If you’ve spent more time on the courts at Pickleland this spring and you’re suddenly noticing a sharp ache on the outside of your elbow when you grip the paddle, you might be dealing with what doctors call lateral epicondylitis — and what most pickleball players just call pickleball elbow. It’s the most common overuse injury in our sport, and the good news is that it’s also one of the most preventable.
We see it every season at Pickleland in Pflugerville, especially in players who jump from one or two days a week to four or five without changing anything else about their routine. Below is the playbook we share with our community: what pickleball elbow actually is, why it happens, the small tweaks that prevent 90% of cases, and what to do if you’re already feeling it.
What Is Pickleball Elbow?
Pickleball elbow is the same condition as tennis elbow — lateral epicondylitis. It’s an overuse injury of the tendons that attach your forearm extensor muscles to the bony bump on the outside of your elbow (the lateral epicondyle). Repeated gripping, paddle vibration, and backhand strokes create tiny tears in those tendons faster than your body can repair them, and inflammation builds up.
The classic symptoms are pretty distinctive:
- Aching or burning pain on the outside of the elbow that can radiate down the forearm
- Pain when gripping the paddle, shaking hands, or turning a doorknob
- Weakness in your wrist or hand on the affected side
- Tenderness right on the bony bump, sometimes with mild swelling
- Pain that’s worst on backhand drives and dinks
If those sound familiar, don’t panic — it’s manageable. But it’s also a signal from your body that something in your setup or training load needs to change.
Why Pickleball Players Get It (and Tennis Players Less)
Pickleball elbow isn’t just tennis elbow with a new name. A few things about our sport make it especially prone to causing this injury:
- The paddle is shorter and stiffer than a tennis racquet. Less length and less flex mean more vibration travels into your forearm on every off-center hit.
- The kitchen line means lots of quick wrist movements. Counters, blocks, and hand battles fire the wrist extensors hundreds of times per session.
- The plastic ball transmits more shock than a felt tennis ball, especially on stiff carbon-fiber faces.
- Most pickleball players are 40+ and tendons get less elastic with age, which means a smaller margin for error.
- The sport is addictive. Players ramp from 0 to 5 days a week in a few weeks, and the tendons can’t keep up.
That last one is the biggest culprit we see. Pickleball is fun, you keep finding excuses to add another day, and suddenly your elbow is screaming.
Top 8 Ways to Prevent Pickleball Elbow
1. Get the right grip size
This is the single biggest gear fix. A grip that’s too small forces your forearm muscles to over-clench just to keep the paddle from twisting in your hand. The classic test: hold the paddle with a relaxed handshake grip — you should be able to fit your other index finger snugly between your fingertips and the base of your thumb. If there’s no room, your grip is too small. Wrap an overgrip or two (or buy a paddle with a thicker handle) to add 1/16″ to 1/8″.
2. Don’t death-grip the paddle
On a 1-to-10 scale where 10 is “white knuckles,” your grip should sit around a 4 during play. A relaxed grip lets your forearm muscles stay loose between shots and absorbs more of the vibration. Most players don’t realize how hard they’re squeezing until they consciously check.
3. Warm up before every session
Cold tendons tear. Five to ten minutes of dynamic warm-up before play makes a real difference — wrist circles, arm swings, and a few light dinks before any hard hitting.
4. Build the load gradually
If you’ve been playing twice a week, don’t jump to five days the week you fall in love with the sport. Add no more than one extra session per week, and give yourself at least one full rest day between hard sessions. Your tendons need 48 hours to recover from a heavy load.
5. Generate power from your legs and core
Beginners try to muscle the ball with their arm. Better players step into shots, rotate the hips, and let the kinetic chain do the work. Letting your legs and core drive the swing takes 30-50% of the strain off your elbow. This is one of the biggest unlocks in any pickleball-specific workout.
