similar to strength. That's kind of like the second most important thing that I tell people is I'd say the most common warm up is going to be a static, stretching warm up.
JESSE N. CHARNOFF: So one where you're just kind of pushing against resistance and trying to get some flexibility and what my recommendation would be, yes, you can have that as part of it but we definitely have to add majority of dynamic warm up. So moving around, getting the muscles and the tendons used to load, getting a little bit of a sweat going, and that's probably the number one thing
JESSE N. CHARNOFF: people are not doing and why there are so many of these acute explosive movement injuries. So depending on what the problem is, I'll definitely stress certain movements, whether it's just going onto your toes, hopping a little bit, high knees, but we got to get the blood flow going before the sport to kind of get maximal benefit and lower the risk of injury.
ANIL NANDKUMAR: I think those days have gone where high school, college,
ANIL NANDKUMAR: we could just go out there and play a little mini tennis, you know, move up to the baseline and start warming up. You know, now, I'm getting a full sweat before I even get on court there. You know, just because it's so important. I think that's what happens when we get these traumatic injuries. You have, you know, these cold tendons that are now doing explosive activity and therefore just can't handle it at that point in time.
ANIL NANDKUMAR: And, you know, I think similarly to a nice cool down is important too, because again, the body is moving the entire time. You need something to gradually bring you down a little bit. So I guess, what are some tips that you would give, you know, your patients and your athletes to kind of cool down a bit?
JESSE N. CHARNOFF: Yeah, I mean, I'll generally try to warn people not to just play a really aggressive couple of games of pickleball and then hop in the car and drive for a couple hours.
JESSE N. CHARNOFF: But people do stuff like that just because that's life. But I'll try to encourage, you know, walking around a little bit. Again, similar movements to how we start, but just some basic movements to let some of those muscles and tendons kind of relax and get back into your normal everyday movement pattern.
ANIL NANDKUMAR: Yeah and I think as people start to play and, and start to understand their form and their bodies, they start to realize where their problem areas lie, right?
ANIL NANDKUMAR: If your hamstrings always bother you after you play. All right, let me spend a little extra time, warm up those hamstrings, cool down those hamstrings, things like that. So yeah, I think it's just knowing yourself and how to handle it and you know. During your practice, I, I've also heard that you're starting to potentially do a study in regards to pickleball and racquet sports.
ANIL NANDKUMAR: Can you speak about that?
JESSE N. CHARNOFF: Yeah so we have a study currently open for any patients or listeners on pickleball injuries and we're trying to find associations between playing habits, equipment and most common injuries that we see so we're about halfway through that study and hopefully, we get some participants from this podcast and we get closer to publishing.
JESSE N. CHARNOFF: But I think there's not enough data on these things. We have a lot of just initial data, and we're seeing a lot of more like billing and money stories out there on how much pickleball is costing, because there's some Medicare data that shows it's a high risk for injury sport. But it'd be interesting to get a little bit more into the details and really figure out how we can make adjustments to reduce risk. So one thing that I would say I see a lot is that when people get injured, even if it's a really severe injury, that hurts a lot.
JESSE N. CHARNOFF: I'm not seeing a lot of patients respect the injury, and I think maybe it's because it's pickleball and it's not such. They don't frame it as an extreme activity, but I'm seeing a lot of people get whether it's like a strain of the gastroc or, you know, the beginnings of tennis elbow, they're not taking the appropriate time or action. They're kind of just blasting through it and trying to play through it, as we said.
JESSE N. CHARNOFF: Yeah and ultimately, it becomes a chronic issue and, you know, even with guidance, they're having trouble kind of backing away.
ANIL NANDKUMAR: And why do you think that's happening?
JESSE N. CHARNOFF: I think it's a sport that lends itself where you can still participate at a certain level, even injured with not such a big drop off. And I think there's just a big social component to it and that's why
JESSE N. CHARNOFF: so many people love it, that people don't want to give up, that, you know, connection. But it's still important to realize when there's a legitimate injury that requires intervention and time off and giving yourself that amount of time to do so.
