First, Sue Schroers broke her shoulder. Then his wrist. And last week, a bullet hit her in the face.

All of the injuries came from pickleball, a game she learned to love — and learned not to underestimate — as she hit the Roseville courts week after week.

“It was like the third time I played,” Schroers said, reflecting on his first injury. “It was kind of a random thing. I ended up falling on my shoulder and breaking it in three places.”

The recreational sport, often touted as an accessible combination of tennis, badminton and table tennis, has become hugely popular, especially among older athletes. But with that popularity comes a growing number of doctor visits for sprained ankles, pulled muscles, broken wrists and more. Medical professionals warn that without proper preparation, equipment, and safety, even seemingly soft pickleball can lead to injury.

“Give him the respect he needs,” said Dr. Sanjeev Kakar, hand and wrist surgeon at Mayo Clinic. “It’s a real sport, and as such you have to train like you’re playing a real sport.”

Pickleball’s popularity has exploded nationwide in recent years, with an estimated 4.8 million American players playing, according to a 2022 Sports & Fitness Industry Association report cited by USA Pickleball, the sport’s national governing body. Among players who play more than seven times a year, the report says more than half are at least 55 years old.

In Minnesota, cities have added dozens of pickleball courts amid growing demand, and private facilities are also popping up.

After Schroers, 64, recovered from her shoulder injury, she was back on the court – until she fell backwards and landed on her wrist trying to reach a ball. It was about a year ago. She’s since started playing regularly with her friends again and was ready to get going with her paddle on a hot Wednesday night in Roseville.

Schroers credits her ability to keep up with pickleball to the care she received at Twin Cities Orthopedics. Physiotherapy was key to being able to regain full range of motion in her right shoulder after such a severe break, she said, especially since she holds her paddle in her right hand.

Trent Stensrud, a physical therapist at TRIA, another orthopedic clinic in the Twin Cities area, says he’s seen a big increase in pickleball-injured patients in recent years.

A HealthPartners spokesperson said TRIA does not have accurate data on the number of pickleball injuries.

“The vast majority of pickleball-related injuries are non-surgical and non-invasive,” Stensrud said. “For what they need in terms of treatment, physiotherapy is usually the answer.”

Compared to other sports, pickleball is relatively safe and low-risk, said USA Pickleball’s Ernie Medina.

Mary Ann Goens-Bradley, who has osteoporosis and is 64, says she doesn’t worry about hurting herself any more when she plays than she does in everyday life.

“I broke a shoulder, I broke a wrist, I do other things, I just do everyday things,” Goens-Bradley said during a break at the Northeast Recreation Center in Minneapolis.

“I’m pretty aware of my body’s capabilities, and I think that makes a difference as well,” she said.

Goens-Bradley even recently bought some special pickleball shoes, but she said she didn’t feel much of a difference. Pickleball shoes are designed to support the foot as it moves in multiple directions, according to Medina.

One of the leading causes of injury is backing up during play, which is why USA Pickleball advises against backpedaling in its health and safety guidelines.

Schroers said if she had been told earlier that running backwards was unsafe in pickleball, she likely could have avoided her second injury. But even after injuries considered serious on the pickleball spectrum, she doesn’t shy away from the sport.

“You know, I don’t think it’s dangerous,” Schroers said. “I think people just have to play smart.”

Pickleball is an accessible sport and the rules are easy to understand, but doctors, physiotherapists and pickleball experts still insist on safety.

“It’s not necessarily that the sport of pickleball is dangerous,” Medina said. “The injuries we see from pickleball are not so much due to the sport itself that people didn’t warm up properly at the start or they were wearing the wrong kind of shoes.”

Before preparing your paddle for a game, the Mayo Clinic emphasizes remembering the “four Ps”: proper stretching, proper equipment, proper mechanics and aim. Practicing purposefully means minimizing the time spent doing the same vigorous movements over and over because many injuries come from overuse, said Kakar, the Mayo Clinic surgeon.

The vast majority of pickleball injuries are not serious, and he said the goal is always to get athletes back on the field as soon as possible.

“I’ve had many patients return to their sport that they love to do,” Kakar said.

Ultimately, the risk of injury from pickleball shouldn’t stop people from getting on the court, Medina said. He said the benefit of exercise outweighs the possibility of injury.

“The impact of physical activity that these people experience versus injuries … there is no comparison,” he said.