Padel Tennis Elbow: Prevention & Treatment Guide for Lateral Epicondylitis
Padel tennis elbow, formally known as lateral epicondylitis, is a common injury among padel players. It is often caused by repetitive arm movements and improper technique, but it can be prevented and well-managed with the right strategies, equipment, and a structured rehabilitation programme.
What Is Padel Tennis Elbow and Why Padel?
Padel tennis elbow refers to the painful degeneration and overload of the common extensor tendons that attach to the bony prominence on the outer side of the elbow, called the lateral epicondyle. This condition isn't an acute tear; rather, it’s a failure of the tendon to repair itself in the face of persistent, cumulative strain.
In padel, the extensor muscles in the forearm are used extensively to stabilise the wrist during ball impact and, crucially, to control the deceleration and impact of the racket. This is particularly true during backhand shots, volleys, and smashes. Poor technique, such as leading with the elbow or using excessive wrist snap (flick) on a backhand, massively increases the load on these small tendons. Over time, the continuous, repetitive mechanical strain causes microtrauma, leading to pain, weakness, and limited arm function.
While experienced players possess the muscle conditioning and refined technique to manage these forces, beginners and those who undergo abrupt increases in training intensity or frequency are particularly vulnerable. The pain is typically felt during padel sessions and can severely interfere with everyday tasks like gripping, lifting, or shaking hands.
Comprehensive Prevention Strategies
1. Mastering Technique
The most critical preventative measure is proper swing mechanics. Players must learn to use the large muscles of the torso and shoulder (the kinetic chain) to generate power, rather than relying on the smaller forearm muscles.
Backhand Focus: Avoid excessive wrist extension or 'flicking' the ball. The backhand should be executed with a stable wrist, leading with the hip and shoulder rotation.
Volleys: Maintain a firm, locked wrist position to absorb the impact force using the larger arm muscles, preventing the shock from localising in the elbow tendons.
2. Physical Conditioning and Strengthening
A structured off-court routine is essential to build resilience.
Warm-up Routine: Begin every session with dynamic stretches (e.g., arm circles, wrist rotations) and light cardio to increase blood flow and muscle temperature.
Targeted Strengthening: Focus on exercises that strengthen the forearm extensors and flexors, as well as the rotator cuff and shoulder girdle. Strong shoulder and core muscles provide a stable base, reducing the strain placed on the elbow. Examples include wrist curls (for flexors), reverse wrist curls (for extensors), and light resistance band rotations for the shoulder.
Flexibility: Regular stretching of the forearm muscles, performed after play, helps maintain tissue elasticity and reduces chronic tension.
3. Equipment Optimisation
Selecting the appropriate equipment is non-negotiable for elbow health.
Grip Size: A grip that is too small forces the player to grip the handle more tightly, engaging the forearm muscles excessively. The correct grip size allows the fingers to wrap comfortably without strain. Overgrips are often necessary to achieve the ideal diameter.
Racket Weight and Balance: Opt for a slightly lighter racket or one with a more head-light balance. This reduces the momentum and force transferred to the elbow upon impact.
Racket Core: Rackets with a soft EVA rubber core tend to absorb more vibration than those with a hard core, helping to dampen the shock reaching the elbow. Carbon fibre surfaces often provide better shock absorption than fibreglass.
Recognising Symptoms and Seeking Intervention
Early recognition of symptoms allows for swift, effective intervention and prevents the condition from becoming chronic. The main signs to look out for include:
Persistent pain directly on the lateral epicondyle or radiating down the forearm.
Pain worsening with gripping, lifting a coffee cup, or turning a door handle (extending the wrist).
Localised tenderness when pressing on the outer elbow bone.
Reduced strength and difficulty maintaining a secure grip during shots.
If these symptoms persist for more than a few days, it's crucial to seek professional advice.
Treatment: The Path to Recovery
Effective padel-centric treatment combines the principles of load management, physiotherapy, and gradual return to play.
Immediate Management: The first step is relative rest. Avoid playing padel and other activities that reproduce the pain. In the initial 48–72 hours, applying cold packs for 15 minutes every hour can help manage inflammation and pain. Over-the-counter anti-inflammatories or topical medications may be used, but always under medical supervision.
Physiotherapy and Rehabilitation: This is the cornerstone of recovery. A physiotherapist will prescribe eccentric exercises (where the muscle lengthens while contracting), which are highly effective in stimulating tendon repair and promoting load tolerance. Treatment may also include manual therapy, dry needling, local electrotherapy, and the use of kinesiology tape to offload the muscle.
Supportive Gear: Braces or compression sleeves worn just below the elbow can temporarily relieve tension on the tendon attachment. However, these are tools to be used alongside active rehabilitation exercises, not a long-term solution.
Diagnostic Clarity: If symptoms persist or worsen despite conservative treatment, an expert consultation and diagnostic imaging, such as a musculoskeletal ultrasound, can clarify the extent of tendon damage or rule out other issues like nerve entrapment.
Long-Term Prevention of Recurrence
The recovery phase ends only when the player can return to full activity without pain. This requires a gradual reintroduction of padel, paying strict attention to the technical corrections learned during rehabilitation.
To prevent recurrence, the player must:
Maintain the conditioning and strengthening routine indefinitely.
Commit to correct technique (stable wrist, using body rotation).
Regularly check and adjust equipment (grip, racket condition).
Padel tennis elbow is preventable and treatable. By prioritising technique, conditioning, equipment suitability, and early intervention, players can ensure pain-free and sustainable enjoyment of the sport.