ANIL NANDKUMAR: Yeah, I think that's what the beauty. I always go back to my roots. I always bring it back to tennis. But I think that's the beauty of what tennis was or is,
ANIL NANDKUMAR: excuse me in the sense of like it's was a globally great exercise for cardiovascular. You know, it, it started to build your mental health and mental strength there, a social component by, you know, either playing with another person or playing doubles and whatnot and then now we're seeing that same thing with pickleball as well. And even more so because the court is shorter
ANIL NANDKUMAR: so you can definitely talk through some points there. And so I think you're right, I think the fact that people are really loving it and they're starting to ignore their injuries, that then these things start to happen. Maybe it was just a little oh, my calf is a little tight, and then I decided to go play and something bad happened. So I think, you know, I would love to talk about a little bit of something that, we call red flags, you know, what are some red flags that, that you can identify right away for, for patients, something easy for them to digest so they can say, you know what, I don't think I got it today OK.
JESSE N. CHARNOFF: I mean, if you had a concerning tendon or muscle injury, I would say keep an eye on it for the next day or two. If you're noticing a lot of bruising, that typically implies that there was some tearing of the muscle or tendon. And in general, I would take that a little bit more serious than if it just hurts a little but after a day or two kind of resolves. That implies that there was some anatomical damage that we should potentially be assessed by a doctor.
JESSE N. CHARNOFF: Other things would be if there's some sort of deformity that you notice after an injury, beyond that swelling of a joint. Difficulty with strength, so if you're noticing acute strength deficit or tingling, pins and needles, those are things that shouldn't typically happen from just your average overuse injury and may require some further attention.
ANIL NANDKUMAR: Yeah and I think, you know, in layman's terms that I like to tell patients too.
ANIL NANDKUMAR: It's like if it alters the way that you normally do something, there's something probably wrong. And that's more than just, you know, kind of doing that Frankenstein walk after you've had a tough workout, right. It's more of like, oh, I'm limping. Oh, something is whatever is sending off those alarm bells in your own head, I think that's when you start to get it checked out.
ANIL NANDKUMAR: And so, you know, from a standpoint, you know, definitely assessing the whole body, the movement, looking at different special tests, really diving into potential injuries that might happen. We isolate certain areas and work on different strength, range of motion and whatnot to get a patient better and of course, bring down their symptoms but from the medical side of things, what are some interventions conventions that you may recommend or you have done for these athletes?
JESSE N. CHARNOFF: Sure, I mean, it's similar to other overuse injuries. So, you know, when we're talking about beyond physical therapy, we have a gamut of options, which include steroid injections. We try to shy away from that, particularly with tendons, just because we have some better options now and there are some downside to doing steroids. PRP is something that we use a lot with tendon or overuse injuries, and that's platelet rich plasma.
JESSE N. CHARNOFF: There's some mixed data on the efficacy, but for certain things like tennis elbow, it's been well proven that it does provide benefit and there's not really a high risk associated with it. We sometimes will do something called shockwave therapy, which is a non-invasive treatment for tendons and muscle injuries. And it's an in-season treatment so it's something that people can play with even while receiving treatment.
JESSE N. CHARNOFF: And obviously for really severe injuries, there can be surgical intervention.
ANIL NANDKUMAR: Yeah if you could just speak a little bit more about shockwave,
ANIL NANDKUMAR: I think that's becoming quite the rage right now, especially just like you said, you can do it while still doing your activity, not having to shut yourself down for a good amount. What is shockwave and how do you, how do you usually do it?
JESSE N. CHARNOFF: Yeah so it's using energy ultrasound energy high amount to cause some small microtrauma.
JESSE N. CHARNOFF: It creates a change in the local environment and it's under the umbrella of regenerative medicine although it's not been proven to actually cause regrowth of tendon and completely resolve the issue. Like, how we think of what a stem cell should be, but it has been proven to have an analgesic effect and help change that environment to a less inflammatory or painful environment.
ANIL NANDKUMAR: OK. Yeah.
ANIL NANDKUMAR: You know, I've had shockwave myself. I'm sure you've had it. The only thing is that it can be quite uncomfortable, you know. And so, you know, when dosing something like an intervention that can be uncomfortable, like how do you educate, you know, your athletes to bear with it, you know, and potentially this might lead to something better.
JESSE N. CHARNOFF: Yeah, I'd say during the treatment itself, it definitely, you know, we were looking for anywhere from a 4 to 7 out of pain, out of 10 for pain.
JESSE N. CHARNOFF: But typically day of or even the following days it should feel better after shock wave, but you do tell them there's always the chance, because we are kind of bringing up the immune system and causing an acute reaction that if it does hurt, beyond that, we want to pull back on the sport. We want to try to treat it with different modalities and just give them the full range of potential things they may encounter, so they're not scared if anything goes off script.
