Pickleball Elbow: What It Is and What Helps

Is pickleball elbow the same as tennis elbow?

The sport changed. The tendon did not. Pickleball elbow describes pain at the outer side of the elbow, from the shared tendon of the muscles that lift your wrist and fingers, and that is exactly what tennis elbow describes. Golfers get it, painters get it, and so do people who have never held a racket or a paddle in their lives.

Saying that plainly saves you money and time. There is no pickleball version of the diagnosis waiting to be found, no pickleball-only exercise, and no reason to look past the treatment that already has the research behind it. The tennis elbow program sets out the staging, from static holds through lifting a light weight to slow lowering, with the numbers and the progression rules on the page. This page covers only what the sport adds on top.

One caution about the name. If your pain sits on the inner side of the elbow instead of the outer, or in the crease at the front, it is a different tendon and a different plan, and golfer's elbow is the page to read instead. Press around the bony points until you find the sore one before you follow any program.

What the paddle changes

Three things about the paddle get blamed for elbow pain: its weight, the size of its grip, and how hard you hold it. Only the last of those is something you do; the first two are things you buy. The evidence sits unevenly across all three.

On weight, the 2024 critical analysis review of pickleball injuries in aging players is the only source that addresses it directly. It observes that players new to the game tend to use heavier paddles, at 8.5 oz (0.53 lb, 0.24 kg) against lighter versions closer to 7.2 oz (0.45 lb, 0.20 kg), and suggests that this small difference may place beginners at increased risk of the outer elbow tendon problem (Touhey and colleagues, 2024). Follow the trail and it gets thinner: the weights are carried over from an earlier clinical review of the sport, and the sentence about risk is the authors' reasoning rather than a result. Nobody has randomized players to paddle weights and counted sore elbows. A lighter paddle is worth a try, but it is not a treatment, and one sentence in a review is thin ground for buying one.

The tennis research on grip size points the other way. A review of elbow biomechanics in tennis players reports that grip size a quarter of an inch above or below the recommended measurement does not significantly affect forearm muscle firing patterns, and concludes that altering grip size might not represent a significant risk factor (Eygendaal and colleagues, 2007). Pick the grip that lets your hand relax, and do not expect a new grip to fix a tendon.

Grip pressure is the one worth working on, though it has not been tested either. The pickleball review advises newer players to hold the paddle loosely to avoid elbow pain (Touhey and colleagues, 2024). The reasoning behind that advice is simple enough: a firm grip is work for the same forearm muscles whose tendon is sore, and a player who holds the handle tight for a whole session does more of it than one who only tightens at contact. Loosening between rallies costs nothing and is easy to practice.

Contact, the dink and the drive

No study has compared pickleball shots for elbow load, so what follows is reasoning from tennis and from what the shots ask of the forearm, not evidence about pickleball.

What the elbow tendon dislikes is being lengthened while it is working. Modeling of the tennis backhand found substantial eccentric contractions in the wrist extensor muscles, which the review names as the likely source of the repeated small damage behind tennis elbow (Eygendaal and colleagues, 2007). That is the tendon holding the wrist steady while the impact tries to push it the other way. A mishit off the edge of the paddle may do more of it, because the paddle twists in your hand and the forearm has to catch it, though nobody has measured that in pickleball.

That points at the drive, not the dink. The dink is a soft touch played over the kitchen line with a short swing and little to resist, and most players can hit hundreds of them without the elbow noticing. The drive, the overhead and the hard third shot ask for a firmer grip, a faster paddle head and a bigger jolt at contact. If your elbow is sore, the soft game is usually the part you can keep.

Two habits matter more than technique lectures. Hitting late, so the ball arrives behind you and the wrist has to snap to catch up, loads the tendon harder than a ball met in front. And playing with a flimsy or badly worn grip means you squeeze more to stop the paddle moving, which brings you back to grip pressure.

How much you play, and what changed

This is where most pickleball elbows are made, and where the honest answer is the least satisfying.

A cross-sectional survey of 232 players at a 2024 tournament in South Korea, mean age 50.5 years, found that 34.2% reported at least one injury in the previous 12 months. Of the injuries reported, the elbow or forearm was the second most common site at 18.1%, behind the knee at 23.3%, and 78% were described as overuse rather than a single traumatic moment (Jeong and colleagues, 2025). A separate chart review of 545 patients who came to one urban health system in the United States with a pickleball injury found the elbow made up 22% of the upper limb presentations (Siow and colleagues, 2026). Neither of those is a risk figure. They count people who were injured or who answered a survey, so they tell you which areas complain, not how likely your elbow is to complain this season.

The same Korean survey looked for a link with playing volume and found something counterintuitive: each extra hour of weekly play went with lower odds of reporting an injury, an odds ratio of 0.913 (95% CI 0.861 to 0.963, p = 0.001), which the authors read as a lower risk (Jeong and colleagues, 2025).

