Pickleball Injury Prevention: Tennis Elbow (Lateral Epicondylitis)
This article is part of our ongoing series on common pickleball injuries, where we explore the causes, treatments, and prevention strategies for the most frequent issues players face. Tennis elbow, or lateral epicondylitis, is a common overuse injury that affects many pickleball players. It occurs when the tendons in the outer part of the elbow become inflamed due to repetitive stress, leading to pain and discomfort.
This overuse injury is often experienced with, or confused with Golfer’s Elbow, which is essentially the same injury but on the medial elbow, rather than lateral.
In this article, we will explore the symptoms, causes, treatment options, and prevention strategies to help you keep your game strong and pain-free.
Symptoms of Tennis Elbow
Tennis elbow typically develops gradually, with symptoms worsening over time. Common signs include:
Pain or burning sensation on the outer part of the elbow
Weak grip strength, especially during activities like holding a paddle or shaking hands
Increased discomfort when lifting objects, making a fist, or extending the wrist
Tenderness around the lateral epicondyle (the bony bump on the outer elbow)
Pain that radiates into the forearm and wrist
Causes of Tennis Elbow in Pickleball
Tennis elbow is caused by repetitive strain on the extensor tendons in the forearm, particularly the extensor carpi radialis brevis (ECRB) tendon. These tendons insert into the outer bone of your elbow, which is why this is typically the most painful area. This overuse injury is common in racket sports, and can become debilitating if not treated properly.
In pickleball, specific actions that may contribute to the development of tennis elbow include:
Repetitive backhand strokes, especially with poor technique
Excessive wrist and forearm involvement during swings
Using a paddle that is too heavy or has an improper grip size
Overplaying without adequate rest and recovery
Insufficient warm-up and stretching before playing
Treatment Options for Tennis Elbow
If you are experiencing symptoms of tennis elbow, early intervention is key to preventing the condition from worsening. Effective treatment strategies include:
Player using an elbow strap.
Rest and Activity Modification: Reducing the frequency and intensity of play can help alleviate symptoms.
Ice Therapy: Applying ice to the affected area for 15-20 minutes at a time can reduce pain and inflammation. (For example, icing after playing a game of pickleball)
Contrast Therapy: Alternating between cold and heat can also be very effective in reducing inflammation and circulating blood to the injured area, bringing nutrients and healing proteins to the injured tissues. This can be done at any time to promote blood flow to the injured area.
Ice Massage: Using a small ice cup or frozen water bottle, apply firm, circular motions directly on the painful area for 5-10 minutes to help reduce inflammation and numb pain. This can also be done at any time to promote blood flow to the injured area.
Bracing: Wearing a counterforce brace or forearm strap can offload stress from the tendons. These are also nicknamed “tennis elbow straps”
Here is a great example of an effective brace from Amazon: Bodyprox Elbow Brace 2 Pack for Tennis & Golfer's Elbow Pain Relief
Strengthening and Flexibility of Forearm: Strengthening and stretching exercises targeting the forearm, wrist, and elbow can improve resilience and healing.
See bellow for exercises to strengthen and stretch forearm muscles
Manual Therapy: Techniques such as massage, scraping, and dry needling can help relieve pain and restore function. Always seek treatment from a qualified clinician who has been specially trained in these techniques. (Depending on your state laws, physical therapists, athletic trainers, and chiropractors are often trained in these techniques)
Anti-inflammatory Medications: Over-the-counter NSAIDs like ibuprofen can provide temporary pain relief. Always consult with a medical professional about proper dosage.
CBD Balms or creams: CBD balms contain anti-inflammatory properties that can alleviate pain while playing or while at rest. This balm from 4Kor is my personal favorite! 4Kor Recovery Stick
Platelet-Rich Plasma (PRP) Injections: Uses the body’s own healing factors to promote tendon repair. This is an advanced technique that requires administration by a qualified medical professional. You can find a local clinic that preforms this treatment, or talk to your physician to be referred to the right provider.
Preventing Tennis Elbow in Pickleball
Preventing tennis elbow requires a combination of proper technique, strengthening exercises, stretching, and smart play habits. Working with a pickleball coach can help identify any issues with your form that may contribute to the development of tennis elbow; for example, using too much wrist motion or simply using the wrong size paddle. Choosing the right equipment, such as a paddle with a comfortable grip size and weight, can further reduce strain on the elbow.
Additionally, players should listen to their bodies, taking breaks when needed and incorporating rest days to prevent overuse injuries. A proper warm-up, including light aerobic activity and dynamic stretching, can help prepare the muscles and tendons for the demands of the game. See our other post for a 5-minute warm-up routine for pickleball.
Try these exercises to strengthen your forearms:
Forearm Pronation/Supination
3 sets of 15 reps, 4xs a week
Begin sitting upright with your elbow supported on a table or a bench. With the end of a dumbbell in your hand, slowly begin rotating your wrist internally, and externally, keeping the motion controlled in both directions. If you don’t have a dumbbell at home, you can use a wrench or a water bottle to serve as your weight.
Watch this video for step by step instructions.
3 sets of 10 reps, 4xs a week
Position yourself so that you are seated upright with your elbow supported on a table or a bench. To strengthen the wrist flexors, begin with a weight in your hand and your palm facing up. Begin flexing your wrist up and slowly lowering it back down, keeping the motion controlled in both directions. To strengthen the wrist extenders, flip your arm over so that your palm is facing down and bring your wrist up towards you and back down again; keeping this movement controlled in both directions.
Watch this video for step by step instructions.
2 sets of 1min. each, every day
For your wrist flexors begin by standing behind the table and place your palms flat on the table. Begin to lean back to ease into the stretch while keeping your arms straight. For your wrist extensors, flip your hands over so that the back of your hands are flat on the table and lean back to stretch the extensors of your forearm. Hold these stretches for a minimum of 20 seconds up to a minute for best results.
Watch this video for step by step instructions.
While none of the above exercises require special equipment, here are a few devices that can be purchased for more advanced forearm strengthening:
Final Thoughts
Tennis elbow is a common but preventable injury among pickleball players. By understanding the causes and taking proactive steps to improve technique, strengthen key muscles, and use proper equipment, you can minimize your risk and keep playing the game you love pain-free. Recovery from tennis elbow can take time, so it’s important to stay patient and consistent with rehabilitation efforts.
If symptoms persist despite treatment, seeking guidance from a healthcare professional or physical therapist can help develop a more targeted recovery plan. Additionally, making small adjustments, such as improving grip strength, adjusting playing habits, and incorporating recovery techniques like massage or acupuncture, can further aid in injury prevention. With proper care and attention, you can continue enjoying pickleball while keeping your joints and muscles healthy.
