Adult pickleball players also report pain in knee regions while making lateral cuts. This may be attributed to other parts of the body due to anticipation based on the coordination of the timings of the movements of the hip, the rotation of the trunk, and the breathing process. I use the single leg step down drill, wherein I step down slowly to learn to control my own body, with no impact on my knees. If with little movement from the hip, I keep the knees in the same plane and I breathe at a certain rhythm, I lower myself, and the system reaches its maximum level of security and its maximum performance. The approach has provided such dramatic change that I have seen an active woman in her late fifties wince with every sideways push on the court when she arrived. She took part in step-down exercises with restricted knee extension for many weeks, focusing on details, and started to trust her body again. This period also marked an improvement in her movement skills. Physical strength is regarded as being just as important as the level of confidence. Other exercises I do include basic hip exercises, such as lateral walks (or monster walks) and wall glute activation, which activate the muscles that stabilize and guide the knee in rapid turns. When the hips are doing their job, the knee should move freely, with no stabilization or sounds but the biggest improvements are when you can follow your body's movement, rather than trying to move through discomfort. They don't tell me that I should focus on achieving smooth movements instead of trying to build stronger knees. The weight distribution stays correct because the cut movements are done in a controlled manner and cause little noise. The player receives feedback and information through the pain given by the human body, and after playing the game, players may have learned that advanced coordination, rather than brute force, is necessary for refinement.
Pickleball is a sport where side-to-side movement is inevitable, even when you have more players on either side. If you're a player of this sport and experience patellofemoral pain that makes it hard to do these lateral cuts, you should try the calf wall stretch. What I love about the calf wall exercise is that it's simple to do, not to mention it effectively reduces the pain in your knee. All you have to do is stand against a wall with your affected leg pulled behind the other. You then bend your front knee towards the wall, and just as you lean your chest and hip as well, hold the stretch for like 20 seconds before you repeat the process. You should start to feel relieved after taking this gentle exercise because it stretches your calf muscles to make your knees move easily. There's a gentleman down here who is a passionate pickleball player, and he once emailed me requesting an appointment. I found out later that he had the patellofemoral that kept him down for days. After I recommended the calf wall stretch, I saw in his eyes that he was unconvinced, but reported back after taking my advice that, at least, his pain was now less severe. Maybe at some point you might overstretch the leg, and the minute you feel uncomfortable, I'd suggest easing off and taking a rest.
I tell my pickleball players to do lateral band walks. You just put a resistance band above your knees and walk sideways. A local rec team I worked with started doing these twice a week, and their knees stopped bothering them during quick cuts. Strong hips really do take the pressure off your knees. It's a simple drill that's worked for almost every racquet sport client I've had. I'd add it in.
As both a tennis and pickleball community leader and long time player....I've found that eccentric single-leg squats are one of the most effective, evidence based drills for reducing patellofemoral pain during lateral movements. This exercise strengthens the quads improving knee tracking and control, which are critical in sports that demand frequent side-to-side cutting. How to Perform It: Stand on one leg, slowly lower yourself into a squat over 3-4 seconds, keeping your knee aligned with your toes, then return to standing. I recommend 3 sets of 8-10 reps, 2-3 times per week. Use Case: One of our Sydney Tennis NSW community members....a 38-year-old tennis and pickleball player, struggled with recurring knee pain during lateral lunges and quick directional changes. After incorporating this single-leg eccentric work for six weeks, her pain during play decreased significantly, and she reported improved stability during defensive movements and recovery steps. This simple but powerful drill enhances strength, making it a staple recommendation for any adult recreational athlete managing knee discomfort. https://www.michaelripia.com/
I continue to go back to the same slow lateral step-down with band resistance at the knee as my drill. It may seem simple. It is not. My objective is to get athletes to have control - to be able to resist the force that is pushing their knee inward and to keep their kneecap tracking straight down the leg. This will help athletes target the hip abductors and external rotators which are important components in pickleball. Most research indicates that athletes who lack hip control increase the patellofemoral load when they cut or decelerate. I instruct athletes to perform the three-second slow descent, lightly tap the heel on the ground and then slowly and intentionally move back up to the starting position. I tell them to never rush or compete against anyone else. Example That Has Stayed With Me I had a 48-year-old recreational pickleball player come into my office complaining of sharp knee pain from wide lateral cuts. Squats and lunges exacerbated the problem so we removed those exercises from his routine. In just three weeks he performed the slow lateral step-downs with band resistance at the knee two times per week, his knee pain decreased rapidly. I also noticed a significant increase in confidence. He no longer stiffened or braced himself when moving laterally. His knee was now tracking properly because his hip had finally engaged to perform its function. I see this type of improvement time and time again. When an athlete's body can share the load (and the stress) of movement by using its proper mechanics to move through space, it decreases the amount of stress placed on the knee.
Slow eccentric step downs to the lateral have been most effectively used as a drill to adult pickleball players with patellofemoral pain. This is common at RGV Direct Care where players who have trained to cut hard were not trained to control frontal planes. The knee pains are seldom concerning the knee. It concerns the way the hip and the trunk cope with the changes in direction of the load. The drill is simple. Be on a four to six inch step. Raise the heel slowly and in a count of three or four seconds, without rotating the knee behind the second toe. The support of light fingertips is permissible initially. It is focused on control, rather than depth. The number of reps of two to three sets of six to eight reps per side is good. This exercise places the quadriceps in an eccentric position whilst training the glute medius to stabilize the femur. Studies always demonstrate better patellofemoral mechanics when the strength of the eccentric quad muscles is stronger as well as the control of the hips. Lateral cuts are less painful in players who are done three times per week in their reports. RGV Direct Care prefers this drill as it slides over to the pickleball stop and push demands without putting excessive load on the irritated tissue.