A new sport, a familiar injury
Pickleball has grown fast enough that we're now seeing a steady stream of new patients with what's essentially tennis elbow, just acquired on a smaller court with a paddle instead of a racquet. The clinical injury — irritation and micro-damage to the tendons that attach the forearm's wrist-extensor muscles to the outer elbow — is the same condition we've always called tennis elbow. But a few features specific to how pickleball is played do change some of the practical advice.
Why pickleball loads the elbow differently
A few factors seem to add up to more elbow strain in pickleball, particularly for players new to racquet sports:
Paddle rigidity. Pickleball paddles are generally more rigid and transmit more shock through the arm on contact than a strung tennis racquet, which naturally absorbs some vibration.
Volley-heavy play. Points at the net involve quick, repetitive volleys with less time to set up technique properly compared to tennis groundstrokes, which can mean more mishits and awkward contact points loading the tendon.
Rapid ramp-up in playing frequency. Pickleball's social, low-barrier-to-entry nature means a lot of players go from occasional play to several sessions a week quickly, often faster than their tendons have had time to adapt.
None of this makes pickleball elbow a fundamentally different injury from tennis elbow — the tissue involved and the healing process are the same — but it does mean the practical fix often has a slightly different starting point.
What's the same as tennis elbow treatment
The core treatment principles don't change: an exam to confirm the diagnosis and rule out other causes of elbow pain, hands-on treatment to reduce tendon irritation, and — most importantly — a progressive loading program to rebuild the tendon's capacity to handle strain. Rest alone rarely fixes tendon issues; the tendon needs to be gradually reloaded in a structured way, or the same pain tends to return once play resumes.
What's different for pickleball players specifically
Paddle and grip review matters more. Because paddle rigidity is a bigger factor than in tennis, reviewing paddle weight, grip size, and vibration-dampening features is often more relevant advice for pickleball players than it would be for a tennis player with the same injury.
Technique coaching may need to address different mechanics. The quick-volley, reactive nature of pickleball means technique breakdowns often show up differently than the classic tennis backhand mechanics associated with tennis elbow — a pickleball-specific look at contact point and wrist position can be more useful than generic tennis elbow advice.
Volume management looks different. Because many pickleball players are newer to racquet sports and ramped up quickly, the more relevant fix is often building in a more gradual increase in playing frequency, rather than the technique refinement a longtime tennis player might need.
Practical steps if you're dealing with it
Reduce playing volume rather than stopping entirely, unless the pain is sharp or significantly limiting — most players don't need to give up the sport, just temporarily dial back frequency and intensity. Ice the outer elbow after play if it's inflamed. Have your paddle grip size and weight reviewed, since an easy equipment adjustment sometimes meaningfully reduces load. And be patient with any loading exercises you start — tendons improve over weeks, not days, regardless of which sport caused the irritation.
The bottom line
Pickleball elbow and tennis elbow are, clinically, the same tendon injury — which means the same evidence-based treatment principles apply. But because pickleball's equipment and playing patterns differ meaningfully from tennis, the practical advice around paddle choice, technique, and volume management is worth tailoring to the sport rather than copying tennis elbow advice word-for-word. If the pain isn't improving with basic modification after a couple of weeks, an exam can confirm the diagnosis and get a proper progressive loading plan started.
