Pickleball elbow: preventing and managing lateral epicondylitis
“Pickleball elbow” is the nickname for lateral epicondylitis — a chronic inflammation of the tendons that attach forearm muscles to the outside of the elbow. It’s the same injury tennis players get, it’s the most common overuse injury in pickleball, and it’s particularly common in players over 50 because the tendons become less flexible with age. The reassuring news: it’s almost entirely preventable, and almost always caused by fixable mistakes in technique or equipment.
What it feels like
Early-stage pickleball elbow feels like a dull ache on the outside of your elbow, especially:
- When you grip something firmly (opening a jar, turning a key).
- When you straighten your arm fully.
- The morning after a hard pickleball session.
- When you lift a coffee cup with your palm facing down.
Late-stage pickleball elbow is sharp, consistent pain — it hurts when you hit a backhand, hurts when you dink, and sometimes hurts just sitting at a desk. That’s the stage you want to avoid. If you have early-stage symptoms, fix them now.
The five causes, in order of how common they are
1. Gripping the paddle too tight
This is the single biggest cause. A death grip on the paddle (8+ out of 10 squeeze pressure) transmits every shock from the ball into your forearm tendons. Tendons don’t love that. After thousands of reps with a tight grip, the attachment points at the elbow start breaking down.
The fix: grip at 3 out of 10 on dinks and 5 out of 10 on drives, never tighter. If your forearm is sore after a session, you’re gripping too tight. The paddle should almost feel loose in your hand during soft shots.
2. A paddle that’s too heavy
A heavier paddle generates more power but also more shock. For players over 50, a paddle over 8.0 ounces is a risk factor. Many players use heavy paddles because their first paddle was heavy and they never reconsidered, or because a friend told them “heavier = better.”
The fix: if you have elbow pain, switch to a paddle between 7.3 and 7.8 ounces. Your power drops slightly, your control improves, and the tendon stress is dramatically lower. See the choosing a paddle wiki page for how to pick one.
3. Hitting the ball late
When you hit the ball behind your body or jammed into your chest, the forearm muscles have to work against the direction of motion, which multiplies stress on the tendons. Late contact + tight grip + heavy paddle is the recipe for inflammation.
The fix: contact in front of your body. Every shot — dink, drive, volley — should be met a few inches in front of your lead foot, not at your hip or behind it. Move your feet to get in position instead of reaching.
4. Too many reps without rest
Tendons don’t heal with use. If you play pickleball six days a week at 2 hours a day, and you’re over 50, your tendons don’t get a chance to recover. The damage accumulates until it becomes chronic.
The fix: take at least one full rest day a week. Two is better. If you feel elbow soreness lingering into a second day, take an extra day. The pickleball will still be there.
5. Cold tendons
Playing without warming up is much harder on tendons than playing after a proper warmup. Cold tendons are stiff, less elastic, and more prone to micro-tears.
The fix: warm up for 5 minutes before every session. See the warmup routine wiki page for a specific routine. Never skip this, especially in cold weather.
What to do if you already have pain
If you’re in the early stages (dull ache after play, not constant):
- Reduce your play frequency. Go from five times a week to three, temporarily.
- Fix the five causes above. Grip, paddle, contact, rest, warmup. Do all five.
- Ice your elbow for 10 minutes after each session.
- Do forearm stretches and eccentric exercises. Eccentric exercises (slow controlled lowering with a light weight) are the single most-evidence-backed treatment for tendinopathy. Your PT can teach you the specifics — two common ones are “wrist curls with slow lowering” and “reverse wrist curls with slow lowering.”
- Consider a counterforce brace. These are little bands you wear on your forearm just below the elbow; they work by redirecting the force of the muscles away from the injured tendon attachment. They help some players, not all.
If you’re in the late stages (sharp, constant pain):
- Stop playing. Really. Keep playing through chronic tendinopathy and you’ll end up with months of forced rest instead of weeks.
- See a sports medicine doctor or physical therapist. Do not try to self-diagnose at this stage. They may recommend eccentric exercises, dry needling, ultrasound therapy, or in rare cases a cortisone injection.
- Plan a 2–6 week layoff from pickleball, during which you do specific rehab exercises daily.
- When you come back, come back at 50% intensity for two weeks, and do everything on the prevention checklist.
Prevention checklist (put this on your fridge)
- Grip: 3/10 on dinks, 5/10 max
- Paddle weight: 7.3–7.8 oz if you’ve had any elbow issues
- Contact in front of the body, every shot
- Warm up for 5 minutes before every session
- Take at least one full rest day per week
- Ice after hard sessions in summer, especially in your 60s and beyond
- Stop playing the moment a dull ache becomes a sharp pain
Pickleball elbow is common, but it’s not inevitable. Players who follow this list play into their 70s and 80s without serious elbow problems. Players who ignore it often quit the sport in their 60s because they can’t hit a ball without pain. The difference is mostly grip pressure and one rest day a week.