Pickleball players get tennis elbow because the repeated gripping and wrist action involved in dinks, drives and volleys places repetitive strain on the tendons that attach to the outside of the elbow. This is particularly common in players who grip the paddle too tightly, use a paddle that is too heavy for them, or increase how often they play too quickly.
If you have a nagging ache on the outside of your elbow that flares up during or after a session, you are not alone. Tennis elbow, known clinically as lateral epicondylalgia, is one of the most common injuries seen in pickleball players of every level, from complete beginners to competitive club players.
What is actually happening in your elbow?
The muscles that extend your wrist and fingers all originate from a small bony point on the outside of your elbow called the lateral epicondyle. Every time you grip the paddle, stabilise a volley, or snap your wrist on a drive, those tendons are working. Pickleball asks these tendons to work repeatedly, often for sustained periods, which is exactly the kind of load that tendons struggle to keep up with if it increases faster than they can adapt.
Tennis elbow is not actually inflammation in most cases. It is a tendinopathy, meaning the structure of the tendon itself has started to break down at a microscopic level in response to load it cannot tolerate. This is an important distinction because it changes what actually helps.
Why is pickleball specifically a problem?
A few features of the sport make it a particularly common cause of this injury.
- Grip pressure. Many players, especially those newer to the sport, grip the paddle far tighter than necessary. A tighter grip increases the constant low-level load on the forearm tendons even before you hit the ball.
- Paddle weight and vibration. A paddle that is too heavy, or one that transmits more vibration on contact, increases the shock absorbed through the wrist and forearm with every shot.
- Volume spikes. This is the biggest factor in clinic. Players who go from playing once a week to playing daily, often during a holiday or a new social league, frequently develop symptoms within two to three weeks. The tendon has not had time to adapt to the new demand.
- Technique under pressure. Reaching for a wide volley or mistiming a drive places sudden, awkward load through the tendon, particularly when fatigued late in a session.
Early warning signs to watch for
Most players describe the same pattern. A mild ache on the outside of the elbow after playing, which settles with rest. Gripping objects, shaking hands or lifting a kettle starts to feel slightly uncomfortable. The pain becomes noticeable during play rather than only afterwards. If this progression sounds familiar, the earlier you address it, the faster and more straightforward your recovery will be.
Tennis elbow is rarely about one bad shot. It’s about a tendon that hasn’t had time to adapt to how much you’re asking it to do.
What actually works
The instinct for most players is to simply stop playing and rest until it feels better. This is rarely the right approach. Complete rest can allow symptoms to settle temporarily, but the tendon often has not actually become more resilient, so symptoms return as soon as play resumes.
What tends to work far better is progressive loading. This means specific, structured strengthening exercises for the wrist extensor tendons, starting at a level the tendon can tolerate and gradually increasing the demand over several weeks. This approach is well supported by current research and is the foundation of most successful tennis elbow rehabilitation programmes.
Alongside this, addressing the contributing factors matters just as much as the exercises themselves: reviewing grip technique, checking whether your paddle is a suitable weight, and managing how quickly you are increasing your playing volume.
When to see a physiotherapist
If your elbow pain has been present for more than two weeks, is affecting your grip strength, or is limiting how much you can play, it is worth getting it properly assessed rather than guessing. A physiotherapist can confirm the diagnosis, rule out other causes of elbow pain, and build a loading programme specific to your tendon’s current capacity and your goals on court.
At Dorset Sports Physio, tennis elbow is one of the most common presentations we see, precisely because of how popular pickleball has become across Dorset and Hampshire. Most players are able to keep playing in some capacity throughout their rehabilitation, with load carefully managed rather than removed entirely.
