Health & injury
Pickleball Elbow
Pickleball elbow (lateral epicondylitis) is one of the most common injuries in the sport. The good news: most cases resolve with rest, technique adjustments, and the right exercises, without surgery or injections.
This page is for informational purposes only. Consult a physician or physical therapist for diagnosis and treatment of any injury.
Pickleball elbow symptoms
- → Pain on the outer side of the elbow (lateral epicondyle)
- → Pain when gripping objects, shaking hands, or turning a doorknob
- → Pain that worsens with backhand shots and wrist extension
- → Morning stiffness in the forearm or elbow area
- → Weakness in grip strength
Causes
Tight grip pressure
Gripping too hard activates forearm extensors continuously and creates micro-tears in the tendon over time. Keep grip at 4-5/10 pressure.
Excessive wrist snap
Using the wrist to generate power on backhand shots overloads the extensor tendons. Power should come from the shoulder and body rotation, not the wrist.
Heavy or stiff paddle
Heavier paddles transmit more force to the arm on every shot. Carbon face paddles can transmit more vibration than fiberglass. Switching to a lighter, softer paddle reduces cumulative load.
Too much volume too fast
Going from occasional play to daily play without conditioning the supporting structures causes overuse injury. Increase play frequency gradually.
Poor backhand mechanics
A one-handed backhand with incorrect elbow lead puts the extensor tendon in a stretched, loaded position. A two-handed backhand or corrected technique reduces elbow stress.
Cold muscles
Playing without warming up makes tendons less elastic and more vulnerable. Always warm up forearm muscles before starting play.
Treatment steps
Rest from aggravating activities
Stop playing or significantly reduce volume for 1-2 weeks minimum. Continuing to play through pain extends recovery time dramatically.
Ice after activity
Apply ice wrapped in a cloth for 15-20 minutes after any activity that loads the forearm. Do not ice directly on skin.
Eccentric wrist extension exercise
The most evidence-backed rehab: hold a light weight (1-2 lbs) with palm down, lower the wrist slowly (3-5 seconds), use the other hand to raise it back. 3 sets of 15, daily. This rebuilds tendon collagen.
Elbow strap during play
A counterforce elbow strap worn 1-2 inches below the lateral epicondyle reduces tendon stress during activity. Not a cure, a management tool during recovery.
Address technique and equipment
Before returning to play, review grip pressure, wrist use, and paddle weight. Returning to the same technique that caused the injury will cause recurrence.
See a doctor if not improving
If pain persists beyond 8 weeks of conservative treatment, consult a sports medicine doctor or physical therapist for evaluation. Cortisone injection or PRP may be appropriate.
Rehabilitation exercises
Eccentric wrist extension (Tyler Twist variation)
Daily during recovery
With light weight or resistance band, slowly lower wrist from extended to flexed position over 3-5 seconds. Use other hand to reset. 3x15.
Forearm pronation/supination
Daily
Hold a light hammer or weight. Slowly rotate palm up and palm down. 3x20. Builds balanced forearm strength.
Wrist circles
Before every session
20 slow circles clockwise, 20 counterclockwise. Warm up the wrist joint and surrounding structures before play.
Grip strengthening
Recovery phase
Squeeze a soft stress ball 10-15 times. Not during acute pain phase, only once inflammation is reduced.
Frequently asked questions
What is pickleball elbow?
Pickleball elbow is lateral epicondylitis, the same condition commonly called tennis elbow, caused by overuse of the forearm extensor muscles that attach at the lateral epicondyle (outer bony bump of the elbow). In pickleball, it is most often caused by: gripping too tightly, using too much wrist/elbow extension on shots (especially the backhand), a paddle that is too heavy or too stiff, repetitive play without adequate rest, and insufficient warm-up. It causes pain on the outer side of the elbow that worsens with gripping and twisting motions.
How do you treat pickleball elbow?
Treat pickleball elbow by: resting from aggravating activities (at least 1-2 weeks), applying ice for 15-20 minutes after play, using an elbow strap/brace during activity to reduce tendon stress, performing eccentric wrist extension exercises (wrist drop exercise) which are the most evidence-backed rehab for lateral epicondylitis, and adjusting technique to reduce wrist snap on backhand shots. Most cases resolve in 4-12 weeks with conservative treatment. Persistent cases benefit from physical therapy; cortisone injection is used for severe cases. Platelet-rich plasma (PRP) therapy has shown benefit for chronic cases.
How do you prevent pickleball elbow?
Prevent pickleball elbow by: keeping grip pressure loose (4-5 out of 10, tight gripping is the number one cause), using a lighter paddle, avoiding excessive wrist action on shots, warming up the forearm before play with wrist circles and gentle stretches, strengthening forearm extensors with eccentric exercises off-court, and not dramatically increasing play volume too quickly. Switching to a softer paddle face material (fiberglass vs carbon) reduces vibration transmitted to the elbow.
Next steps
Put this into action
Use what you just read to find a game, get on court, and show up prepared.