Padel Elbow: Why It Hurts and How to Get Back on Court

The most common padel injury

Quick take. Pain on the outside of the elbow is the injury padel players report most often. It usually settles with lighter play, daily forearm exercises and time. Injections are rarely the answer. Fix the cause as well: technique, racket, grip and how much you play.

Its medical name is lateral elbow tendinopathy (or lateral epicondylitis), but almost everyone calls it tennis elbow. It is a problem in the tendon that joins the muscles that lift your wrist to the bony bump on the outside of the elbow. It hurts when you grip, lift a kettle or shake hands, and on court it bites on backhands, volleys and the bandeja.

In 2023 a systematic review in BMJ Open Sport & Exercise Medicine gathered the published padel injury studies and found the elbow was the most common injury site. In one Spanish study, 74% of the players who reported an injury had tennis elbow. The studies are small and measured injuries in different ways, so treat the numbers as a guide. We covered the wider picture in our summary of the injury research.

Why padel is hard on the elbow

The review authors and a 2023 ultrasound review in the Journal of Ultrasound suggest a few reasons. They are likely explanations, not proven causes:

• Lots of overheads and volleys. Padel is full of short, repeated swings at the net and above the head, and the forearm muscles brake the racket after every contact.
• A bent wrist on the backhand. The ultrasound review says beginners who hit backhands with a flexed wrist put extra strain on the tendon on the outside of the elbow.
• Pain on the inside instead? Experienced players are more prone to the inside of the elbow (golfer's elbow), from snapping the wrist on smashes, slices and volleys.
• Vibration. Hard racket materials pass more vibration to the arm.
• Kit and technique. Orthopaedic surgeon Dr Carlos Rebollón adds that an unsuitable racket or a worn-out grip increases the strain, and so does poor hitting technique.

Bangkok adds its own risks. Many players go from one game a week to four or five within a few months, and in the heat a sweaty, slippery handle makes you squeeze harder.

What to do when it starts

A patient leaflet from St George's University Hospitals, part of the UK's NHS, sets out the standard approach:

• Change the load first. Adapt the activities that cause the pain. For padel that means fewer or shorter sessions and longer breaks. Dr Rebollón's advice is the same: do not push through the pain.
• Be patient. With advice and watchful waiting, up to 50% of cases settle within three months and up to 90% within a year. Symptoms usually last between six and 24 months.
• Do the exercises every day (see the table below).
• Short-term relief. An anti-inflammatory gel rubbed on the elbow can ease the pain for a while.
• Braces. There is limited evidence for an elbow strap on its own, but together with other treatment it can relieve pain.
• Injections. A steroid injection gives relief for four to six weeks but worse results at 12 months than waiting, so it is rarely used. Platelet-rich plasma (PRP) injections did no better than placebo.

The leaflet's three daily exercises:

Exercise	How	Dose
Wrist stretch	Arm straight, palm down; use the other hand to gently bend the wrist down	Hold 30 seconds, 3 times
Resisted wrist lift	Seated, forearm on a table, palm down; lift the wrist against your other hand, forearm stays on the table	Hold 60 seconds, 5 times
Rolling pin turns	Seated, elbow bent on the table, holding a rolling pin; turn the palm up, then down, keeping the elbow still	10 to 15 turns, 3 times

The rubber bar exercise

A popular home exercise uses a rubber bar you twist with both hands. It comes from a small study led by physiotherapist Timothy Tyler in New York, presented in 2009. Twenty-one patients did either standard wrist strengthening or an "eccentric" exercise with a rubber bar (Flexbar), three sets of 15 every day. The rubber bar group did so much better that the study was stopped early. It was small, so ask a physiotherapist to show you the movement and set the resistance rather than copying a video.

Stopping it coming back

• Build up slowly. Add sessions one at a time instead of jumping to five a week.
• Warm up the forearms. Wrist circles and light rallying before points; our 10-minute warm-up covers the rest of the body.
• Strengthen the forearm and shoulder. Our gym plan for padel is a simple twice-a-week start.
• Fix the technique. A coach can spot a bent wrist on the backhand or a whippy bandeja in one session; find one on our coaching page.
• Check your kit. Swap a worn grip for a fresh overgrip (our overgrip guide for Bangkok humidity) so you do not have to squeeze, and if your elbow is sore, talk to your club or coach about a softer racket.

When to get it checked

See a doctor or physiotherapist if the pain does not ease after a few weeks of lighter play, if it started with a fall or a sudden injury, or if it stops you doing everyday things. A sore tendon caught early is much easier to settle than one ignored for months.

Ask other players who they see for elbow trouble: join the Bangkok Padel Community on Facebook.

Sources

• Dahmen J. et al., Incidence, prevalence and nature of injuries in padel: a systematic review (BMJ Open Sport & Exercise Medicine, 2023)
• Cocco G. et al., Musculoskeletal disorders in padel: from biomechanics to sonography (Journal of Ultrasound, 2023)
• St George's University Hospitals NHS Foundation Trust, Tennis elbow (patient leaflet)
• ScienceDaily, Easy strength training exercise may help treat tennis elbow (2009)
• Dr Carlos Rebollón, Padel and elbow pain: should I keep playing?