Padel Elbow: Causes, Prevention & Treatment

Padel is the fastest-growing sport in the world. Over 35 million people now play across 150 countries, and Cyprus is no exception — courts are popping up everywhere from Nicosia to Limassol. But here's the problem nobody talks about at the club: the elbow is the number one injury site in padel players.

A systematic review published in BMJ Open Sport & Exercise Medicine found that padel has an injury prevalence of 40-95%, with the elbow consistently ranking as the most commonly affected area (Dahmen et al., 2023). That's significantly higher than tennis, where the shoulder and knee tend to dominate the injury statistics.

I see padel players every week in my clinic in Nicosia. Most of them arrive with the same story: pain on the outside of the elbow that started gradually, got ignored for a few weeks, and is now making it impossible to grip the racket without wincing. They've tried rest, they've tried a brace, they've Googled "tennis elbow" — and nothing has worked.

This article is the guide I wish every padel player in Cyprus would read before their elbow forces them off the court.

What Is "Padel Elbow" — And Why It's Not Just Tennis Elbow

Let's start with the name. "Tennis elbow" is the common term. The clinical name is lateral epicondylalgia — pain at the bony prominence on the outside of your elbow, where the wrist extensor tendons attach. These are the muscles that control your grip and extend your wrist — every time you hit the ball, they're working.

But calling it "tennis elbow" in a padel context is misleading, because padel puts unique stresses on the elbow that tennis doesn't:

• Wall shots. Playing off the glass walls means absorbing unpredictable vibration and impact angles that you don't get in tennis. Your forearm muscles have to react and stabilise in milliseconds.
• The bandeja and vibora. These padel-specific overhead shots require a combination of wrist control and pronation under load that generates significant eccentric stress on the wrist extensors.
• Smaller court, faster pace. Padel rallies tend to be longer and more continuous than tennis, meaning more repetitive loading cycles per session.
• Racket design. Padel rackets are solid (no strings), which transmits more vibration directly to the forearm. Research shows that vibration transfer from racket sports is implicated in the development of lateral epicondylalgia (Yeh et al., 2019).

So while the injury looks the same on paper as tennis elbow, the mechanism in padel is often more aggressive and develops faster — particularly in players who are new to the sport and suddenly loading their forearm in ways it's never experienced before.

Why Your Elbow Hurts — The Real Mechanism

Here's what most people get wrong: they think "padel elbow" is an inflammation problem. It's not. It's a load management problem.

The most widely accepted model of tendon injury is the tendinopathy continuum, described by Cook and Purdam and updated in the British Journal of Sports Medicine (Cook et al., 2016). It has three stages:

1. Reactive tendinopathy. This is what happens when you suddenly increase your playing load — say, going from one match per week to four. The tendon swells and stiffens as a short-term protective response. It's reversible with proper load management. This is where most padel players are when they first feel pain.
2. Tendon disrepair. If you keep overloading, the tendon structure starts to break down. Collagen fibres separate, new blood vessels grow into the tendon (which shouldn't happen), and the tissue becomes weaker. Still partially reversible, but harder.
3. Degenerative tendinopathy. Areas of the tendon have died. The tissue is disorganised and structurally compromised. This is the "I've had this for a year" stage. It requires longer, more careful rehabilitation.

The 5 Biggest Risk Factors in Padel

A systematic review comparing injuries across padel, tennis, and squash found specific risk factors that make padel players particularly vulnerable to elbow problems (King et al., 2025):

1. Wrong grip size. A grip that's too small forces excessive squeezing, dramatically increasing the load on your wrist extensors. A grip that's too large also strains the forearm. Check yours — you should be able to fit one finger between your fingertips and palm when holding the racket.
2. Playing more than 6 hours per week without conditioning. The research is clear: playing frequency above 6 hours per week and racket weight above 350g are both associated with significantly higher injury rates. If your forearm muscles aren't conditioned for that volume, your tendon pays the price.
3. No warm-up. Walking onto court cold and immediately hitting hard shots is one of the fastest ways to overload an unconditioned tendon. A proper padel-specific warm-up takes 10 minutes and can prevent weeks of rehabilitation.
4. Poor backhand technique. A wrist-dominant backhand — "flicking" the ball rather than driving through with the shoulder and trunk — concentrates force on the lateral epicondyle instead of distributing it through the kinetic chain.
5. Sudden spikes in playing volume. This is the most common trigger I see. Someone discovers padel, falls in love with it, and goes from zero to five sessions a week in a fortnight. The tendon can't adapt that fast.

What Doesn't Work (And What the Evidence Says)

Let me save you some time and money by telling you what the research says about popular treatments that don't work as standalone solutions:

Cortisone Injections

They feel amazing for 2-3 weeks. Then the pain comes back — often worse. Multiple studies have shown that corticosteroid injections provide short-term relief but are associated with worse long-term outcomes compared to doing nothing. They weaken the tendon structure and increase the risk of recurrence.

Complete Rest

Deloading — reducing your playing volume — is helpful. Complete rest is not. When you completely stop loading a tendon, it loses its capacity to handle stress. When you return to playing, it's even less prepared than before. This is why "I took 3 months off and it came back in the first week" is such a common story.

