Part of Tennis elbow
Playing pickleball or padel with tennis elbow
Warning signs, and when to get help
Can you keep playing pickleball or padel with tennis elbow?
Most players can. Playing pickleball or padel with tennis elbow is usually a question of which shots and how many, not of whether you are allowed on court at all, and the players who do worst are the ones who carry on unchanged and the ones who put the paddle in a cupboard for a season. Complete rest settles the pain for a while and leaves you with a weaker arm and the same tendon, which is why the program on the tennis elbow page is built around adding load rather than removing it.
Two things make this page's job narrow. Why these sports load the outer elbow, and what the research on paddles, rackets, grip size and overgrips actually shows, are covered already on pickleball elbow and padel elbow. Read whichever matches your sport for the mechanics. What follows here is the bit neither of them answers in full: how to decide week by week whether to play, and how to get back to a full session after a flare.
The test that decides it, and it is not how the game felt
A little discomfort at the outer elbow during the exercises is common. Many programs accept mild discomfort that settles within a few hours and is no worse the next morning. Sharp pain during a repetition means stop that exercise. If the elbow is clearly worse the next morning, the load was too much. Drop back a step rather than stopping altogether.
That rule is the whole decision, and it transfers straight onto a court. The session is a poor judge of itself: you are warm, you are competitive, and the elbow is not being asked to grip a kettle. The morning is honest.
Two parts of it translate directly. Sharp pain at the outer elbow during a shot is the court version of sharp pain during a repetition, so the answer is the same one: stop. Not swap to a softer shot and play on, and not finish the match first. And an elbow that is clearly worse the next morning means the session was too much, which is a reason to drop back a step rather than to come off court for the season.
Give yourself one gauge you can repeat exactly, and keep it off court so the game does not contaminate it. Squeeze a ball, or lift something with the palm turned down, the same way each time, on both arms. Check it before a session and again the next morning. The Brisbane trial used pain-free grip force as one of its main outcome measures (Bisset and colleagues, 2006), and in clinic it is the number we watch, because it moves later and more truthfully than a pain score does. Base progression on pain-free grip and the 24-hour response rather than a fixed sheet.
How much should you play while it settles?
Count three things, and cut them in this order: the number of hard shots, then the length of the session, then the number of sessions a week. Players reach for the third one first because it is the easiest to say out loud, and it is the one that costs the most enjoyment for the least benefit to the elbow.
Hard shots are where the load lives. A session of dinks, drops, resets and controlled volleys asks very little of this tendon, while twenty drives and a handful of overheads ask a lot in a few minutes. Taking the hard shots out of a normal-length game often drops the elbow load more than halving the time would.
Then build back one variable at a time, roughly one change a week. Add the length of the session before you add intensity, and add intensity before you add a second or third session. A week in which you played longer, hit drives again and entered a ladder match tells you nothing about which of the three your elbow objected to.
Drilling needs its own thought. It is not the same as playing, and a feeding drill of the same shot for twenty minutes can be a heavier dose of that one shot than a whole game is. And a tournament or a social day with back-to-back matches is a different animal, not a bigger version of a session, because the recovery between the loads disappears. Those go last, well after your normal games are comfortable.
Should you change the paddle before you change the training?
No, and the reason is the evidence rather than loyalty to your paddle. The surveys and reviews behind the equipment question are set out in full on pickleball elbow and padel elbow, and the short version is that they do not agree with each other. The few positive findings come from cross-sectional surveys and from one review's observation rather than from any trial, and nobody has randomized players to equipment and counted sore elbows. Meanwhile the loading program has a guideline recommendation behind it on moderate evidence (grade B, Lucado and colleagues, 2022).
So if the budget and the attention go one way first, send them to the strength work. A new paddle is worth trying once the elbow is settling, changed on its own, with two weeks to answer, and chosen for how relaxed your hand can be on it rather than for a claim on the box. How hard you hold the handle matters more than what the handle is made of, and that one is free.
A strap during play comes up here too. The NHS lists a forearm strap or a wrist or elbow brace among the things to try at home, and some players find one takes the edge off a match, but the Cochrane review of these devices could not reach a conclusion either way (Struijs and colleagues, 2002). Tennis elbow braces and straps has the detail. Play in one if it helps. Do not let it talk you into a longer session.
Coming back after a flare, the four steps applied to an elbow
Returning to play after an injury sets out the four steps and the criteria for moving up a level, and they are the same four whatever the body part. Here is what each one means when the sore part is the outer elbow.
Settle it first. For this tendon that means pain at rest and at night has gone, pressing the bony point is tender rather than sharp, and the static holds are comfortable. If you have high blood pressure, breathe steadily through every hold and never hold your breath. Isometric wrist extension is usually the first thing in, because it loads the tendon without asking the elbow to move.
Rebuild the strength until the sore side is close to the other one, which on this page means grip rather than anything you can see. Wrist extension with a weight is the exercise most trial programs are built around, with forearm supination with a band for the turning muscles. Many programs use 2 to 3 sets of 10 to 15 slow repetitions for the strength exercises, once a day or every second day, with a weight light enough that the last few repetitions still look controlled. Your physio will adjust this.