6. Strengthen your forearm and grip
Stronger tendons handle more load before they get inflamed. Two simple exercises, three sets of 10-15, twice a week:
- Wrist extensions: Forearm resting on a bench, palm down, slowly raise and lower a 2-5 lb dumbbell. Do the eccentric (lowering) phase slowly — that’s the part that builds tendon resilience.
- Wrist flexions: Same setup, palm up, same slow lowering.
The Tyler Twist, using a rubber FlexBar, is another evidence-backed exercise that works wonders if you’re already symptomatic.
7. Pay attention to your paddle
If you’ve been using the same paddle for two-plus years, the core may be breaking down (this is “core crush”), which lets more shock reach your arm. Newer paddles with thicker 16mm cores absorb more vibration than thin 13mm power paddles. We touch on this in our roundup of the best pickleball paddles in 2026 — if elbow issues keep coming back, a control-oriented 16mm paddle is worth a try.
8. Cross-train
Doing only pickleball loads the same tissues over and over. Adding strength work, swimming, cycling, or yoga distributes stress across different muscles and lets your forearm tendons recover.
Treatment: What to Do If You Already Have It
If you’re already feeling the burn, the good news is that most cases respond well to conservative treatment within 6-12 weeks. The bad news is that pushing through it usually makes things worse. Here’s the order of operations:
Modify activity (don’t fully stop)
Old advice was “stop playing for six weeks.” Newer evidence says total rest weakens the tendon further. Instead, dial back to a level that doesn’t aggravate the pain — maybe one shorter, dink-only session per week — while you let the tendon heal.
Ice, NSAIDs, and topical relief
Ice for 15-20 minutes after play helps with inflammation. Over-the-counter NSAIDs like ibuprofen or naproxen can manage pain. Topical anti-inflammatories or CBD/menthol rubs are popular with our older players who don’t want to take pills daily.
Counterforce brace
A counterforce brace (the simple Velcro band that wraps around the meaty part of your forearm just below the elbow) shifts force away from the inflamed tendon attachment. Most players notice a real difference within a session or two. They cost $15-25 and live in many of our regulars’ bags.
Eccentric loading exercises
Once acute pain settles, slow eccentric wrist extensions (the lowering phase done over 4-5 seconds) are the gold standard for rebuilding tendon strength. A physical therapist can program these properly. The Tyler Twist with a FlexBar is the most-cited home version.
Physical therapy
If you’re not making progress in 4-6 weeks of self-care, see a sports-focused PT or orthopedist. Manual therapy, dry needling, and a guided strengthening program get most stubborn cases back on the court. In Austin and Pflugerville we have several PT clinics that work specifically with pickleball players.
When to See a Doctor
Self-management is fine for mild-to-moderate cases. Book an appointment with an orthopedist or sports medicine doc if:
- Pain has lasted more than 6 weeks despite consistent rest and ice
- You can’t grip a coffee cup without sharp pain
- The elbow is visibly swollen or hot to the touch
- You feel weakness or tingling running down into your hand
- The pain woke you up at night
For persistent cases, options range from cortisone injections (use sparingly — they can weaken the tendon long-term) to PRP (platelet-rich plasma) injections, which have better evidence for tendinopathy. Surgery is rarely needed.
Pickleland’s Two-Cent Take
Pickleball elbow is almost always a load problem disguised as a gear problem. Players come in convinced they need a new paddle, and sometimes they do — but more often the real fix is two rest days a week, a slightly thicker grip, and 10 minutes of forearm work twice a week. Our broader injury prevention guide covers the rest of the body if you want a full overview.
If you’re playing at Pickleland and noticing nagging elbow pain, come grab one of us at the desk. We’ll look at your grip, your paddle, and your weekly volume — usually we can spot the culprit in two minutes. The goal is to keep you on the court for years, not weeks.
This article is for general education and isn’t a substitute for medical advice. If your symptoms are severe or persistent, please see a qualified healthcare provider.