The holy month in Pakistan has its own patterns: work is relaxed, charity is abundant and patience in short supply. Another recurring feature is the surge in sporting activity, running late into the night, with padel now joining long-established Ramazan fixtures such as cricket, volleyball and futsal.

Those getting caught up in the excitement often include people who have spent the past 11 months largely sedentary.

As a regular player — balancing volleyball and football alongside cricket — I can attest to the increase in frequency of matches and the intensity that comes with it. This is particularly visible during small tourneys — I had played three volleyball tournaments by the time this went to print — where the competitive spirit tends to take over and people end up jumping higher, hitting harder and diving farther than they usually would. I know I have also been pushing myself despite the recurring, albeit manageable, pain in my wrist and persistent stiffness in several fingers.

This results in more-than-usual strain on a body that is already less hydrated and sleep-deprived from fasting. The question, then, is whether Ramazan and injury risk are meaningfully connected.

Every year during the holy month, thousands of Pakistanis dust o! their racquets, lace up their trainers and head to the nearest padel or volleyball court or cricket ground. The spirit is willing, but the body may not be ready…

NOT THE FAST, BUT THE GAP

The first thing every specialist Eos spoke to was keen to establish is that fasting itself is not the direct culprit.

“Basically, there is no such rise in sports injuries specifically because of fasting,” says Professor Badaruddin Sahito, an orthopaedic surgeon at the Civil Hospital, Karachi. Dr Mansoor Ali Khan, the chair of the orthopaedic department at Aga Khan University Hospital, echoes this: “Injuries are not directly related to fasting,” he tells Eos.

The real issue, they agree, is the sudden and dramatic increase in physical activity by people who have done very little of it for months — or years. “Many people play sports at night, often after many years’ gap,” notes Dr Khan.

Dr Amina Bhatti, a chiropractor, puts it plainly: “It’s not limited to Ramazan. Anyone who suddenly increases their activity level without following a routine will precipitate an injury.”

The Ramazan recreational sportsman — what Prof Sahito calls the “yearly Ramazan sportsman” — is therefore in a category of his own. They are enthusiastic, competitive, typically in their thirties or forties — and wholly unprepared for what they are about to ask their body to do.

WHAT GOES WRONG, AND WHERE

When injuries do occur, they follow recognisable patterns. Soft tissue damage is the most common category: ligament sprains, muscle strains and overuse injuries that accumulate across multiple sessions.

Around the knee, ligament injuries are particularly frequent, as are twisting injuries to the ankle. Tennis and badminton players tend to suffer shoulder problems, specifically rotator cuff injuries, while elbow complaints — the medial pain of golfer’s elbow and the lateral pain of tennis elbow — are also regularly seen.

Padel’s injury picture has its own character — a sport built on lateral movement, sudden stops and overhead shots. “When a player is under-recovered, dehydrated and still attempting to play at full intensity, that’s usually when problems occur,” padel instructor Samad Shajani tells Eos.

Tennis and padel instructor Nameer Shamsi identifies tennis elbow as the single most common complaint he sees, followed by lower back and knee injuries. He also points to a dynamic that is easy to overlook: padel’s social appeal. “The addictive nature of the game means that some people end up over-playing, and the body doesn’t get enough time to recover,” he tells Eos.

Away from the padel courts, a quieter but equally familiar Ramazan scene plays out in parks and open grounds across cities and towns: the neighbourhood volleyball game. Requiring nothing more than a net and enough players, volleyball has been a Ramazan fixture long before padel arrived. But its injury risks are no less real.

Repetitive jumping loads the knees heavily — patellar tendinopathy, or jumper’s knee, is among the most common complaints — while ankle sprains from awkward landings and shoulder strain from spiking and serving are routine.

The risk is compounded by surface: concrete courtyards and uneven ground offer none of the shock absorption of a proper indoor floor, and the near-total absence of any warm-up means conditions for injury are set from the opening serve.

THE DEHYDRATION FACTOR

While fasting alone does not cause injuries, one of its physiological consequences does increase risk. Prolonged dehydration — the result of going 12 to 16 hours without fluid intake — compromises muscle function, slows reaction times and reduces the body’s ability to absorb impact and strain.

“Dehydration definitely increases muscle injuries,” says Dr Khan. Prof Sahito explains the mechanism: glycogen, derived from glucose in the blood, is the primary energy source for working muscles. On depleted reserves, muscles become more susceptible to tears and cramps.

The risk is highest in the hour or two before iftar, when the fast is at its longest and the body’s reserves are lowest. Dr Bhatti’s advice is, therefore, to schedule training at one of two optimal windows: after sehri, when the body is hydrated and fuelled for the hours ahead, or after iftar, once fluid and energy levels have been restored. “The timing of the workout is essential,” she says. “Choose optimal windows when the muscle will perform efficiently.”

CONDITIONING, WARM-UP AND THE AGE FACTOR

Beyond hydration and timing, the specialists converge on a third factor: the almost universal neglect of warm-up, cool-down and basic conditioning. “The injuries I come across are related to poor conditioning and loading joints far more than they are used to,” says Dr Bhatti.

Prof Sahito’s advice to recreational players begins with the same point: do some exercise and take a practice session before rushing directly into sport. Dr Khan’s guidance is equally direct: “Know your level of fitness and proceed slowly.”

This is harder than it sounds — the social atmosphere of group sessions and friendly rivalry creates constant pressure to push beyond what the body is ready for. Dr Bhatti describes a “brain-body disconnect” that develops in group settings, where players override genuine warning signs because others around them appear to be managing fine.

Age compounds everything. “You can’t be 45 or 55 and decide one day you want to change your lifestyle,” she says. “That’s admirable — but it should come with a foundation of activation exercises, stretches, warm-ups and cool-downs built into the routine first.”

THE PRESCRIPTION

The advice from the specialists, taken together, is consistent and not complicated.

Rehydrate thoroughly after iftar before playing. Eat for sustained energy rather than simply breaking the fast with sugar-heavy foods that produce a spike and a crash. Warm up properly — not a token stretch, but genuine activation of the muscles and joints you are about to load. Don’t play five nights in a row if your body has no base fitness to draw on. And if something hurts, stop.

“Keep playing throughout the year,” urges Prof Sahito. “That is the key. Keep playing, and it will keep you healthy and active.”

The Ramazan courts will fill regardless. They always do. But the difference between a month that leaves you fitter and one that leaves you in a brace often comes down to the 15 minutes before play — and the honesty to admit when you have done enough.

As I type this with a sprained wrist, it is something I should perhaps have mulled over sooner.

The writer is a member of staff. X: @hydada83

Published in Dawn, EOS, March 15th, 2026