Pickleball Tennis Elbow | Pickleball Injuries & Prevention

A foreword about the pickleball elbow

The medical term for "tennis elbow" or "pickleball elbow" -as some players are now calling it- is "lateral epicondylitis". It's a painful condition that affects the tendons that join the forearm muscles on the outside of the elbow.  If you've have it or have in past you'll recognize the pain coming from the area near the bony bump on lateral side (outside) your elbow.  The pain and inflammation can be quite severe. Depending on the stage, the pain will occur or worsen and can take time to heal.  Below we give some more details and a few things to consider about your paddle gear, grip and stroke. 

Disclaimer

I am not a doctor nor do I play one on the internet. None of the information in this article is intended as medical advice. The sole purpose of this article is to raise awareness of the fact that some pickleball players suffer from this condition. We point out a few things we have researched that are known to alleviate the problem.  If you are suffering from any pain while playing pickleball please consult with your doctor. 

What is "lateral epicondylitis"?

Basically, every tennis and pickleball player uses several muscle groups more than others – the ones revolving around elbows in particular. When the player exerts the muscles over time, the tendons joining the muscles on the forearm may suffer from inflammation. Although it's commonly called "tennis elbow" is most often not caused by the sport itself but the symptoms can increase due to repeated use while playing pickleball or tennis - which can aggravate the problem. 

After continuous repetition of the same elbow motion, the pain starts to kick in, and most people just mistake it for muscle exertion rather than muscle inflammation. It's important that you try your best to prevent this as tendon inflammation can be pretty painful to deal with.

What causes the "pickleball tennis elbow"?

There are many activities that could cause pickleball and tennis elbow, but one of the most notable cases is overuse. Other activities involve different sports, and it's safe to assume that athletes are more vulnerable than others. Age is also a valid factor (most tennis elbow sufferers first get it between ages of 30-50) but there are certain "insidious" cases where the cause can't be traced.

Simply put, the muscles and tendons around your elbow can quite easy become inflamed since they're performing a singular motion (reference: fingers are incomparably more mobile, hence the muscles and tendons connecting them are sturdier, or so to speak).

How to prevent pickleball elbow?

One of the best ways to prevent pickleball elbow from affecting you is to first make sure your paddle "fits" your hand- equipping yourself with proper gear may help minimize the risk of pickleball elbow from presenting itself – your pickleball grip is crucial here! Namely, the size of your grip and your paddle weight are the two most important things you should be concerned with.

If you are already suffering from pain, it's important to listen to your body. Take more time to rest up after each game, skip a training session if your elbow is feeling too tender, and make sure to contact your doctor if anything feels off.​

Limit wrist action.

The technique of your swing and how much "wrist action" you put into your shot can have a definite impact on tennis elbow. In general, we see a lot of pickleball players relying too much on their wrist to add snap to their swing. Ideally you should get power from your shoulder- not your wrist!

Practice swinging from your shoulder and limiting the use of your wrist. Apart from being a more efficient swing, it will put less stress on your forearm extensor muscles. Avoid the overuse of these muscles - it is one of the keys to reducing tennis elbow. 

Most professionals advocate that warm-ups are just as important as the training itself, and for a good reason too. Getting your body ready for the game is tightly correlated to pickleball elbow as well. 

Performing regular wrist exercises and doing proper warm-up and cool down should help prevent or alleviate elbow pain. Keep it in mind next time you play- dedicating even 5-10 minutes to warm up before your game can have a beneficial effect especially if you make a habit of it every time you play.  

Use a Tennis Elbow Brace While you Play

While it's not a permanent solution to tennis elbow, wearing a elbow brace or strap has been proven to relieve pain. We discussed the study here and gave some top options for the different styles of elbow straps and sleeves.  

I think the key is to wear the brace while playing but also do proper warm up before playing and do rehab exercises off the court to relieve your tennis elbow - so that hopefully in the long run you won't need to rely on a brace. However, in the meantime they can be very helpful. 

Paddle Weight: mid-weight paddle is the best.

The issue with your pickleball paddle's weight is quite self-explanatory. A paddles that weigh too much will put extra stress on your arm and you may even notice that your muscles feel sore. That is the first indication that the first stages and symptoms of pickleball elbow have begun.

