How to Deal with Pickleball Elbow


Addressing the chronic condition, common among racket- and paddle-sport players.

GARY A. PATTEE, M.D. is a Diplomate of the American Board of Orthopaedic Surgery, a Fellow of the American Academy of Orthopaedic Surgeons, and a motorcycle-racing enthusiast. 

SOME ATHLETES turn to pickleball as a lower-impact alternative to tennis, but despite the sport’s many benefits, regular players may still be faced with a common condition: tennis elbow, or, rather, “pickleball elbow.” 

Lateral epicondylitis, as it’s known medically, involves a series of microscopic tears of the forearm tendons at their anchor point on the outside of the elbow. This area of the arm is subjected to repetitive stress on the court, particularly during backhand shots and perhaps among players who grip their paddles too tightly. If left untreated, the condition can progress and interfere with simple daily activities, such as lifting a glass of water; in severe cases, the pain can be present at rest and even interrupt sleep.

Unfortunately, the suggested course of action isn’t always popular—players should first decrease the frequency and/or intensity of their play. It’s easier said than done, but when it comes to treatment options, there are no simple answers. 

Adjusting your paddle weight, stiffness, and grip size can help, but there’s no specific formula that’s universally effective. Icing the painful area or using occasional over-the-counter anti-inflammatories may alleviate symptoms, but neither option cures the underlying condition. Band braces and straps, worn on the forearm just below the elbow, can work for pain relief, and physical therapy to stretch and strengthen the wrist and forearm may also reduce the chance of recurrence.

If the pain persists or worsens, consult with your physician for a thorough evaluation. X-rays and MRIs can help rule out conditions such as arthritis, stress fractures, and tumors. In stubborn cases, a corticosteroid injection may relieve symptoms, but because it can lead to complications, such as local soft-tissue atrophy, it’s not a treatment that should be done with any regularity. Another option to consider is PRP, or platelet-rich plasma, which involves extracting growth factors from the patient’s own blood and re-injecting them to induce a healing response. But studies have shown varying results, and the procedure isn’t usually covered by insurance.

Although most cases resolve eventually with conservative measures, there are times when surgery may be recommended. There are many variations, but most involve removing the damaged part of the tendon and reattaching the healthy tissue to the bone. It’s an outpatient procedure, but recovery takes time: Players might not return to the game for four to six months. 

With any athletic pursuit, there’s the risk of stressing the body to the point of pain. If that pain persists and begins to affect your life, don’t ignore it or try to play through it; seeking the help of a licensed physician is the shortest road to recovery.