Pickleball elbow: what it is and how to keep playing

What’s actually hurting?

Lateral elbow tendinopathy involves the tendons around the outside of your elbow, where muscles that help extend your wrist attach. Gripping, lifting and repeated wrist use can aggravate symptoms. You might notice pain when holding your paddle, pouring from a kettle or picking up a bag. These are common features of tennis elbow. Confirming the cause of your pain still requires an assessment. (NHS: Tennis elbow)

The older term “lateral epicondylitis” can make this sound like a simple inflammation problem. The 2022 JOSPT guideline discusses changes in tendon structure, muscle function and pain processing, which is one reason treatment often includes rebuilding strength and activity tolerance. (JOSPT clinical practice guideline)

In pickleball, repeated gripping and wrist movement give you plausible places to look for aggravating activity. A backhand might bother you more than a soft dink. Serving might be comfortable while a hard volley hurts. Those observations tell you which movements provoke symptoms. Whether a particular stroke caused tendon damage is a separate question that your pain pattern alone won’t answer.

Pain on the inside of the elbow, tingling into the hand or symptoms extending from the neck deserve a closer look. Joint and nerve problems can resemble tendon pain. Calling all of it “pickleball elbow” can send you toward the wrong exercises. (JOSPT clinical practice guideline)

When to get checked before trying exercises

Get urgent medical assessment if you have:

• A significant fall or direct blow, especially if the elbow looks misshapen or you cannot move it normally afterward.
• A hot, red, markedly swollen elbow, particularly with fever or feeling unwell.
• New or worsening numbness, pins and needles, weakness or altered hand sensation.
• A hand that becomes unusually cold or pale, or other signs of a circulation problem.
• Severe pain that disrupts sleep or substantially limits ordinary activity.

A history of cancer, osteoporosis or prolonged steroid use should also lower the threshold for getting elbow pain checked urgently. Tell the clinician about these risk factors. (NHS joint health guidance: Elbow pain)

For less urgent symptoms, talk with a qualified clinician if pain persists despite reducing aggravating activity, keeps returning when you play, or makes everyday tasks increasingly difficult. Get the cause checked if you’re unsure where the pain is coming from. This article offers general education; choosing treatment for your elbow may require an examination. (NHS: Tennis elbow; JOSPT clinical practice guideline)

Can you keep playing?

Sometimes. Reducing aggravating activity is part of tennis elbow care, and physical therapy guidance supports a phased return to athletic demands. That leaves room for some activity, with limits based on your symptoms. Playing through escalating pain falls outside that advice. (NHS: Tennis elbow; JOSPT clinical practice guideline)

Start by looking at your actual session. “I played pickleball” could mean twenty minutes of easy practice or an afternoon of competitive games. Those are different demands.

Consider shortening the session and taking more breaks. Temporarily leave out shots that reliably provoke symptoms. If you notice yourself squeezing the paddle hard throughout every rally, easing unnecessary grip effort is another adjustment to explore. These suggestions apply general pacing advice to pickleball. No trial cited here tested them as a pickleball treatment protocol. (BMJ Open: Development of a physiotherapy treatment protocol)

Suppose your usual session is ninety minutes and the last few games consistently make the elbow worse. A shorter session with breaks gives you a specific change to evaluate. Even that amount could be too much for your elbow right now, so check how you feel during play and afterward.

If even light hitting brings escalating pain, stop that session. Repeated flares are a reason to reduce the load and get help choosing the next step. In the OPTimisE protocol, physiotherapists reduced the exercise demands when participants found their symptoms unacceptable. (BMJ Open treatment protocol)

Judge the session after you leave the court, too

The question is bigger than “Did I get through the game?”

The OPTimisE study tracked function as well as pain, including grip strength and difficulty with daily activities. At home, you can notice whether gripping and familiar tasks are becoming easier. These observations help you track progress and give a clinician useful context. They cannot establish a diagnosis. (OPTimisE study report)

Keep a brief note of:

• What you played, how long you played and which movements bothered you.
• How the elbow felt during the session and later that day.
• Whether familiar tasks, such as lifting your usual mug, felt easier or harder the next morning.

Checking the next morning is a practical way to capture a delayed response. A comfortable morning is encouraging, but readiness for unrestricted pickleball needs a broader assessment of your symptoms and function. (JOSPT clinical practice guideline)

If the modified session makes your symptoms or everyday tasks worse, reduce the next session again. Bring that pattern to a clinician if it continues. If the same amount becomes consistently manageable, you have something concrete to discuss when planning progression. Base that discussion on how your elbow is responding, even if you had hoped to be back to full games by a particular date. (OPTimisE study report)

There is no universal pain score in this evidence that gives every player permission to continue. The OPTimisE protocol used symptoms the individual considered acceptable, with physiotherapists guiding adjustments. Because acceptable symptoms varied by participant, you can’t turn that approach into a rule that pain below a certain number is safe to ignore. (BMJ Open treatment protocol)

What exercises are worth doing?