Because of that, some people go to the other extreme and by a very lightweight paddle, but unfortunately that might not be such a smart way to go - and may actually make it worse for you if you are already suffering from tennis elbow. Using lightweight paddles requires you swing the paddle harder to get power behind the ball.  So when trying to hit the ball hard with a light paddle you may be increasing stress and shock to your elbow joint and increase the chance of aggravating your pickleball elbow.

The best solution may be to look for a mid-weight paddle – different paddle manufacturers define paddle weights but the ideal range would be approximately 7.3 - 8.4 ounces. This should give you a good balance between mobility and strength required for your shots without putting  undue stress on your tendons and muscles.

Some of the best mid-weight paddles we recommend are the Selkirk Sport Pro S1 (there is a Plus+ version of the paddle but that's not the one for you if you have elbow pain - since it's a half ounce heavier). Another great option is the Engage Encore Pro Pickleball Paddle.  We did a full review of the Encore Pro on our page dedicated to Engage paddles.

How does grip size affects tennis elbow?

Playing with a paddle grip size that doesn't match your hand size may be an important factor that could worsen your elbow pain.  Playing with a grip that's too small will force you to squeeze the paddle too tight, use excess wrist action and put undo stress on your elbow tendons.

While smaller grips appeal to some people - since it allows you to move your wrist more freely and unobstructed, there's a problem with this - as it tends to increase the amount of wrist action on your swing which then puts undo stress on your elbow.  

A grip size that is exaggeratedly large will cause reduction of mobility and put on your wrist joints and requires an excess amount of forearm muscle strength to keep a strong grip on it. 

In conclusion, both extreme sizes of your pickleball grip are sure to get you in trouble.

...but what's the "correct" grip size?

There's some debate about this. There is some evidence, by a 2006 study done by the The American Journal of Sports Medicine (The Effect of Tennis Racket Grip Size on Forearm Muscle Firing Patterns) found that ... "Alterations in tennis racket grip size within 1/4 in of Nirschl's recommended sizing do not have a significant effect on forearm muscle activity and therefore may not represent a significant risk factor for upper extremity cumulative trauma, such as lateral epicondylitis".

Keep in mind the study only refers to a very small change in grip size (.25 inches). There are however, many pickleball players out there playing with a paddle that is above the 1/4 inch threshold that was used by the study- for example, I've seen plenty of large male players well over 6 feet tall using a 4" grip when they should be using something more like a 4.5" grip so I still think it's important to reconsider your grip size, especially if you are already feeling the effects of tennis elbow and looking for a way to relieve your pain. 

​There is quite a bit of anecdotal evidence from many players that their elbow pain seems to be reduced by playing with a "comfortable fitting" grip size.  So the best size may not necessarily the exact grip size that is calculated based on standard grip sizing techniques...but rather the most "comfortable" grip size - the one that feels the best when you play for an extended time with it, one that feels good with a balanced amount of muscle pressure to clutch the paddle while minimizes strain. 

There are a couple way's to measure grip size but those generally go off your height or measuring your hand...but they only break down the grip into the standard grip sizes that come in 1/4" increments. 

While those are good starting estimates, if you are serious about getting it's really important that you build up the circumference with replacement grips and overgrip if needed to get a properly fitting paddle handle that you find most comfortable for your hand and feels comfortable after extended time playing pickleball.  

We normally don't link to youtube exercise recommendations since there's a lot of un-documented "bro-science" out there but I do follow this trainer and think the info he delivers is worth sharing. 

Jeff Cavaliere MSPT, CSCS served as both the Head Physical Therapist and Assistant Strength Coach for the New York Mets during the National League East Championship 2006, 2007 and 2008. 

I think this video is helpful to understand tennis elbow and good to look at the problem from a different perspective- rather than hyper-focusing on the actual pain but questioning where the pain is originating from. In the case of pickleball, often times it's the overuse of the wrist.

Conclusion

The pickleball elbow is a delicate topic, and that's an understatement. There are chances that you do everything right, and still it might happen to you, whereas there are people who subject themselves to fatiguing, harsh exercises without catching the slightest of symptoms. Hopefully the information in this article has shed some light on the causes and potential things to look at to minimize the pain and put you on the road to recovery so you can continue to enjoy the sport you love. 

Sources:

Athleanx.com: The real cause of Elbow Pain. Embedded video.

American Academy of Orthopaedic Surgeons: Tennis Elbow​

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