Read that carefully before you act on it. The survey recorded how much people played at the time they filled it in and asked about injuries over the previous 12 months, so an injured player who had cut their hours back would produce this result without playing volume protecting anyone. A snapshot cannot tell you which came first. Everyone answering had turned up to enter a tournament, which leaves out anyone whose elbow had already stopped them playing. Nothing here is permission to add hours, and nothing here shows that playing more keeps an elbow well.

What physios watch instead is change. A tendon copes with what it is used to and objects to a jump, so the week that matters is usually the one where you went from two sessions to five, added a tournament, or started drilling drives for an hour. When the elbow flares, look back at the two weeks before it, not at the session it happened in.

What to change on court

Take the load off in the order that costs you the least. None of these has been tested against elbow pain in pickleball players. They are load management borrowed from tendon rehab and applied to a paddle sport.

Cut the volume before the enjoyment. Fewer or shorter sessions beat quitting, and the soft game usually survives when the drives do not.
Loosen the grip between points and on every dink. A firm grip belongs on contact, not on the walk back to the baseline.
Trim the shots that involve a hard grip and a fast swing: drives, overheads and hard serves. Keep dinks, drops and resets.
Meet the ball in front of you. Late contact makes the forearm work harder to steady the paddle.
Replace a worn or slippery overgrip, because a paddle that moves in your hand gets squeezed harder.
Watch what you carry off the court too. Bags hooked on two fingers and heavy kettles pull on the same tendon between sessions.

The NHS lists a forearm strap or an elbow brace among the things to try at home for tennis elbow, and players often find one takes the edge off during a game. Treat it as something to play in, not something to heal in, and keep the loading program going underneath it.

Exercises to sit alongside the program

These are the parts of a tennis elbow program that deal with the hand and the tendon under a static load, which is where a paddle sport puts most of its demand. They do not replace the staged program, so use them alongside it, not in place of it.

Expect some ache at the outer elbow during the work. That is acceptable while it fades over the following few hours and the elbow wakes up no worse than it went to bed. A sharp pain inside a repetition is the signal to drop that exercise for today. If you have high blood pressure, breathe steadily through every hold and never hold your breath.

After a broken or dislocated elbow, or elbow surgery such as a tendon repair, follow your surgeon's or physio's plan, and start these exercises only when they have cleared you. If you have just hurt your arm and have severe pain, cannot move the elbow or heard a snap, do not exercise it. Go to an urgent care center or emergency department the same day. If the arm looks a different shape or sits at an odd angle, a bone is showing, or your arm or hand tingles, feels numb or turns cold, pale or blue, go to an emergency department straight away or call emergency services, and do not drive yourself. After a broken wrist, hand or forearm, or surgery on any of them such as a tendon repair, start only when your doctor, surgeon, physio or hand therapist says the bone or repair is ready for this, and follow their plan for how much to do.

Squeezing hard can set off pain at the base of the thumb where there is arthritis in that joint, so ask your physio how firm the ball should be. Leave the squeezes out on days when the small joints of your hand are hot and swollen, as they can be in rheumatoid arthritis.

The forearm stretch has two limits of its own. A fully bent wrist can press on the nerve that runs through the front of it, so if the thumb and first fingers tingle while you hold it, come out of the stretch and tell your physio. After a recent wrist sprain, check with your physio before you stretch into a full bend.

Exercises that can help

These three sit around the program and do not replace it: a hold that loads the tendon while the elbow stays still, a grip exercise for the hand that squeezes the paddle, and a stretch for the back of the forearm. Common starting points are 5 to 10 holds of 5 to 10 seconds once or twice a day, 10 to 15 squeezes of a soft ball held for about 3 to 5 seconds 1 to 3 times a day, and 2 to 4 stretch holds of 15 to 30 seconds a few times a day. Follow the numbers on each exercise page, and expect your physio to change them for you.

When to see a physio (physical therapist)

The NHS advises seeing a GP if elbow pain is still there after resting the elbow and trying self-care for at least 2 weeks. Go sooner if the arm has become weak rather than sore, if your fingers tingle, or if the pain arrived with a snap.

An assessment is mostly about sorting and dosing. A physio will test resisted wrist lifting against the other side, feel each bony point in turn, check that your neck is not the source, and then set a load your tendon can handle today. Bring your playing diary with you, because the number of sessions a week and what changed before the flare tell a clinician more than a pain score does. If you have had elbow surgery, your surgical team decides when new exercises start.

Related exercise programs

See a doctor promptly if

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.
Emergency: 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.
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.
Same day: 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.
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.
Same day: 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.
Same day: your wrist or fingers will not lift properly, for example the fingers droop at the knuckles or the wrist drops when you hold your arm out in front of you. Get medical advice the same day. If the weakness is getting worse by the hour, go to an emergency department.
Same day: pain spreads from your neck down the arm, or turning or tilting your neck brings on the tingling in your hand. The problem may be in the neck rather than the elbow. If a doctor or physio has not checked it yet, get medical advice the same day.
Same day: pins and needles in your arm or hand that 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.
Within a few days: the elbow locks, catches or keeps giving way in everyday use, without a pop from throwing. Stop the exercises that bring it on and see a physio or doctor within a few days rather than pushing on.
Within a few days: the pain is there at night or at rest and keeps getting worse. See your doctor within a few days. 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. If you are being treated for cancer now, contact your cancer team the same day.

