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Pickleball Tennis Elbow | Pickleball Injuries & Prevention

A foreword about tennis {pickleball} elbow

pickleball player on court

Editor’s Note: Meet Kerry Pittenger, the eyes behind the lens at Pickleball Portal.

Table of Contents

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 had it or have in past you’ll recognize the pain coming from the area near the bony bump on the 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.  Learn more about the impact of this common sports injury and what you can do to prevent damage and treat the pain.


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 help 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, the ones revolving around elbows, more than your average person. 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”, the problem is often not caused by the sport itself. However, 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.  While racket sports are most commonly listed as the cause and it is safe to assume that athletes are more vulnerable than others, there are many activities that can cause the problem. The repetitive motion associated with many other activities or jobs can also be the cause (chef chopping with a knife, plumber using a wrench, office job using a computer mouse for long hours).

Age is also a valid factor (most tennis elbow sufferers first get it between ages of 30-50) but there are also many cases where the specific 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, so the muscles and tendons connecting them are sturdier, or so to speak, than the elbow joint.

How Do Previous Injuries Impact the Risk of Pickleball Elbow?

Previously injured areas of the body are typically at a greater risk for injury. If you hurt your elbow prior, the risk of developing irritation or further damage in that area is higher. When the previous injury is severe, future injuries can be as well. Other potential risk factors for tennis elbow from pickleball include:

  • Age: Repetitive injuries can affect anyone, but adults between 30 and 50 years old are likelier to develop tennis elbow during pickleball.
  • Playing other sports: Playing baseball, softball, or another racket sport, such as squash or tennis, can exacerbate an elbow injury or increase the risk of developing one.
  • Occupation: If you have a job that requires repetitive arm motion, that will increase your risk. For example, chefs, plumbers, butchers, and carpenters are more at risk than other occupations.

Taking preventative steps to nurture a previous injury and avoid pickleball elbow is the most effective way to take care of your elbow and stop an injury before it can occur. If you already suffer from pain in your elbow, understanding the cause is essential to your recovery.

The Role of Vibration

Pickleball tennis elbow is a repetitive strain injury. Whenever you strike a ball with the paddle, vibration passes from the ball to the handle and up through your hand, wrist, and arm. When that happens over and over, sending pulses to the bony knob on the side of your elbow, it can eventually cause irritation and the burning pain associated with repetitive injuries in that area.

What Are the Best Solutions for Pickleball Elbow?

tennis elbow

When you develop tennis elbow after playing pickleball, you know immediately. The sooner you start treating it and taking preventative measures, the better. Prolonging proper care can only exacerbate the problem, worsening the injury over time. In some cases, medical intervention is necessary.

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.

Click here to see our Complete Buyers Guide to finding the right pickleball paddle for you.

Seeking Medical Care

The first step is to see a doctor. They can often prescribe medications to help with the inflammation that causes most of the pain. However, this is only a temporary solution. Pain medications help but do not cure the root of the issues.

Physical therapy is another option your physician may prescribe. PT is a necessity for professional athletes and anyone with a sports injury. Depending on how your body responds and the extent of your injury, ou may need further medical intervention to make it more manageable.

Although rare, surgery is an option for treating pickleball-induced tennis elbow. However, doctors will typically opt for less invasive options first.

Getting Plenty of Rest

Rest is the first and often the most effective option for immediate relief from the pain. Of course, putting down the paddle is challenging for professional pickleball players and enthusiasts. However, by taking enough time to rest your elbow, reducing the repetitive motion and vibration, you could completely heal.

When you do return to the court, consider incorporating paddle techniques and elbow exercises that can prevent reoccurring injuries.

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 a 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.

How Can Your Technique Help You Prevent Pickleball Elbow?

Technique and experience are the roots of protecting your elbow from potential injury. It starts with proper conditioning. Professional pickleball players and other athletes train their bodies to perform comfortably and work on perfecting their grip to outperform other pro players. A byproduct of that training is learning efficient techniques, which reduces the strain their bodies go through during practice and playing.

How is your paddle stroke? An unorthodox stroke may look fine, but it could contribute to developing or existing elbow inflammation, especially if you have an undisciplined backhand swing. The solution to poor technique is to work with an instructor and take lessons. Making minor adjustments to how you swing the paddle can make a profound difference in how your body responds to the game. Being mindful of your court position can also help improve your technique and reduce the number of backhand swings and their strain on your elbows.

Pickleball Elbow Exercises for Improvement

If you already suffer from elbow pain, regular exercise can help as you rest your joint. An effective method is a basic wrist extension technique many tennis and pickleball athletes use. To perform it, follow these simple steps:

  1. Use a light hand weight, such as 2 or 5 pounds, or something around the house, like a bottle of water.
  2. While seated, rest your elbow and forearm on the top of your thigh and begin with your wrist extended and palm facing down.
  3. Allow your knuckles to slowly drop and hold the wrist and elbow in place on your thigh as the hand drops slowly in with control.
  4. After allowing the hand to hang in place for a few seconds, use your other hand to help it rise into the extended position again slowly.
  5. Complete between 8 and 10 reps with both arms, and do at least one set of three before you play a round of pickleball.

