Pickleball Elbow: How to Prevent This Overuse Injury

Pickleball has exploded in popularity across Southern California, filling courts in Claremont, Pomona, and throughout the Inland Empire with players of every age. Along with the sport's growth has come a steady rise in a very specific injury our sports medicine team now sees regularly: pickleball elbow.

The good news is that this overuse injury is highly preventable and, when caught early, responds well to conservative treatment. Here is what causes it, how to treat it, and what you can change on the court to stay in the game.

Because pickleball attracts so many players who are new to racquet sports altogether, or returning to one after years away, the injury pattern we see is often different from classic tennis elbow in lifelong tennis players. Understanding why makes it easier to prevent.

Unlike traditional tennis, which many players grow into gradually over years starting in childhood, pickleball often recruits adult beginners who go from zero racquet sport experience to playing several times a week within a matter of months. That compressed learning curve, combined with tendons and forearm muscles that have not been conditioned for repetitive paddle strikes, is a major reason elbow injuries are showing up so quickly in new players.

What Is Pickleball Elbow?

Pickleball elbow is a version of lateral epicondylitis, more commonly known as tennis elbow, in which the tendons that attach your forearm muscles to the bony bump on the outside of your elbow become irritated and inflamed. The repetitive wrist-extension motion used to hit forehands, backhands, and especially the hard paddle strikes common in pickleball places significant strain on these tendons.

Because pickleball paddles are shorter and stiffer than tennis rackets and transmit more shock directly into the wrist and elbow, players who pick up the sport, particularly those over 40 who make up a large share of the pickleball boom, are especially prone to developing this overuse injury.

The rapid pace of pickleball also plays a role. Points are fast, exchanges happen close to the net, and players often react with a stiff, locked wrist rather than a fluid swing, which increases the jarring force transmitted straight into the elbow tendon with every shot.

Signs You Might Have It

• Pain or burning on the outside of the elbow that worsens with gripping or swinging
• Weak grip strength, such as difficulty shaking hands or lifting a coffee cup
• Tenderness when pressing on the bony bump on the outer elbow
• Pain that builds gradually over days or weeks of play rather than appearing suddenly

Treating Pickleball Elbow

Early treatment focuses on calming inflammation and giving the tendon time to heal. Resting from paddle sports for one to two weeks, applying ice for 15 to 20 minutes several times a day, and taking an over-the-counter anti-inflammatory as recommended by your doctor all help in the first stage of recovery.

A counterforce brace, worn just below the elbow, can reduce strain on the irritated tendon and allow many patients to stay somewhat active while healing. For symptoms that persist beyond a few weeks, a course of physical therapy centered on eccentric strengthening exercises, which slowly load the tendon under controlled tension, is one of the most well-supported treatments for tennis elbow according to the American Academy of Orthopaedic Surgeons (AAOS). Stubborn cases that do not respond to several months of conservative care may benefit from a corticosteroid injection or, rarely, a minor surgical procedure.

Most patients are surprised to learn that complete rest is rarely the full answer. A modified return to light activity, combined with the right strengthening exercises, generally produces a faster and more durable recovery than staying off the court entirely for months on end.

How to Prevent It Before It Starts

• Choose a paddle with a larger grip size and more built-in vibration dampening, which reduces shock transmitted to the elbow
• Warm up your forearm and wrist with light stretching and gentle swings before playing
• Work on technique, since leading shots with a bent wrist rather than a firm, neutral wrist significantly increases tendon strain
• Build forearm strength in the off-court gym with light wrist curls and reverse wrist curls
• Take rest days between sessions rather than playing multiple consecutive days, especially when you are new to the sport

A lesson or two with a local pickleball instructor can also be one of the best injury prevention investments a new player makes, since correcting a stiff-wristed swing early avoids months of repetitive strain that can be hard to unlearn later.

When to See a Sports Medicine Specialist

If elbow pain lingers for more than two to three weeks despite rest and home treatment, or if you notice weakness that affects daily tasks like turning a key or carrying grocery bags, it is time to have it evaluated. Left untreated, tennis and pickleball elbow can become a chronic problem that takes far longer to resolve than if it is addressed early.

An evaluation can also rule out other causes of outer elbow pain, such as a nerve entrapment or referred pain from the neck, which occasionally mimic tennis elbow but require an entirely different treatment approach.

What Happens If You Keep Playing Through It

It can be tempting to push through a nagging ache, especially when your regular group is counting on you for a match. But continuing to play at full intensity on an irritated tendon tends to prolong healing significantly, sometimes turning what would have been a two-week recovery into a two-month one. Chronic tennis elbow that has been aggravated repeatedly over months is also more resistant to conservative treatment and more likely to eventually require an injection or procedure.

A short, deliberate break early on is almost always the faster path back to full-intensity play, even though it feels counterintuitive in the moment.

The Bottom Line

Pickleball is a fantastic way to stay active, social, and competitive at any age, and a sore elbow does not have to end your season. With the right equipment, technique adjustments, and a proactive approach to treatment, most players are back on the court within a few weeks.

As the sport continues to grow across the Inland Empire, taking a few preventive steps before your elbow ever starts hurting is far easier than treating it after the fact. A brief conversation with a sports medicine provider about your technique and equipment can go a long way toward a full, injury-free season on the court.