Pickleball Elbow: Why It Happens, How to Treat It, and How to Keep Playing

If the outside of your elbow started aching a few weeks into playing pickleball more often, you are in very large company. Pickleball elbow is one of the most common complaints at any court, especially among players who went from twice a week to most days.

Here is what it is, why it happens, what helps and how to keep it from coming back. This is general information, not medical advice. If the pain is severe, keeps getting worse or does not improve with rest, see a doctor or physical therapist.

What pickleball elbow is

Pickleball elbow is the everyday name for lateral epicondylitis, the same condition usually called tennis elbow. It affects the tendons that attach the forearm muscles, the ones that pull your wrist and fingers back, to the bony point on the outside of the elbow.

Repetitive gripping and wrist movement irritate those tendons and can cause tiny tears. It is an overuse problem, which is why it tends to appear after a jump in how much you play rather than after a single bad shot.

What it feels like

• Pain or burning on the outside of the elbow
• Pain that spreads down the forearm toward the wrist
• Pain when gripping: shaking hands, holding a coffee cup, turning a doorknob, lifting a bag
• Pain on backhands and on hard volleys
• A weaker grip than usual
• Symptoms that build up over weeks, not in a single moment

Pain on the inside of the elbow is a different condition, sometimes called golfer's elbow, and it is worth getting checked separately. Sudden, severe pain after a specific shot, or numbness and tingling in the fingers, also need a doctor.

Why it happens in pickleball

Gripping too hard. The most common cause. A white-knuckle grip keeps the forearm muscles tense on every shot. Most good players hold the paddle much more loosely than beginners expect.

Hitting late. Contacting the ball beside or behind your body, instead of in front, forces the wrist and forearm to do the work the shoulder and body should do. Backhands hit late are especially hard on the elbow.

Wrist-driven shots. Flicking the wrist on dinks, volleys and backhands loads the exact tendons involved.

Grip size. A grip that is too small makes you squeeze harder to control the paddle. Too big can also cause strain.

Paddle weight and feel. A paddle that is too heavy tires the forearm; one that is very light can encourage a whippy, wristy swing. Stiff, loud paddles transmit more vibration.

A sudden increase in play. Going from two sessions a week to six gives the tendons no time to adapt. This is the classic retiree pattern.

Weak forearm and shoulder muscles. When the bigger muscles are weak, the small forearm muscles take more load.

What helps

These are the approaches most commonly recommended by clinicians. A doctor or physical therapist can tailor them to you.

Relative rest. Cut back on play, especially sessions that make it worse. Complete rest from everything is rarely necessary, but playing through sharp pain usually prolongs it.

Ice after play. Ice wrapped in a cloth on the outside of the elbow for 10 to 15 minutes can calm symptoms after activity.

A counterforce strap. An elbow strap worn just below the painful spot can reduce the load on the tendon during play. Many players find it helps them keep playing while they recover.

Strengthening exercises. Eccentric wrist extension exercises, slowly lowering a light weight with the palm facing down, are among the most studied treatments for this condition. A physical therapist can show you the right load and progression.

Stretching. Gentle forearm stretches, arm straight and wrist bent down with the other hand, can ease tightness.

See a professional if it lingers. If pain lasts more than a few weeks despite changes, a doctor can confirm the diagnosis and discuss other options.