The neighborly pitch to bring people into the pickleball craze has been simple.

Players just need an open space, a net, a ball and pair of paddles — and they can play for hours. There's less movement than what is needed in tennis, and really, as the New York Times wrote last September, "anyone can play."

That simple pitch may be coming at a price. In a recent research note, UBS analysts estimated $250 million to $500 million in medical costs attributable to pickleball in 2023. The sport could even be contributing to an uptick in outpatient surgeries among seniors, they said, in addition to factors like a procedure backlog built up in the pandemic and the removal of mask requirements.

So how did what seems like a harmless sport suddenly become a potential culprit behind higher healthcare costs in America?

"Pickleball was almost too easy to play," Dr. Joshua Dines, an orthopedic surgeon who specializes in sports medicine and shoulder surgery at Hospital for Special Surgery told Yahoo Finance. "Sopeople that hadn't done anything in years, this was kind of their entrance back into sport, and maybe weren't ready for it."

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It's about who's playing

Dines, like many Americans, has been swept up in the pickleball wave. His bio on the HSS website — highlighted by roles as a team doctor for the New York Mets, New York Rangers and the Los Angeles Dodgers — now also includes "Medical Director for Major League Pickleball."

And while he's seen an increasing number of patients with pickleball-related injuries, he doesn't believe that's a symptom of the sport being more dangerous than others he's worked closely with, like baseball, hockey and tennis. It's about who's playing it.

As UBS points out, pickleball is projected to grow from 3.5 million players in 2019 to an estimated 22.3 million players at the end of 2023. And the majority of injuries from that growing pool of players comes from people over 60 years old, per UBS, which cites a 2021 study using data from the National Electronic Injury Surveillance System (NEISS).