Common questions

What is pickleball elbow?

It is tennis elbow with the sport's name swapped in. The medical term is lateral elbow tendinopathy, and it describes pain at the tendon that anchors your wrist-lifting muscles to the outer side of the elbow. The NHS describes the main symptom as pain on the outside of the elbow, worse with lifting, gripping or moving the wrist, sometimes with tenderness, swelling and difficulty straightening the arm fully. Players usually notice it first when they pick up a kettle or a full mug, not during a game. No pickleball study has shown that the sport produces a different tendon problem from the one racket players and plumbers get, so the label is marketing rather than medicine.

Does a lighter paddle help pickleball elbow?

It might, though the case for it rests on one suggestion in a review. A 2024 review of pickleball injuries in aging players notes that players new to the game tend to pick heavier paddles, for example around 8.5 oz (0.53 lb, 0.24 kg) rather than the lighter 7.2 oz (0.45 lb, 0.20 kg), and says this small difference may put beginners at increased risk (Touhey and colleagues, 2024). Both the weights and that sentence are carried over from an earlier clinical review of the sport rather than measured by the authors. Nobody has tested paddle weight against elbow pain in a controlled study, so treat it as a reasonable thing to try, not a cure. If you do swap, change one thing at a time and give the elbow two weeks to answer, because a new paddle usually comes with a new grip and a different swing at the same time.

Should I change my grip size for pickleball elbow?

Comfort is the reason to change it, not injury prevention. In a review of elbow biomechanics in tennis, moving grip size a quarter of an inch above or below the recommended measurement did not significantly change forearm muscle firing patterns, and the authors concluded that grip size might not be a significant risk factor for tennis elbow (Eygendaal and colleagues, 2007). What seems to matter is how hard you squeeze, not what you squeeze: the pickleball review advises newer players to hold the paddle loosely to avoid elbow pain (Touhey and colleagues, 2024). A grip that feels awkward makes you hold tighter, so a size that suits your hand may help that way, not through any direct effect.

Can I keep playing pickleball with tennis elbow?

Usually yes, with the session shortened and the hard-hitting shots trimmed first. Complete rest takes the pull off the tendon but also removes what rebuilds it, and the staged program on our tennis elbow page is built around adding load, not taking it away. A workable trial is to halve your usual court time for two weeks, drop the drives and overheads while keeping the soft game, and see what the next morning says. If the elbow is worse when you wake, the last session was too much whatever it felt like at the time. If gripping a mug has started to hurt, take that as a signal to cut back further for now instead of pushing through.

How long does pickleball elbow last?

Longer than most players want to hear. The NHS says tennis elbow usually gets better after resting the arm for a few weeks but can sometimes last over a year, and its advice is to see a GP if the pain is still there after at least 2 weeks of self-care. Give a loading program months before you judge it, and expect progress to show as more tolerance before soreness instead of a day when the pain simply stops. The 2022 physical therapy clinical practice guideline for lateral elbow pain describes the condition as often self-limiting and likely to settle on its own, but notes high recurrence rates and long spells off work (Lucado and colleagues, 2022), so build back to your full playing hours in stages. The tennis elbow program on this site sets out what that build looks like.

References

Touhey DC, Bozorgmehr CK, Tartibi DS, Smith MV, Knapik DM. Pickleball injuries in the aging athlete: a critical analysis review. Cureus. 2024;16(9):e69950. https://doi.org/10.7759/cureus.69950
Eygendaal D, Rahussen FTG, Diercks RL. Biomechanics of the elbow joint in tennis players and relation to pathology. British Journal of Sports Medicine. 2007;41(11):820-823. https://doi.org/10.1136/bjsm.2007.038307
Jeong B, Lee KJ, Nam SH, et al. Injury risk and epidemiology of pickleball players in South Korea: a cross-sectional study. Frontiers in Public Health. 2025;13:1617291. https://doi.org/10.3389/fpubh.2025.1617291
Siow MY, Zafar-Khan A, Limpisvasti O. Pickleball-related orthopaedic injury presentations to a large urban healthcare system from 2015 to 2024. JAAOS Global Research and Reviews. 2026;10(3):e25.00477. https://doi.org/10.5435/JAAOSGlobal-D-25-00477
Lucado AM, Day JM, Vincent JI, MacDermid JC, Fedorczyk J, Grewal R, Martin RL. Lateral elbow pain and muscle function impairments: clinical practice guideline. Journal of Orthopaedic and Sports Physical Therapy. 2022;52(12):CPG1-CPG111. https://doi.org/10.2519/jospt.2022.0302
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. Heart attack. Page last reviewed 31 March 2026. https://www.nhs.uk/conditions/heart-attack/
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 2026-10-01.

This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.

Pickleball elbow: the same tendon, a newer name