Pickleball Elbow: What the Evidence Says About Causes, Prevention and Treatment

Person holding a pickleball paddle near the net

Short answer: "Pickleball elbow" usually means pain on the outside of the elbow (tennis elbow) or, a little more often in one study, the inside (golfer's elbow). In a courtside study of 129 recreational players, 5.4% tested positive for outer elbow pain and 7% for inner elbow pain. The treatment with the best support is a graded exercise program, ideally guided by a physio. Most cases of tennis elbow improve within a year. No study has yet tested whether paddle choice prevents or fixes it.

Last checked: 20 October 2026.

Written by Peter and Amanda, founders of Ace Sporting Goods. We're not doctors or physiotherapists, so this article summarises published research, linked at the end. If elbow pain lasts or gets worse, see your GP or a physio.

What is pickleball elbow?

It isn't a separate medical condition. Players use the name for elbow pain that comes on with play. Most of the time it's one of two tendon problems.

  • Outer elbow pain is lateral elbow tendinopathy, often called tennis elbow. It involves the tendons that extend your wrist.
  • Inner elbow pain is medial elbow tendinopathy, often called golfer's elbow. It involves the tendons that flex your wrist.

Pain from a fall, a sudden pop, swelling, numbness or tingling is different. Get that checked.

How common is it?

Elbow problems are common in pickleball, but they aren't the most common injury.

  • A US survey of 1,758 regular players (average age 62.7) found 68.5% reported an injury complaint in the past 12 months. The knee was the most affected area (29.1%). The elbow came fifth, at 18.4%, behind the knee, the rest of the leg, the shoulder and the back (Owoeye 2025).
  • One study tested 129 recreational players at the court. 5.4% tested positive for outer elbow pain, 7% for inner elbow pain and 2.3% for both. Players with at least four years of experience had a lower risk (Myers and Hanks 2025).

We could not find any published Australian research on pickleball injuries when we searched PubMed and the web on 20 October 2026. Our search wasn't exhaustive. The figures here come from the US.

How do most pickleball players get hurt?

For context, serious injuries look different from elbow pain. US emergency department data is the largest source we have.

  • Pickleball injuries seen in US emergency departments rose sharply as more people took up the game. One study found a 91% rise from 2020 to 2022 (Cheng 2025). These are counts, not rates. They grew mostly because more people play.
  • Most patients are older. In one analysis, over 85% of injury cases were players aged 60 or over (Weiss 2021).
  • Falls were the most common cause, at 65.5% of injuries in a 10 year analysis (Yu 2025).
  • Fractures and sprains or strains were the most common diagnoses (Yu 2025, Cheng 2025).
  • Among injured players aged 60 and over seen in US emergency departments, women had about nine times the odds of a wrist fracture compared with men (Weiss 2021). Women also had higher odds of fractures overall (McMillan 2026).

What raises the risk of elbow and arm pain?

The research here is thin. Two small studies give us clues, not proof.

An online survey of 253 recreational players found 41% had had at least one arm or shoulder injury from pickleball (Hanks and Myers 2025). The risk was 1.51 to 1.53 times higher in people who:

  • played longer sessions
  • played more often
  • played on back-to-back days

Sudden injuries were more likely in people who played more than two hours at a time, played on consecutive days, or kept a tight grip on baseline shots. Longer term problems were more common in people who had played for more than two years, at a higher level, or for more than six hours a week. Stretching and strengthening habits showed no link either way.

A survey shows a link. It can't show cause. Still, the pattern fits what we know about overuse.

Does your paddle make a difference?

The short answer: nobody has tested it in pickleball yet.

  • We found no study linking paddle weight, grip size, core or face material to elbow pain in pickleball.
  • The tennis research is old, small and points in different directions. A 1979 survey of over 500 tennis players linked larger grips to more elbow pain in older players (Gruchow 1979). A 2006 lab study of 16 college players found grip size changes of a quarter inch made no difference to forearm muscle activity (Hatch 2006).
  • A lab study found tennis string dampers did not reduce vibration reaching the forearm (Li 2004).

No paddle is proven to fix elbow pain. Choose one that feels comfortable, then focus on how much you play and how you recover. Our paddle buying guide covers weight and grip size if you're choosing one anyway.

What treatment does the evidence support?

Most of this research is on tennis elbow (outer elbow pain). Here's what it shows.