Passive Treatments Without Exercise

A major meta-analysis of 30 trials and 2,123 patients published in the British Journal of Sports Medicine found that exercise interventions consistently outperform passive treatments for lateral elbow tendinopathy (Karanasios et al., 2021). Massage, ultrasound, laser therapy — they can feel good, but without progressive loading, they don't fix the underlying problem.

Shockwave Therapy Alone

Shockwave has some evidence for mid-term pain reduction, but a systematic review of 27 studies found no clinically significant benefit over sham treatment (Karanasios et al., 2021). It can be useful as an adjunct to exercise, but it's not a magic bullet.

What Actually Works — The Evidence-Based Approach

The treatment that works is not glamorous. It doesn't involve fancy machines or quick fixes. It involves progressive loading — gradually building the tendon's capacity to handle stress through a structured exercise programme.

Phase 1: Pain Management (Weeks 1-2)

Start with isometric exercises. Research by Rio et al. published in the British Journal of Sports Medicine (2015) showed that a single bout of heavy isometric contraction reduces tendon pain immediately for at least 45 minutes and increases muscle strength without damaging the tendon. A follow-up study confirmed that isometric contractions are more analgesic than isotonic contractions for tendon pain (Rio et al., 2017).

How to do it: Place your forearm on a table, palm down. Press the back of your hand against the underside of the table and hold at 70% effort for 30-45 seconds. Repeat 3-5 times. Do this before playing and whenever you have pain.

Phase 2: Progressive Loading (Weeks 2-8)

Move to eccentric-concentric exercises. The latest evidence suggests that combining eccentric and concentric loading with isometric work produces the best outcomes — better than eccentric exercise alone (Stasinopoulos, 2022). A comprehensive rehabilitation programme published in the International Journal of Sports Physical Therapy recommends 3 sets of 15 repetitions, progressing resistance over 6-12 weeks (Day et al., 2019).

The key is progression: start light, increase load gradually, and monitor pain response. Mild discomfort during exercise is acceptable. Pain that lasts more than 24 hours means you've done too much.

Phase 3: Return to Court (Weeks 6-12)

Don't go from rehab straight back to competitive matches. Start with:

• Light rallying (no competitive points) — 20 minutes
• Gradual increase in shot power and spin
• Add match play once you can rally for 30 minutes pain-free
• Get your technique checked — particularly your backhand and grip
• Continue your strengthening exercises 2-3 times per week indefinitely

4 Exercises You Can Start Today

When to See a Physiotherapist

You should book an assessment if:

• Your elbow pain has been present for more than 2 weeks with no improvement
• Pain is getting worse despite reducing your playing volume
• You've noticed a significant drop in grip strength
• Pain is waking you up at night
• You've tried self-management for a month and it's not working

A physiotherapist can determine which stage of tendinopathy you're in, identify contributing factors (technique, equipment, training load), and design a progressive loading programme specific to your needs. Not sure if you need one? Read our guide on when to see a physio vs when to wait it out.

Frequently Asked Questions

Can I keep playing padel with elbow pain?

It depends on the severity. Mild discomfort that settles within 24 hours of playing may be manageable with load modification — reducing session frequency or duration. But if pain increases during or after play, or if your grip strength is noticeably weaker, continuing to play without addressing the problem will make it worse. A physiotherapist can help you modify your load so you stay on court while the tendon recovers.

How long does padel elbow take to heal?

With proper rehabilitation (progressive loading, not just rest), most cases improve significantly within 6-12 weeks. Reactive tendinopathy caught early can resolve in 4-6 weeks. Chronic degenerative tendinopathy that's been present for months may take 3-6 months. The earlier you start proper treatment, the faster the recovery.

Should I use an elbow brace for padel?

A counterforce brace (the strap worn just below the elbow) can help reduce pain during activity by offloading the tendon. It's a useful short-term tool while you rehabilitate. But a brace alone won't fix the problem — it needs to be combined with progressive strengthening exercises to address the underlying tendon weakness.

Is shockwave therapy effective for padel elbow?

The evidence is mixed. A 2021 systematic review found that shockwave therapy may reduce pain in the mid-term, but the clinical significance over placebo is limited (Karanasios et al., Clinical Rehabilitation, 2021). It can be a useful adjunct to exercise-based rehabilitation, but should not be used as a standalone treatment. Progressive loading exercises remain the gold standard.

Can grip size cause elbow pain in padel?

Absolutely. A grip that's too small forces you to squeeze harder to control the racket, increasing the load on your wrist extensor tendons with every shot. A grip that's too large can also strain the forearm by requiring excessive wrist deviation. The correct grip size should allow you to fit one finger between your fingertips and palm when holding the racket. Racket weight above 350g is also associated with higher elbow injury risk (King et al., 2025).

Sources & Further Reading

Antonis Petri, BSc, OMPT

Lead Clinician & Co-Founder at Right Track Physiotherapy. Clinical Practice Supervisor at Frederick University. A former amateur footballer with over a decade on the pitch, he specializes in sports rehabilitation and return-to-performance programs for athletes in Cyprus.