Pickleball Elbow: Treating Tennis Elbow Before It Sidelines You
You picked up pickleball for the cardio, the community, or just to keep up with your foursome — and now every dink and drive sends a jolt of pain down the outside of your forearm. If you've started avoiding your backhand or wincing when you shake hands, you're dealing with what's become known as "pickleball elbow," and you're far from alone. Here's what's actually happening in the tendon, why it's so common in this sport specifically, and the treatment path that gets high performers back on the court without losing the progress they've built.
What Is "Pickleball Elbow," Exactly?
Despite the nickname, pickleball elbow treatment in Carrollton, TX almost always addresses the same underlying condition as tennis elbow: lateral epicondylitis. It's an overuse injury to the tendons that attach your wrist extensor muscles to the bony bump on the outside of your elbow (the lateral epicondyle).
Every time you snap your wrist back to hit a dink, drive, or overhead smash, those tendons absorb the force of deceleration. Do that a few hundred times in a two-hour session — which is common in pickleball's fast-paced, high-repetition rally style — and the tendon starts to break down faster than it can repair itself.
Why Pickleball Is Especially Hard on the Elbow
Pickleball's smaller court and lighter paddle create a deceptively high-repetition sport. Points are short, but rallies are frequent, and the paddle's stiffness transmits more shock to the elbow than a strung tennis racquet does. Add in a tight grip — common among newer players still building confidence with the paddle — and you have a near-perfect setup for tendon overload.
The Research: How Common Is This Injury?
This isn't a fringe complaint. A 2025 survey of 253 recreational pickleball players found that 41% reported at least one upper extremity injury, split between acute (10%) and chronic, overuse-type injuries (37.5%) — the category lateral epicondylitis falls into (Hanks & Myers, 2025).
The same study found that players who gripped the paddle tightly at baseline had more than double the relative risk of acute injury, and that playing more than six hours a week or for more than two years significantly raised the odds of chronic injury (Hanks & Myers, 2025). In other words: the more you play, and the tighter you hold on, the more your elbow pays for it.
Why "Just Resting" Often Isn't Enough
Most players' first instinct is to power through, then eventually take a week or two off when the pain gets bad enough. That approach helps in the short term, but it rarely solves the underlying problem.
Lateral epicondylitis isn't simply inflammation — despite the "-itis" suffix, chronic cases involve a degenerative process in the tendon called tendinosis, where collagen fibers become disorganized and poorly vascularized. Rest reduces the aggravating load, but it doesn't rebuild that tissue. That's why so many recreational athletes report the same pattern: they rest, feel better, return to the court, and the pain comes right back within a few sessions.
Treatment Options That Actually Work
Shockwave Therapy for Lateral Epicondylitis
Extracorporeal shockwave therapy (ESWT) delivers focused acoustic pulses into the tendon to stimulate blood flow and a controlled healing response in tissue that has stalled out. It's one of the more established options for stubborn, chronic tennis elbow that hasn't responded to rest and stretching alone.
It's worth being honest about the evidence here, the same way we approach every treatment we recommend. A 2024 systematic review and meta-analysis comparing shockwave therapy to corticosteroid injections for chronic lateral epicondylitis found that injections produced faster short-term relief at one month, but shockwave therapy pulled ahead at the three-month mark on pain and function scores (Zhang et al., 2024). Translation: if you want a quick fix for a big event, an injection may work faster initially. If you want a more durable, tissue-level fix without the risks that can come with repeated steroid injections, shockwave therapy tends to hold up better over time.
How Forward Health and Wellness Approaches It
At Forward Health and Wellness, we don't treat pickleball elbow with a single tool. A typical plan combines shockwave therapy with soft-tissue work — often IASTM to address the fascial restriction and scar tissue that builds up around a chronically irritated tendon — plus a progressive loading program to rebuild the tendon's tolerance for the exact forces that got it hurt in the first place.
We've used a similar staged approach with heel pain that behaves the same way — you can read more about how we apply shockwave therapy for chronic plantar fasciitis, a condition that shares a lot of the same degenerative tendon biology as tennis elbow.
At-Home Strategies You Can Start Today
You don't have to wait for your first appointment to start protecting the tendon. These steps are safe to begin immediately if your pain is mild to moderate.
1. Loosen your grip. Actively practice holding the paddle with the lightest grip that still gives you control — think "holding a bird," not "choking a rope." This single change can meaningfully reduce the load on the tendon during every shot.
2. Try an eccentric wrist extensor stretch. Extend the affected arm in front of you, palm down. With your other hand, gently pull the fingers and wrist down and back until you feel a stretch along the top of your forearm. Hold 20–30 seconds, repeat 3 times, a few times a day.
3. Add light eccentric strengthening. Hold a light dumbbell (1–3 lbs) with your palm down and wrist hanging off the edge of a table. Use your other hand to lift the wrist up, then slowly lower it under control over 3–4 seconds. Ten to fifteen slow reps, once daily, builds the tendon's capacity to absorb load over time.
4. Ice after play, not before. Fifteen minutes of ice on the outside of the elbow after a session helps manage the inflammatory response without blunting your performance during play.
5. Take a real break from high-repetition drilling. You don't have to quit pickleball, but reducing volume for one to two weeks — especially skipping back-to-back-day sessions — gives an irritated tendon a fighting chance to catch up.
6. Check your paddle. A paddle that's too heavy, or has a grip size that's too small for your hand, increases strain on the forearm with every shot. A quarter-inch grip adjustment can make a real difference.
When to See a Specialist
If your elbow pain has lasted more than two to three weeks despite backing off volume and trying the exercises above, or if you're losing grip strength, it's time for a professional evaluation. Left untreated, chronic lateral epicondylitis tends to get harder to resolve the longer it's ignored, and compensating with altered mechanics elsewhere in the swing can create shoulder or wrist issues on top of the original problem.
Ready to Get Back on the Court?
Pickleball elbow doesn't have to end your season. At Forward Health and Wellness in Carrollton, TX, we specialize in getting active adults and athletes back to the activities they love with a treatment plan built around the actual biology of your injury — not just symptom management.
Call us at (214) 506-3029 or book online to schedule your evaluation. Let's get that tendon rebuilt and get you back to the kitchen line.
Move Forward.
References
Hanks, J., & Myers, B. (2025). Risk of upper extremity injury in recreational pickleball players. Journal of Functional Morphology and Kinesiology, 10(3), 247. https://doi.org/10.3390/jfmk10030247
Zhang, L., Zhang, X., Pang, L., Wang, Z., & Jiang, J. (2024). Extracorporeal shock wave therapy versus local corticosteroid injection for chronic lateral epicondylitis: A systematic review with meta-analysis of randomized controlled trials. Orthopaedic Surgery, 16(11), 2598–2607. https://doi.org/10.1111/os.14212