Option What the research found Strength of evidence
Exercise program (often wrist extensor strengthening) Recommended as first-line treatment in a 2022 physiotherapy guideline (Lucado 2022). A review of 30 trials found exercise beat passive treatments, but the benefit was small (Karanasios 2021). Low to very low certainty, but the best supported option
Wait and see In a Brisbane trial of 198 people, most in both the physio and wait-and-see groups reported success at one year (Bisset 2006). One randomised trial
Cortisone injection Better at six weeks, then high relapse and worse results later (Bisset 2006). In another Brisbane trial, 83% recovered or much improved at one year after cortisone, against 96% after a placebo injection (Coombes 2013). Two randomised trials
PRP or blood injections Probably no meaningful improvement over a placebo injection (Karjalainen 2021, Cochrane review). Moderate certainty
Elbow strap or brace No firm conclusion possible from the trials available (Struijs 2002, Cochrane review). The 2022 guideline allows short-term use for pain relief, based mainly on expert opinion (Lucado 2022). Weak

A physio can tailor an exercise program and tell you how much play is sensible while it settles.

Does a warm-up prevent pickleball injuries?

Nobody has tested a pickleball warm-up yet. Here's what other sports show.

  • In recreational and sub-elite football, the FIFA 11+ warm-up program cut the injury rate by 39% across four trials (Thorborg 2017).
  • A review of 25 trials found strength training and balance training reduced sports injuries. Stretching on its own did not (Lauersen 2014).
  • The one trial in adult recreational tennis players found an online prevention program made no difference. Only 8% of players stuck to it closely (Pas 2020).

A short warm-up before play is sensible and low risk. Just don't expect it to be a guarantee.

For older players, the bigger risk is falling. A Cochrane review of 59 studies found exercise cut the rate of falls in older people by 23%, and balance and functional exercise by 24% (Sherrington 2020). That work happens off the court.

What can you do to lower your risk?

These steps follow the research above. None of them is proven to prevent pickleball elbow.

  1. Build up gradually. Longer, more frequent sessions and back-to-back days were linked to more arm injuries.
  2. Relax your grip between shots. A tight baseline grip was linked to sudden arm injuries in one survey.
  3. Warm up. It's unproven in pickleball but works in other sports.
  4. Do some strength and balance work off court. Especially if you're over 60. In US data, falls cause most serious pickleball injuries.
  5. Get persistent pain checked early. A GP or physio can confirm what it is and set up an exercise plan.

Frequently asked questions

Is pickleball elbow the same as tennis elbow?

Often, yes. Outer elbow pain from pickleball is usually lateral elbow tendinopathy, the same condition as tennis elbow. In one study of pickleball players, inner elbow pain (golfer's elbow) tested positive slightly more often (Myers and Hanks 2025).

Will a lighter paddle help my elbow?

There's no evidence either way. No study has tested paddle weight and elbow pain in pickleball. Pick a weight that feels comfortable and that you can swing without strain.

Should I wear an elbow strap?

Some people find a strap eases pain during play. The research can't confirm a lasting benefit (Struijs 2002, Lucado 2022). Ask your physio.

How long does tennis elbow take to get better?

In an Australian trial, most people reported success at one year, whether they had physio or simply waited (Bisset 2006). Physio helped more in the first six weeks.

Is cortisone a good idea?

It can help in the short term, but two Brisbane trials found worse results or more relapses later (Bisset 2006, Coombes 2013). Talk it through with your doctor.

Is there Australian research on pickleball injuries?

Not that we could find. Our searches of PubMed and the web on 20 October 2026 found none, though they weren't exhaustive. The data above is from the US.

Related guides

References

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  2. Cheng R, et al. A substantial increase in injuries and hospitalizations associated with playing pickleball from 2020 to 2022. Arthrosc Sports Med Rehabil. 2025. PMID 40297091. doi:10.1016/j.asmr.2024.101067
  3. Coombes BK, et al. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia. JAMA. 2013. PMID 23385272. doi:10.1001/jama.2013.129
  4. Gruchow HW, Pelletier D. An epidemiologic study of tennis elbow. Am J Sports Med. 1979. PMID 474862. doi:10.1177/036354657900700405
  5. Hanks J, Myers BA. Risk of upper extremity injury in recreational pickleball players. J Funct Morphol Kinesiol. 2025. PMID 40700183. doi:10.3390/jfmk10030247
  6. Hatch GF, et al. The effect of tennis racket grip size on forearm muscle firing patterns. Am J Sports Med. 2006. PMID 16861576. doi:10.1177/0363546506290185
  7. Karanasios S, et al. Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small. Br J Sports Med. 2021. PMID 33148599. doi:10.1136/bjsports-2020-102525
  8. Karjalainen TV, et al. Autologous blood and platelet-rich plasma injection therapy for lateral elbow pain. Cochrane Database Syst Rev. 2021. PMID 34590307. doi:10.1002/14651858.CD010951.pub2
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