ANIL NANDKUMAR: Sure. You know, this has been a fantastic conversation. And, you know, I think what we've learned is that there it's a multimodal approach in order to treating pickleball athletes, athletes in general. You know, I really feel like pickleball is booming and it's going to continue to boom because just like you said, people love the sport because it's a social aspect. It's a physical aspect.
ANIL NANDKUMAR: It's just something that you can do to, you know, keep yourself going, keep yourself out there and moving. And so, you know, I think injuries will arise. But I think, like you said, as you've collected your data, as we see how it moves, we can then start treating these players a little bit more specifically. And, you know, using a specific method for, you know, good protocol to treat everyone.
JESSE N. CHARNOFF: So I have a question for you.
ANIL NANDKUMAR: Yes, please.
JESSE N. CHARNOFF: So do you find that pickleball messes up your tennis game?
ANIL NANDKUMAR: Absolutely. In what way? So basically I've found that playing tennis, you can then translate that ability to playing other racquet sports or paddle based sports and you can pick it up quite quickly. But going the other way, I've found it to not ruin my game, but I have to change my mindset.
ANIL NANDKUMAR: Kind of like what you said before in the sense of, you know, you can't play pickleball like you're playing tennis. It's a different motion, different stroke. And for me, I've always been a player that really gets used to their equipment and so therefore if I change equipment, it takes me a while to then, you know, change it back or, you know, and so for that aspect I found it
ANIL NANDKUMAR: but what translates directly is just timing. I think like after I play pickleball, I'm way better, you know, timing wise on the tennis court, my feet are set, my hands are more alive. I can play doubles at the net just a lot quicker and I've always struggled with that. So that's definitely helped. So I think, you know, it's something that these two can kind of help each other.
ANIL NANDKUMAR: If you are a player like myself who was reluctant to start playing pickleball, there's definitely some benefits back and forth. But, you know, I still think I need to separate the two a little bit better. And how about yourself?
JESSE N. CHARNOFF: For me, it's more the mindset that you kind of touched on it, but it's more the strategy. OK so the strokes for me feel different.
JESSE N. CHARNOFF: I don't feel like it has a negative impact because I feel like I'm playing more of a ping pong type. It's my style for ping pong, but what I get messed up with is the strategy. Like, I'll have a short ball in tennis and I'll just do like a little dink and then just get smashed at me. I see and I see you like just mentally have that, you forget, like you try to get behind someone like you would with pickleball.
JESSE N. CHARNOFF: Yeah, but they can just come up to the net and smash it. So it's like that quick, you know, split moment decision that where if I play tennis right after pickleball, I'll get kind of catched up.
ANIL NANDKUMAR: Yeah, but like you said, I think the strategy with tennis is at least the modern game now is like, you're going to unleash all your skills at the baseline, you know, and then you might move into the net to finish the point,
ANIL NANDKUMAR: whereas pickleball, you rush the net almost immediately any, any chance you get. So you're right, I think the strategy is the biggest thing for sure. And, you know, I think as the sport grows and, you know, people are going to be moving around to different sports, it'll be a little bit of an adjustment but you know, I think really overarching theme that I think for all treating these athletes is, you know, to potentially just cross train, prepare yourself, understand what your body is doing and understand, all right, maybe something is wrong.
ANIL NANDKUMAR: You know, and know when to kind of reach out to get help. And here at HSS, I really think that we're pushing the envelope to being like the first to really start to look at these things and, and really start to analyze, like how, how can we treat these pickleball athletes as a separate subgroup and really treat them specifically.
JESSE N. CHARNOFF: Yeah. It's exciting. I'm looking forward to the future.
ANIL NANDKUMAR: Well, thank you so much for sitting down with me. Thank you to HSS for the opportunity here at the podcast and we'll see you next time.
VOICEOVER: [MUSIC PLAYS] Thank you for listening to this podcast episode from HSS Presents. a ConveyMed production, and keep listening to HSS Presents for other offerings. The views expressed on this podcast are those of the interviewers and interviewees alone, and do not reflect the views of HSS.
VOICEOVER: Information relayed on the podcast is for informational and educational purposes. This information is not medical advice and should not be used for diagnosis or treatment. Listeners should seek advice from a licensed medical professional before making any personal health decisions. [VIDEO AND MUSIC ENDS]
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