Pickleball Elbow: Causes, Symptoms, Treatment, and Prevention

Pickleball can cause tennis elbow due to some of the same stressors that occur while playing tennis, such as the following:

Repetitive Swing Mechanics

Repetitive swing mechanics can play a major role in pickleball elbow pain, especially the backhand stroke. During a backhand, your wrist extensor muscles absorb force from the paddles as you stabilize your forearm.

Imagine how many times you hit a backhand during a pickleball game. Over time, this repeated movement can cause tendon irritation.

Who's Most at Risk

Anyone can develop a pickleball elbow, but some players may be at higher risk, such as:
• New pickleball players who ramp up their playing frequency too fast.
• Middle-aged players (40 to 60-year-olds) because their tendons can become less resilient due to age.
• Players who return to the sport after months of inactivity.
• Individuals who use poor stroke technique, especially on their backhand.

Equipment Factors

Your paddle choice can also stress the elbow, leading to tennis elbow from pickleball. For instance, if you choose a heavier paddle, it can place increased load on your forearm.

With every swing, you're making the forearm muscles and tendons work a bit harder. If you have had pickleball elbow in the past, choosing a lighter paddle weight may be a good move.

One overlooked factor is grip size. If you choose the wrong grip size, you're likely to compensate by altering your grip. The result is more strain on the tendon.

Pickleball elbow pain doesn’t typically develop all at once. It usually starts gradually. Although it can vary, it typically progresses in the pattern below.

Early Warning Signs

At first, early warning signs of pickleball elbow are often subtle and may include:

• A mild ache on the outside of the elbow after playing
• Tenderness when you press on the outside of the elbow
• Pain that might improve with rest but starts back up when you play again
• Mild pain during certain movements, such as a backhand

The early warning signs are just that. A signal that you may have an overuse injury. Some players push through despite soreness, which can lead to further injury. But recognizing symptoms early and treating pickleball elbow pain can make the difference between a fast recovery and a chronic problem.

Moderate-to-Severe Symptoms

Moderate to severe symptoms can develop as the tendon irritation increases. Symptoms may include:

• Pain that radiates from the outside of the elbow down the forearm.
• Weakened grip strength, such as difficulty holding a paddle and opening jars
• Morning stiffness
• Discomfort when doing everyday activities, such as turning a doorknob and lifting an object

People who continue to try and play through the discomfort may notice pain during almost all forceful shots. At this stage, it is likely not just pickleball that is affected. It can be difficult to ignore an injury.

When to See a Doctor

Mild elbow pain from pickleball may only require home treatment and allowing more recovery time between sessions. But there are times when it is helpful to see a doctor to prevent an injury from worsening.

Consider seeing a doctor for pickleball elbow if:

• Elbow pain lasts for more than a few days after stopping play
• Grip strength has significantly decreased
• Pain does not ease up with over-the-counter anti-inflammatory medications or ice
• Your symptoms become worse every time you play

Seeing a doctor early can help determine an accurate diagnosis and start you on the path to appropriate treatment before the condition becomes chronic.

If you have an elbow injury, it's common to ask, "How long will it take before I can play pickleball again?" There is no single timeframe that will be appropriate for everyone.

When you can play again depends on the severity of the injury and how quickly you start treatment. The quicker you start treating the injury, the faster you are likely to recover and get back on the court.

Typical healing time may follow the timeframe below.

Mild Cases (2–4 Weeks)

If you catch pickleball elbow pain early, you may recover as quickly as 2 to 4 weeks. Usually, treatments such as resting the elbow, applying ice, and gentle stretching exercises are enough for the tendon to heal. During this stage, it's also critical to return to the court gradually and see how your elbow feels.

Moderate Cases (6–12 Weeks)

If you try to push through the pain and don't treat pickleball elbow, recovery time is likely to increase. It can possibly take 6 to 12 weeks. During this stage, the tendon is likely to become significantly inflamed, and microscopic damage has occurred. The treatment will take longer since the injury is more significant.

Severe or Chronic Cases (3–12 Months)

Chronic pickleball elbow or severe injury can take months to recover from. In general, healing time is 3 to 12 months. Pickleball elbow that has progressed to the chronic stage involves degenerative changes of the tendon as opposed to just irritation. Medical treatment is likely necessary, which may include resting the elbow for longer, physical therapy, and/or steroid injections.

Determining how to treat pickleball elbow depends on the severity of the condition. Possible treatment strategies include the following:

Rest and Activity Modification

If you're deciding how to treat tennis elbow from pickleball, one of the most important steps is to rest and modify your activities. For many people, this may be the hardest part. Although this can be frustrating when you want to get out on the court, it's an essential step to allow the tendon to heal.

Resting your elbow doesn't mean you have to stop everything. Instead, you're stopping activities that aggravate the elbow tendon. You're likely still able to use your lower body for activities you enjoy, such as jogging, lower-body strength training, and core work.

Cold Therapy

Applying cold therapy to the lateral elbow for 15 to 20 minutes after activity helps reduce inflammation and pain. It is especially helpful in the early acute phase.
During the acute phase, easing discomfort is a top priority. If you're looking for targeted relief from elbow pain, consider Picklebalm's topical relief products that contain menthol and provide a cooling sensation.