Rebuild the movements the sport asks for, which is the step nearly everyone skips. Shadow swings with no ball, then a slow cooperative feed, then the shot at pace, in that order. A wrist twist with a flexible bar is a reasonable bridge here because it loads the forearm through a twist and a release rather than a straight lift.
Then return in stages, and let the shot type be your ladder rather than the clock. Cooperative dinking and drops first, then controlled rallies, then a friendly game with the drives left in but the overheads out, then your usual games, and the smashes and hard serves last. One step a week, and drop back a step rather than off the ladder if a morning goes badly.
What to do before and after a session
Warm the forearm up properly rather than generally. A few minutes of soft hitting at close range does more for this tendon than arm circles, and the full routines are on the pickleball warm-up and the padel warm-up.
Some physios use the static wrist holds just before a session as well as in the program. There is no trial on that timing for this condition, so treat it as a reasonable thing to try rather than something proven, and leave it out if it leaves the arm tired for the first few games.
Afterwards, the useful habits are dull. Loosen your grip on everything you carry off court, because a kit bag hooked on two fingers pulls on the same tendon. Use a hot or cold pack wrapped in a towel if it helps, for up to 20 minutes, as the NHS suggests. Write down what you played and how the next morning felt, because after three weeks that notebook is worth more than any pain score, and a physio can read it in thirty seconds.
Keep the strength work going once you are back to full sessions. For the wider conditioning that keeps a paddle player's arm and shoulder up to the job, there is a strength plan for pickleball players over 50 and a padel strength plan.
When to stop playing and get it assessed
Come off court and get it looked at if the elbow is worse the next morning after every version of a session you have tried, if your grip is getting weaker rather than just sorer, or if the pain has stopped being predictable.
The NHS advises seeing a GP if elbow pain is still there after at least 2 weeks of looking after it yourself. Get seen sooner if it is stopping you working or sleeping. If you already have a program and it is not helping after several weeks, a physio can check the diagnosis and change the load. The warning signs below need prompt medical attention. Bring your playing diary, because the fortnight before a flare explains more than any description of the pain does.
Some things are not load management questions at all. Tingling, numbness or pins and needles in the hand, a wrist or fingers that will not lift properly, and a pop or snap at the front of the elbow each have their own time frame in the list below, and none of them waits for the end of the match. If chest pain, pressure or tightness does not ease quickly when you rest, spreads to your arm, neck, jaw, stomach or back, or comes with sweating, feeling sick, feeling light-headed or being short of breath, call emergency services straight away, as this can be a heart attack. If it eases quickly and none of these happen, get medical advice the same day, and do not exercise again until you have been checked. If you faint while exercising, call emergency services, even if you feel fine again quickly.
In the United States that assessment usually comes from a physical therapist or a PT; elsewhere from a physio or physiotherapist. If you have had surgery on the elbow, follow the program your surgeon or physio gives you rather than this one.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: any sign of a stroke, even if it goes away. That means a face that droops on one side, an arm you cannot lift or keep up, slurred or muddled speech, weakness or numbness on one side of your body or face, sudden blurred vision, double vision or loss of sight, trouble swallowing, sudden dizziness with unsteadiness or falling over, a sudden severe headache, or a sudden fall where your legs give way but you do not black out (a drop attack). Call emergency services straight away.
- Jaw, neck, shoulder or arm pain that comes with chest pain or tightness, sweating, feeling sick, feeling light-headed or being short of breath, or that comes on when you exert yourself, feel stressed or go out in the cold and does not ease within a few minutes of rest. Call emergency services straight away, as this can be a heart attack. If it eases quickly with rest and none of these happen, get medical advice the same day, and do not exercise again until you have been checked.
- Chest pain or tightness, which may spread to your arm, neck or jaw, or shoulder or arm pain that comes with shortness of breath, sweating or feeling sick. This can be a heart attack. Call emergency services straight away.
- Emergency: after a fall or a blow to the elbow, the arm has changed shape or sits at an odd angle, a bone is showing through the skin, a cut is bleeding heavily, or the hand has gone numb or tingly or turns cold, pale or blue. Go to an emergency department or call emergency services straight away, and do not drive yourself.
- Your arm, hand or fingers turn cold, pale, blue or gray compared with the other side. Call emergency services or go to an emergency department straight away, and do not drive yourself. The blood supply to the arm may be blocked.
- The pain started with a fall or a blow to the elbow, and the pain is severe, you heard a snap, the elbow is swollen or bruised, or you cannot bend or straighten the arm. Go to an urgent care center or emergency department the same day.
- A sudden pop or snap at the front of your elbow, sudden sharp pain there, or the muscle at the front of your upper arm bunches up or changes shape. Stop and go to an urgent care center or emergency department the same day, even if you can still bend the elbow, as this can be a torn biceps tendon.
Get help today
- Your wrist or fingers will not lift properly (the fingers may droop at the knuckles), or your hand keeps getting weaker, not just sore. Get medical advice the same day, as this can be a problem with a nerve rather than the tendon. If the weakness is getting worse by the hour, go to an emergency department.
