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Understanding and Preventing Pickleball Elbow

pickleball players with their racquets witting on the ground

It’s that time of year again! Pickleball in MInnesota is outdoors for the summer

Pickleball has rapidly gained popularity as a fun, accessible sport that combines elements of tennis, badminton, and ping-pong. However, as with any physical activity, players can experience injuries, one of the most common being "pickleball elbow." Let’s look at the relationship between pickleball and tennis elbow, and effective treatment and prevention strategies to help players maintain their game without pain.

What is Pickleball Elbow?

Pickleball elbow, akin to tennis elbow, is a form of lateral epicondylitis. It manifests as pain and inflammation on the outer part of the elbow, where the tendons of the forearm muscles attach to the bony prominence of the elbow. This condition arises from repetitive motions and overuse of the forearm muscles and tendons, leading to microscopic tears, muscle tightness and subsequent irritation.

Does Pickleball Cause Tennis Elbow?

Although pickleball is a relatively low-impact sport, its repetitive motions—particularly swinging the paddle and making contact with the ball—can lead to overuse injuries similar to those seen in tennis. Therefore, yes, playing pickleball can indeed cause tennis elbow, especially if proper technique is not employed or if a player engages in the sport intensively without adequate rest and conditioning.

How to Treat Pickleball Elbow

Treating pickleball elbow involves several strategies, focusing on alleviating pain and promoting healing. Here are the key approaches:

  1. Rest and Activity Modification: The first step in treating pickleball elbow is to reduce or eliminate the activities that aggravate the condition. Rest allows the tendons to heal and prevents further damage.

  2. Heat Therapy: Applying heat to the affected area can increase blood flow that carries nutrition to the muscle in tendon that is screaming for repair. Heat therapy is most effective when used for 10-15 minutes several times a day, especially before activities that exacerbate the pain.

  3. Pain Relief Medications: Over-the-counter pain relievers, such as ibuprofen or naproxen will block the pain signal from being processed by the brain, however, the microtrauma to the muscle and tendon has already been done.  The pain signal is meant to be a warning that the repetitive activity is causing damage.  The pain and inflammation is also a beacon that signals cells that repair tissue to flock to the site of the injury. 

  4. Professional Assisted Stretching: Working with a stretch professional can be highly beneficial. A stretch professional can perform stretches that will decrease the chronic tightness that has developed over time.  Exercises to strengthen the forearm muscles and improve flexibility will be taught. Stretching exercises, in particular, help alleviate tension in the muscles and tendons and will retrain the muscle to more effectively absorb the repetitive shock absorption needed to play pickleball.  

  5. Bracing: Using an elbow brace or strap can reduce strain on the affected tendons by distributing the load more evenly across the forearm muscles. This can be particularly useful during activities that might otherwise exacerbate the condition. 

  6. Gradual Return to Activity: Once the pain subsides, it’s important to gradually return to pickleball, ensuring that proper technique is employed to prevent recurrence.  Always listen to your body when you feel pain. 

How Proper Pickleball Technique Prevents Tennis Elbow

Proper technique is crucial in preventing pickleball elbow. Here are some key elements to focus on:

  1. Grip Size and Pressure: Using a paddle with an appropriate grip size is essential. A grip that is too small or too large can force the player to exert excessive pressure, increasing the risk of tendon strain. Additionally, holding the paddle with a relaxed grip rather than a tight one can reduce stress on the forearm muscles.

  2. Stroke Mechanics: Ensuring proper stroke mechanics is vital. Players should use their whole arm and shoulder rather than just their wrist and forearm to hit the ball. This distributes the force more evenly across larger muscle groups and reduces the strain on the tendons of the elbow.

  3. Footwork: Good footwork reduces the need for overreaching and awkward strokes, which can put additional stress on the elbow. Players should position themselves properly to make controlled and balanced strokes.

  4. Warm-Up and Cool-Down: Proper warm-up and cool-down routines help prepare the muscles and tendons for the physical activity and aid in recovery. Dynamic stretching before playing and static stretching after playing can be very effective.  Muscle stripping techniques can be taught to ensure maximum muscle movement during the upcoming activity. 

How to Prevent Tennis Elbow in Pickleball

Preventing tennis elbow requires a multifaceted approach:

  1. Strengthening Exercises: Regularly performing exercises that strengthen the forearm, wrist, and shoulder muscles can enhance muscle endurance and resilience, reducing the risk of overuse injuries.

  2. Flexibility Training: Stretching exercises that improve the flexibility of the forearm muscles and tendons can help prevent stiffness and strain. Incorporating yoga or specific flexibility routines can be beneficial.

  3. Proper Equipment: Using the right equipment, including paddles with the appropriate grip size and weight, can make a significant difference. Players should periodically check their equipment and replace it as necessary to ensure optimal performance and injury prevention.

  4. Technique Coaching: Taking lessons from a certified pickleball coach can help players refine their technique, ensuring that they use biomechanically sound movements that minimize stress on their tendons.

  5. Regular Breaks: Avoiding prolonged play without breaks can prevent overuse. Players should listen to their bodies and take regular breaks to rest and recover, especially if they start feeling any discomfort.

  6. Hydration and Nutrition: Maintaining proper hydration and a balanced diet supports overall muscle and tendon health. Dehydrated or nutrient-deficient muscles are more prone to injury.  See the nutrition recommendations for activity and recovery at

Keep Moving

Pickleball elbow, while common, is preventable and treatable with the right approach. By understanding the condition, employing proper techniques, and taking preventive measures, players can enjoy pickleball without the pain and interruption caused by this overuse injury. Whether you’re new to the sport or an experienced player, prioritizing your physical health will allow you to continue playing pickleball with joy and longevity. 

For a personalized plan for stretching and strengthening contact Performance Care Stretch Clinic


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