Progressive wrist extensor strengthening is a supported rehabilitation option for subacute or chronic lateral elbow tendinopathy. The wrist extensors help lift the back of your hand toward your forearm. The JOSPT guideline supports resisted exercise using holds, lifting movements, lowering movements or a combination. It leaves room for different approaches, with no single exercise type recommended as best for everyone. (JOSPT clinical practice guideline)

That means you don’t need to chase a supposedly perfect exercise.

An isometric exercise involves producing force while keeping the wrist still. A moving exercise might involve lifting and slowly lowering the hand against resistance with the forearm supported. Choosing the resistance, repetitions and range requires attention to your symptoms, strength and assessment findings. (JOSPT clinical practice guideline)

How you progress the exercise matters too. In the OPTimisE study, the exercise advanced once the current level was no longer painful. When pain became unacceptable, the exercise was made easier. This was one supervised protocol, so it does not set a universal progression rule. If symptoms worsen, make the exercise easier and reassess before advancing. (OPTimisE study report)

A physical therapist can help when you cannot find a manageable starting load, are unsure whether you are doing the movement correctly, or keep flaring symptoms whenever you add resistance. Athletic rehabilitation may also need to address endurance and movement control as you return to the demands of play. (JOSPT clinical practice guideline)

Will strengthening make it recover faster?

Exercise may help pain and function, but the evidence gives us little basis for promising a faster recovery.

In their 2024 analysis, Lowdon and colleagues found no significant short term advantage over control or placebo and a possible midterm benefit from physiotherapy or exercise. Many of the included studies were small, so a fixed recovery promise would go beyond the evidence. You should not expect a particular routine to fix your elbow by next weekend. (Lowdon and colleagues: Comparison of interventions for lateral elbow tendinopathy)

Improvement can take weeks to months, and some people have symptoms for longer. Your progress may look like easier daily tasks before it looks like a full afternoon on court. (NHS: Tennis elbow)

What about an elbow strap or a different paddle?

An elbow strap may offer temporary symptom relief during activity. NHS guidance includes supports among self care options, and a counterforce brace was one part of the broader OPTimisE treatment program. Relief from a strap tells you little about whether strength has recovered. A strap’s ability to prevent the problem from returning also remains unproven in these sources. (NHS: Tennis elbow; OPTimisE study report)

If a strap makes holding the paddle more comfortable, that may be useful. You still need to pay attention to the amount you play and how your elbow feels afterward.

You can test equipment or technique changes, but these sources do not show that one paddle weight, grip size or material treats elbow pain. “Buy this paddle and cure your elbow” goes beyond what the evidence supports.

Where GoodMetal fits

GoodMetal’s programs are built by licensed physical therapists with 10+ years of experience each. They designed the exercises, weekly sessions and phase progressions every plan follows, giving you guidance on pacing and when to hold back before moving forward. GoodMetal also includes a large guided exercise video library.

These programs are general templates, so they have limits on how much they can account for your situation. Diagnosis and individualized medical care require a clinician’s assessment.

If your symptoms need an examination, start there. If a general exercise program is appropriate, look for a plan that makes your next session clear and explains how to adjust when symptoms interfere.

Before your next game

Write down what happened after your last session, including any change in everyday tasks the next morning. If your symptoms allow continued activity, use those observations to choose a smaller amount to evaluate. Bring them to a physical therapist if the pattern is unclear or symptoms keep worsening.

Gradual reintroduction of athletic demands is supported by the clinical guideline. Repeating a session that keeps causing a flare gives you little room to progress. (JOSPT clinical practice guideline)

The next useful goal may be modest: finding an amount of play you can tolerate while working on strength. If you cannot find that starting point, get assessed before trying another full session.

Sources

[1] Lateral Elbow Pain and Muscle Function Impairments - PubMed; [2] Tennis elbow; [3] Development of an optimised physiotherapist-led treatment protocol for lateral elbow tendinopathy: a consensus study using an online nominal group technique | B; [4] Optimising physiotherapy for people with lateral elbow tendinopathy – Results of a mixed-methods pilot and feasibility randomised controlled trial (OPTimisE) - ; [5] JOSPT PERSPECTIVES FOR PRACTICE; [6] Comparison of Interventions for Lateral Elbow Tendinopathy: A Systematic Review and Network Meta-Analysis for Patient-Rated Tennis Elbow Evaluation Pain Outcome; [7] Unsupervised Isometric Exercise versus Wait-and-See for Lateral Elbow Tendinopathy.; [8] Elbow pain - My Joint Health Hub.