- You have numbness, tingling or pins and needles in the hand or fingers, or pain that spreads from your neck down the arm. Stop any exercise that brings it on and see a physio or doctor, because this points to a nerve or to your neck rather than the tendon. If the pins and needles do not go away after you stop, or part of your arm or hand goes numb, get medical advice the same day. If one side of your face or body suddenly goes numb or weak, or your speech becomes slurred or muddled, call emergency services, even if it goes away.
- The elbow is hot, red and swollen, or you have elbow pain with a high temperature or feel hot, cold or shivery. Get medical advice the same day, and go to an emergency department if you feel very unwell. This can be a sign of infection in the joint, which needs treatment quickly.
- The pain is there at night or at rest and keeps getting worse. If you are being treated for cancer now, contact your cancer team the same day.
Book an appointment
- The elbow locks, catches, or feels unstable, as if it slips or gives way. Get it assessed before you start these exercises, and ask your doctor or physio for an appointment within a few days.
- The pain is there at night or at rest and keeps getting worse. If you have had cancer, now or in the past, or are losing weight without trying, see your doctor sooner, within a day or two, and mention it. This applies even if the pain is not getting worse.
- The pain is there at night or at rest and keeps getting worse. See your doctor within a few days.
Common questions
How long should I stop playing with tennis elbow?
For most players the answer is not a number of weeks off, because complete rest removes the loading that rebuilds a tendon's tolerance, and across 30 trials exercise came out ahead of passive approaches for this condition, with a small effect and low certainty attached (Karanasios and colleagues, 2021). What usually works better is a short, deliberate reduction followed by a planned build back up: fewer hard shots, shorter sessions, and the strength work running underneath. If every version of a session leaves the elbow worse the next morning, that is the signal to come off court for a couple of weeks while the loading program does the early work, and then to return through the stages rather than straight into a game. How long tennis elbow lasts has the figures on the timeline, which is measured in months.
Should I ice my elbow after playing?
You can, and the NHS self-care advice for tennis elbow is to try a hot or cold pack wrapped in a towel for up to 20 minutes every 2 to 3 hours, so either is reasonable and neither is treatment. Use it for comfort after a session rather than as a reason to play a longer one. What the ice cannot tell you is how the session went, because it changes how the elbow feels for a few hours and the information you need arrives the next morning. If you need a pack after every session, the session is the thing to change.
Which shots should I leave out first?
Start with the hard-grip, fast-head shots, because they combine the two things this tendon likes least: a firm hold and a jolt at contact. In pickleball that is the drives, the hard third shot and the overheads; in padel it is the smashes and the flat drives, while lobs, drop shots and volleys usually survive. The soft game is the part most players can keep almost untouched. Late contact is worth watching too, because a ball that arrives behind you makes the forearm work harder to steady the paddle. The shot-by-shot reasoning for each sport is on pickleball elbow and padel elbow.
Can I play through tennis elbow if it only hurts afterwards?
Pain that arrives only after a session is still information, and the question is how long it lasts rather than whether it appears. Soreness that fades within a few hours and leaves the elbow no worse the next morning is the pattern most loading programs accept. Soreness that is still there when you wake, or that is worse on the second morning, means the session was too much even though it felt fine at the time, which is the commonest way players get stuck here for months. Treat the morning as your scoreboard and adjust one thing for the next session.
References
- Lucado AM, Day JM, Vincent JI, MacDermid JC, Fedorczyk J, Grewal R, Martin RL. Lateral elbow pain and muscle function impairments: clinical practice guidelines. Journal of Orthopaedic and Sports Physical Therapy. 2022;52(12):CPG1-CPG111. https://doi.org/10.2519/jospt.2022.0302
- Karanasios S, Korakakis V, Whiteley R, Vasilogeorgis I, Woodbridge S, Gioftsos G. Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials. British Journal of Sports Medicine. 2021;55(9):477-485. https://doi.org/10.1136/bjsports-2020-102525
- Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006;333(7575):939. https://doi.org/10.1136/bmj.38961.584653.AE
- Struijs PAA, Smidt N, Arola H, Dijk CN van, Buchbinder R, Assendelft WJJ. Orthotic devices for the treatment of tennis elbow. Cochrane Database of Systematic Reviews. 2002;(1):CD001821. https://doi.org/10.1002/14651858.CD001821
- NHS. Tennis elbow. Page last reviewed 31 May 2024. https://www.nhs.uk/conditions/tennis-elbow/
- NHS. Elbow and arm pain. Page last reviewed 26 January 2024. https://www.nhs.uk/symptoms/elbow-and-arm-pain/
- NHS. Chest pain. Page last reviewed 8 August 2023. https://www.nhs.uk/conditions/chest-pain/
- NHS. Septic arthritis. Page last reviewed 3 September 2026. https://www.nhs.uk/conditions/septic-arthritis/
- NHS. Symptoms of a stroke. Page last reviewed 12 September 2024. https://www.nhs.uk/conditions/stroke/symptoms/
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-24.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.