Can I Keep Playing Pickleball With Knee or Hip Arthritis?

If you have knee or hip osteoarthritis and you have found pickleball, you have probably also found the worry that comes with it. The joint aches after a long session, and the natural conclusion is that the sport is grinding the cartilage down faster. That worry is understandable, and for most people it is also the wrong read on what is happening.

Exercise does not wear out the arthritic joint

The fear that activity is damaging the joint runs deep, and the evidence points the other way. A systematic umbrella review of physical activity in knee and hip osteoarthritis found that physical activity decreased pain and improved physical function, with no evidence of accelerated osteoarthritis progression at ordinary activity levels. In plainer terms, moving the joint is not the same as wearing it out.

This is why exercise sits at the centre of the major treatment guidelines, not at the edges. The UK's NICE guideline on osteoarthritis (NG226) tells clinicians to offer therapeutic exercise to every person with the condition, tailored to their needs, regardless of age, weight, or how the joint looks on imaging. Structured strengthening and general fitness are treatment for osteoarthritis, not a risk to be avoided.

What a flare means, and what it doesn't

When you start or increase exercise with an arthritic joint, the joint can hurt more for a while. That does not mean it is being harmed. NICE addresses this directly, advising that joint pain may increase when someone starts therapeutic exercise, and that regular, consistent exercise remains beneficial for the joint even when it is initially uncomfortable.

The distinction worth learning is hurt versus harm. A flare after a long game, an ache that settles over a day or two, and next-morning stiffness that eases once you move are all hurt without harm. They are the joint reacting to load, not evidence of a joint being destroyed. Harm looks different: a sharp, mechanical pain, a joint that swells and locks, or a symptom that keeps climbing week after week no matter how much you back off. The first pattern is something you can work with. The second is worth having assessed.

The evidence that keeping active pays off

When pickleball players over 50 do get hurt, arthritis is already part of the picture. In a single-institution study of pickleball injuries from 2017 to 2022, arthritis-related pain was the second most common diagnosis at 10.0 percent, behind soft-tissue strains and ahead of fractures. The median age of an injured player in that data was 65. Arthritis and pickleball share a demographic, so the question of how to play with a sore joint is a common one, not a niche one.

The reassuring part is what a strengthening program does for that joint. A Cochrane systematic review of exercise for knee osteoarthritis found that land-based exercise produced a moderate reduction in pain and a moderate improvement in physical function, with the benefit holding for at least two to six months after the formal program ended. The muscle around the knee and hip is not decoration. It shares the load the joint would otherwise carry alone, which is a large part of why stronger legs tend to mean a more comfortable game.

How to manage load so the joint tolerates the game

Playing well with osteoarthritis is mostly a load-management problem, and load has several dials you can turn. The first is volume. Two shorter sessions your joint tolerates beat one marathon that leaves you limping for three days. Building playing time up gradually lets the joint adapt rather than getting overwhelmed by a sudden jump.

The other dials are the practical ones. Rest days between sessions give the joint time to settle, and they matter more as playing frequency climbs. Surface plays a role: repeated hard stops on unforgiving concrete load the joint differently than a cushioned indoor court, so mixing surfaces can help. Footwear with genuine cushioning and lateral support takes some of the shock out of the quick sideways movements the game is built on. None of these are cures. They are ways to keep the total load inside what your specific joint can handle, which is the whole game with arthritis.

Sensible modifications that keep you on the court

When a joint is having a rough stretch, the goal is to stay in the game at a level it tolerates rather than stopping outright. Dropping down a level of play, choosing doubles over singles to cut the court you have to cover, and giving yourself a longer, gentler warm-up all lower the demand on the joint without ending the session. A flaring knee or hip usually needs a quieter week, not a permanent retirement from the sport.

Off the court, a strengthening program is what raises the ceiling on what you can do on it. This is where a physiotherapy assessment earns its place: a physiotherapist, who in British Columbia is regulated by the College of Health and Care Professionals of BC (CHCPBC), can test how the joint behaves under load and build a program matched to it rather than a generic sheet of exercises. In our clinic, the players who keep playing longest are usually the ones doing regular strengthening away from the court, not the ones relying on rest alone.

When to get the joint assessed

Not every sore joint needs an appointment, but some patterns do. It is worth booking an assessment if the pain is sharp and mechanical rather than a dull ache, if the joint is swelling, catching, locking, or giving way, if the pain keeps climbing week to week despite backing off, or if it has started limiting the daily things you do off the court. Those are the signs that the joint needs a plan, not just a rest.

An assessment is also the moment to talk about whether osteoarthritis is even the right explanation, since a physiotherapist can screen for the other things a knee or hip does when it is unhappy. If the joint has reached the stage where surgery is on the table, physiotherapy still has a role first, both for knee osteoarthritis before considering surgery and for hip osteoarthritis before a replacement. And if a sudden injury rather than a gradual ache is what stopped you, our overview of pickleball injuries after 50 covers the more acute end of the spectrum. Coverage and booking details for any of our five studios are on the rates and FAQ page.

This article is general information, not personal medical advice. A regulated practitioner can confirm whether the patterns described apply to you.

Frequently asked questions

Will playing pickleball wear out my arthritic knee or hip faster?

The evidence does not support that fear. A systematic umbrella review found physical activity improved pain and function in knee and hip osteoarthritis with no sign of accelerated joint progression at ordinary activity levels. Managing how much and how hard you play matters more than whether you play at all.

My knee flares after a game. Does that mean I am damaging it?

Usually not. A flare that settles over a day or two, and stiffness that eases once you move, is the joint reacting to load rather than being harmed. Pain that is sharp and mechanical, comes with swelling or locking, or keeps climbing week after week is different and worth having assessed.

Should I stop playing pickleball if I have osteoarthritis?

For most people, no. Guidelines like NICE recommend exercise for everyone with osteoarthritis, and modifying volume, surface, footwear, and rest days usually lets you keep playing. A quieter week during a flare is more useful than stopping the sport entirely.

Does exercise actually help arthritis pain, or just distract from it?

It helps directly. A Cochrane review of exercise for knee osteoarthritis found a moderate reduction in pain and improvement in function that lasted for months. Stronger muscle around the joint shares the load the joint would otherwise carry alone.

How do I know when to see a physiotherapist about it?

Book an assessment if the pain is sharp rather than achy, if the joint swells, catches, or gives way, if it keeps worsening despite backing off, or if it is limiting daily life. A physiotherapist can test the joint under load and build a program matched to how it behaves.

Sources

• Effects of Physical Activity in Knee and Hip Osteoarthritis: A Systematic Umbrella Review, PubMed (2019)
• Osteoarthritis in over 16s: diagnosis and management, NICE guideline NG226, Recommendations (2022)
• Exercise for osteoarthritis of the knee: a Cochrane systematic review, Fransen et al., PubMed (2015)
• Evaluation of Pickleball-Related Injuries at a Single Institution From 2017 to 2022, Orthopaedic Journal of Sports Medicine (2025)