Pickleball may look easy to pick up, but the competitive sport requires coordination, endurance and practice, especially as you get older.

While pickleball gets your heart rate up, it doesn’t put as much stress on the body as other racket sports. It also offers the benefits of strengthening cognitive ability while reducing symptoms of anxiety and depression. That said, it’s best to approach the game with caution.

Players in their 50s and 60s are at the greatest risk of injuries, such as falls and fractures, often because of weakening bones. That’s why warming up before hitting the court is the most important thing you can do, said orthopedic surgeon Dr. Philip Mulieri of Novant Health Orthopedics & Sports Medicine - Belfair, near Hilton Head.

The AARP recommends some ways to warm up before you play.

6-minute pickleball warmup

Complete each warmup exercise for two minutes.

• March in place. Lift your knees and pump your arms. This elevates your heart rate without putting stress on your joints.
• Do squats. Stand with your feet shoulder width apart. Bend at your knees and push your hips back like you are about to sit in a chair. Keep your back as straight as possible, chest up and heels planted on the floor. Make sure your knees don't extend forward over your toes and try to keep your weight evenly distributed on both feet. This warms up the muscle groups in your legs, including your calves, quadriceps, hamstrings and glutes, as well as muscles in your lower back and core.
• Pretend to swim. Swim strokes, both forward and backward, warm up your shoulders and can help avert a rotator cuff tear.

Mulieri specializes in elbow and shoulder surgery. Here, he discusses how to ensure a safer approach to America’s fastest-growing sport.

How often are you treating patients with pickleball-related injuries?

It’s very common. I’m seeing patients on a daily basis with some injury related to pickleball. Many players forget to stretch beforehand, which keeps the joints flexible and mobile.

Most people think about falls and broken bones, but the most common problems I see are shoulder injuries. Older players are more prone to fall, but players of any age can get a shoulder injury from overuse. We also see wrist fractures, particularly with women, because osteoporosis is a variable. But soft tissue injuries are more common in men.

When played safely, with a good warmup, can pickleball actually help prevent injuries in seniors?

For women, bone loss can accelerate during menopause, so pickleball is a great option for strengthening bones and preventing osteoporosis, an advanced stage of low bone density. Screenings are recommended for women 65 and older, and for women younger than 65 with risk factors. There is no screening recommendation for men.

What do older players take for granted when approaching pickleball for the first time?

Pickleball doesn’t require the same cardiovascular demands as tennis, which makes it more accessible to more people. But that doesn’t mean everybody is an athlete. The pickleball court is also a lot less forgiving than the tennis court in terms of both the surface and the fast pace of the game. That’s why players, especially newer ones, are more prone to fall.

Many injuries are related to falls, and the majority of those are patients who backpedal and lose their balance. One thing I hear a lot is, “I just started playing, then decided to play five days in a row — and now I can't move my arm.” If you’re new to the game, take your time wading in. It’s important to know your limitations and what your body can handle at one time.

When is surgery for an injury necessary, versus reconstruction or replacement?

The underlying injury is the driving factor of how we treat our patients. Most injuries are sprains and strains, but some injuries absolutely necessitate surgery, such as an Achilles tendon rupture or rotator cuff tear. We can usually accomplish this with minimally invasive techniques to reduce soft tissue injury during surgery.

The shoulder is the most mobile joint in our body. The elbow is where the majority of our muscles that move our hand and wrist attach. There’s a lot of stress on the soft tissue when playing pickleball. Fortunately, the elbow is a stable joint and less prone to injury than the shoulder.

Elbow and shoulder problems can usually be addressed with minimal incisions and shorter recovery times. In cases where minimally invasive surgery is not indicated, I also perform complex reconstruction and shoulder replacement procedures. Injections or physical therapy can also help manage pain.

What is a question you wish patients would ask?

Very few people ask about how to fall properly. We usually reflexively put out our hands but end up breaking something. To prevent injury, the best thing is to tuck and roll, rather than break your fall with your wrists and hands. Obviously, things happen very quickly, but the more prepared you are for a fall, the more you think about how to fall properly.

Bottom line: Not only is pickleball a low-impact sport, it offers a social component and a way to stay in physical and mental shape. But it’s important to move into the game gradually. Warming up for a few extra minutes makes all the difference in keeping you mobile and safe.