This simple exercise will help with existing pain, and it also reinforces the connective tissue between the elbow, wrist, and fingers, reducing the risk of injury. The pain from a pickleball elbow injury primarily occurs around the tendons connecting your elbow to the muscles in your forearm. This exercise improves the function of those tendons.

Exercises for Prevention

Tricep extensions, bicep curls, and hammer curls are all strength exercises every pickleball player should include in training. Building muscle endurance in the triceps and biceps also helps reduce strain on the elbows and strengthens the area around your joints.

Dynamic stretching before you play and cool-down stretching after a match are other crucial elements of preventing elbow injuries. Your stretching routine should incorporate practicing your strokes to help improve your technique.

Tools To Help Your Technique

Reinforcements can also help prevent injuries. For example, an elbow brace offers more support and stability to vulnerable joints and tissue. If you already have pickleball tennis elbow, braces can lessen the damage as you continue playing. The type of paddle you use also requires careful consideration and can make a significant difference.

SIMIEN Tennis Elbow Brace (2-Count), Tennis & Golfer's Elbow Pain Relief with Compression Pad, Wrist Sweatband and E-Book
Simien Tennis Elbow Brace (Image Source: Amazon)

While it’s not a permanent solution to tennis elbow, wearing an elbow brace or strap has been proven to relieve pain. Some studies have shown that a brace can help alleviate pain. To see our reviews of some of the top tennis elbow braces click here. We’ve included several 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.  I’m currently using this strap style brace from Simien, the pad puts direct pressure on the outside of the tendon to create  “counter-force”.

I also use the Theraband Flexbar to rehabilitate my elbow when it flairs up. I’ve had tennis elbow for years and find that using this does help me. If you want to read more about it, see my detailed review of the Flexbar here. 

What Paddles Help Pickleball Elbow?

The paddle you use can impact your technique and performance, and when you choose the right one, it can lessen the strain on your elbow and reduce the risk of injury as well. Great USAPA-approved paddles for vulnerable elbows include:

  • Franklin Aspen Kern Centre: This paddle has a carbon surface for a high-value bargain. Its design manages the vibration to decrease the impact felt when you make contact with the ball.
  • Wilson Juice: This paddle reduces off-center vibration for better stability and has a cushion-aire perforated grip. Wilson is a trusted brand in sports gear.
  • ProKennex Ovation Flight: This paddle is a top choice for regular players because of its intentional special vibration control feature specifically designed for people with tennis elbow. It is also lightweight to reduce strain on the arm.
  • Baddle Echelon Midweight: This paddle has a graphite surface and is approved for tournament play. The anti-slip grip and long handle make it a stable choice for backhands.

The beneficial gear does not stop at the paddle. A good pair of playing shoes for quick starts and abrupt stops help support better technique as well.

Is a Lightweight Paddle Better To Use?

A heavy paddle can increase the risk of pickleball elbow and worsen the symptoms if you already are experiencing them. While a lightweight paddle may seem like an apparent solution, though, it is not always the best option. A lighter paddle does allow you to move your wrists around more and makes the paddle easier to control. However, these paddles also generate less power, requiring you to compensate with harder swings. Swinging with more force creates more vibration, especially on the sweet spots.

Therefore mid-weight paddles are generally the recommended option. The average range for a pickleball paddle is between 7.2 and 8 ounces, and many come in multiple size options. For example, the Wilson Juice paddle listed above starts at 7.6 ounces and goes to 8 ounces, while the ProKennex Ovation Flight does not go above 7.6 ounces. That mid-weight range improves control without sacrificing power.

How does grip size affect 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 undue 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 extra 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?

You should be able to fit the index finger of your non-hitting hand in the space between your palm and fingers of your grip.

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).  But 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.


There are plenty of health benefits to playing pickleball. Unfortunately, the repetitive motion of hitting the ball can aggravate elbow injuries.  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.

There are chances that you do everything right and you still suffer from it while other people who subject themselves to fatiguing, harsh exercises without catching the slightest of symptoms of pickleball elbow.

A preventative approach to pickleball elbow and other sport-related injuries is always preferable. This starts with incorporating stretching and exercises to reduce strain and improves with a practical acceptance of your need for occasional rest. Remember, the gear you have, from your paddle to your shoes, can help, but keeping your body strong and perfecting your technique are your first lines of defense.


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

American Academy of Orthopaedic Surgeons: Tennis Elbow

WebMD: Tennis Elbow (Lateral Epicondylitis)

Mayo Clinic:  Tennis Elbow: Symptoms and Causes

Dublin Physiotherapy Clinic:  Grip size effect on elbow and tennis performance

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About Dan Langston

With experience in the ecotourism industry and time well spent as a fly fishing guide in the remote absaroka mountain range for 6 years, Dan brings a unique perspective on customer service to the digital world. As the operator, Dan is now committed to revitalizing Pickleball Portal and plans to build a support system for content creators and provide helpful information for the pickleball community. dan@pickleballportal.com

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