July 22, 2024
So Long, Knee Pain!
By Noe Sariban, PT, DPT, Cert. DN, TPI MII, CPTP
The secret is out: Pickleball is more fun than any other activity out there! People are playing five, six and seven days a week for multiple hours at a time—and even twice a day for some. While many claim pickleball is the source of more injuries than other sports, the reality is that we’ve rarely seen a sport with such intense participation from people across all age groups.
As the popularity continues to rise, it’s expected injuries will increase, too. Of the many aches and pains pickleball players experience, knee pain is high on the list.
A lot of pickleball players started playing later in life, after their body already endured wear and tear from other sports and activities in the past. Therefore, high-load-bearing joints such as knees are particularly vulnerable because of the repetitive nature of sports. Most athletic people will develop some level of arthritis over time. Arthritis is defined as the wearing down of the articular cartilage in a joint, leading to increased friction between the bones and causing irritation, inflammation, and pain.
While our bodies can’t build new cartilage, evidence shows that targeted exercise is the best option for mild to moderate osteoarthritis. If the osteoarthritis is too advanced, exercise is no longer beneficial and more invasive procedures may be needed.
Aside from osteoarthritis, which is a disease process that occurs over time, there are other sources of knee pain such as tendinopathy, patella-femoral pain syndrome, and ligamentous/meniscal issues that may sideline pickleball players as well.
The key to addressing knee pain is to perform a thorough assessment of the kinetic chain to determine the biomechanics involved in one’s motion. Knee alignment and muscle recruitment during active motion is key to understanding the potential forces placed on the knees. When the knee is exposed to poor biomechanics over time, that’s when problems occur.
As pickleball players spend hour after hour on the courts, muscle imbalances and poor biomechanics will be amplified because of the repetitive nature of the motion performed. While braces and taping techniques may feel good during play, it’s not an ideal long-term solution. Instead, addressing muscle imbalances up and down the kinetic chain that may be contributing to poor biomechanics during active motion will ensure that the knee is better-positioned during athletic movements.
So where to start? The best first step would be to consult a competent physical therapist who can perform a thorough examination and determine whether there are limitations or impairments that contribute to the knee pain you are experiencing. Then, based on the findings, an individualized program aimed at addressing those impairments in a progressive manner is the best way to achieve long-term pain relief.
Typically, people who have a training routine perform a lot of movements in a single plane of motion (think of cycling, running, squats, lunges, bicep curls, hamstring curls, bench press, etc.). All the movements happen in the same sagittal plane of motion. To reduce the stress placed on the knee, a significant emphasis of the strength training should be targeting muscle groups that operate in the frontal plane (movements such as side steps, single leg activities, etc.).
The planes of motion are pictured below for reference.
Unfortunately, it’s not enough to just start doing strengthening exercises, and I caution you to avoid doing so without having undergone a thorough examination. There could be mobility issues that need to be addressed at the joint level prior to strengthening to allow full motion of the knee to perform certain movements without stressing the knee itself. This is where a competent doctor of physical therapy can determine the best course of action for you.
If you have been experiencing lingering knee pain, know that pain is not a normal state, and with the proper intervention, it can improve over time.
If you’d like to learn more about this, contact me, The Pickleball Doctor, at thepickleballdoctor@gmail.com. I work with Ben Johns, pickleball’s No. 1 men’s player in the world. •
Noe Sariban is a doctor of physical therapy and owner of Move It Physical Therapy in Chapel Hill, NC. He is known as The Pickleball Doctor and is a certified pickleball teaching professional through the IPTPA, and part of professional player Ben Johns’ team. Noe has a physical therapy business as well as a pickleball coaching business. If you’d like to register for camps or lessons, contact thepickleballdoctor@gmail.com.