Topical Pain Relief

Topicals and analgesics are effective ways to manage pickleball elbow pain without taking oral medication. Oral medications, such as non-steroidal anti-inflammatories, can have side effects such as stomach discomfort. Topical products are easy to use and pose no risk of systemic side effects.

For fast, targeted relief, explore Picklebalm's topical pain relief products, designed to soothe sore muscles and joints so you can stay active while your elbow heals.

Compression and Bracing

A pickleball elbow brace, which is also called an elbow band or strap, reduces force on the tendon insertion point. The strap applies light pressure to the forearm muscle, decreasing strain on the tendon. Although it is not a substitute for rest, it may be useful to wear during play and when performing everyday activities that stress the elbow. The strap should sit about 2 inches below the painful area. Not directly on the sore part.

Stretching and Strengthening

Gentle wrist extensor stretches may also be beneficial.

To perform:

1. Extend your painful arm straight in front of you with your elbow straight and your palm facing down.
2. Using your opposite hand, lightly bend your wrist down, so your fingers point at the floor.
3. You should feel a stretch along the top of your forearm.
4. Hold for 30 seconds and relax, repeating three times.

After the acute phase is over, eccentric strengthening exercises may help prevent future injury. An example is finger extension.

To perform:

1. Place a rubber band around your fingers.
2. Open your fingers.
3. Slowly return them to the starting position, resisting the band's resistance.

For a more complete routine with additional stretches, see our Picklebalm stretches and exercises guide.

When Conservative Treatment Isn't Enough

There may be instances when conservative treatment is not enough for pickleball elbow pain. Medical treatment may include the following:

• MRI for assessment: MRI is useful for assessing tearing and the severity of the damage to determine appropriate treatment.
• Steroid injections: They decrease inflammation and swelling. They may help make everyday activities easier or help with pain that prevents participation in a physical therapy program. But steroid injections are usually not advisable long-term because they can damage the tendon.
• PRP (platelet-rich plasma): This involves processing a small amount of your blood to concentrate the platelets. It stimulates the body's natural healing process. Currently, it is an emerging option, and more research is needed.
• Surgery: Rarely needed for pickleball elbow. Typically, it's a last option when symptoms continue for months and don't respond to less invasive treatment. The procedure involves repairing the damaged tendon.

Learning how to prevent tennis elbow in pickleball is always your best bet. There are several things you can do.

Fix Your Technique First

Poor technique and mechanics are the biggest culprits when it comes to pickleball elbow pain, especially the backhand. Consider working with a coach to help determine specific movement patterns that are overloading the tendon. A coach can also encourage you to use a two-handed backhand, which will reduce the amount of stress placed on the tendon of the dominant arm.

Additionally, be aware of your wrist position. Keeping your wrist in a neutral position throughout the swing, rather than using a snapping motion, also reduces force.

Choose the Right Paddle

Paddle weight can affect how much stress reaches your elbow tendon. A lighter paddle places less force on the forearm and, consequently, on the outside of the elbow.

Some paddles also have materials that decrease vibration after the ball contacts the paddle. This technology reduces tendon stress.

Also, use the correct grip size to decrease additional force. To determine your grip size, perform the finger test:
• Hold the paddle with your normal grip.
• You should be able to fit your index finger of the opposite hand between your fingertips at the base of the palm.
• If there's a large gap, the grip size is too big. If there's no room, the grip is too small.

Warm Up Properly

A proper warm-up is essential to avoid starting a game with cold muscles and tendons. Warming up properly improves mobility, increases blood flow, and gets your forearm muscles ready to handle the stress of pickleball.

Spend a few minutes performing dynamic forearm movements, such as grip exercises and wrist circles, before a game.

For a full warm-up routine to reduce your risk of injury, explore Picklebalm’s warm-up guide.

Manage Playing Volume

Since pickleball elbow is an overuse injury, managing playing volume is vital. A rapid increase in play time can be a risk factor. Instead, add playtime gradually over weeks, not days.

Strengthen Off the Court

Strong forearm muscles help reduce the load placed on your elbow tendons during play. Perform exercises that strengthen the wrist extensors, such as an eccentric wrist extension. Adding shoulder and upper back strengthening exercises also improves overall playing mechanics.

Lastly, don't forget flexibility exercises. Gently stretching the forearm muscles after play can reduce tightness and improve mobility.

The biggest question players may have is, "Should you play pickleball with tennis elbow?" Generally, the answer is no during the acute phase of the elbow injury. Continuing to play can make the pain worse, delay healing, and is the main reason pickleball elbow can become chronic.

Mild cases may be managed by modifying technique, such as reducing playtime and wearing a brace. However, it's critical to stop playing if the pain worsens.

Pickleball elbow is a common, treatable, and largely preventable overuse injury. Fortunately, there are ways to minimize the risk of it becoming a chronic condition, including treating early, fixing techniques, choosing equipment wisely, and not rushing to return to play.

As you heal, Picklebalm’s recovery products can be a useful addition to your home remedies. They provide targeted support for before and after pickleball play. Pair them with a proper warm-up and consistent strengthening exercises to decrease pain and keep you in the game.

For additional ways to stay healthy on the court, check out our articles on Pickleball Injury Prevention and Pickleball Recovery.