Tennis Elbow in Padel: Causes, Prevention and Treatment

Tennis elbow in padel (lateral epicondylitis or lateral elbow tendinopathy) is irritation and pain in the tendon where the wrist extensor muscles on the outer forearm attach to the elbow, caused by repetitive load. Short answer: in padel, this problem usually stems from a combination of an overly tight grip, hitting with the wrist alone, a stiff and heavy racket, a thin grip and a sudden jump in training; prevention comes down to managing load gradually and strengthening the forearm. The information in this article is for general educational purposes; for diagnosis and treatment, consult your doctor.

As the O’Padel Sky coaching team, this is the complaint we hear most often on court. In this guide, we look at the causes specifically in the context of padel, give you preventive exercises, explain the impact of equipment and offer a realistic answer to the question “Can I play with pain?”

What exactly is tennis elbow?

On the outer side of the elbow there is a small bony bump (the lateral epicondyle). The forearm muscles that bend the wrist back and open the fingers attach here through a common tendon. This tendon works every time you grip the racket, stabilize your wrist and strike the ball. When the load exceeds the tendon's capacity to recover, structural changes and pain develop in the tendon tissue. Although it's called “tennis” elbow, it can appear in any activity that requires repetitive gripping, such as padel, squash or even computer use.

Typical symptoms: tenderness when pressing on the outside of the elbow, pain when lifting a cup or shaking hands, morning stiffness, and sharp pain on backhands or shots that require gripping. Symptoms develop slowly over weeks; there is usually no single “moment of injury.”

Why is it so common in padel?

Padel is played with a shorter racket and a slower ball than tennis, which at first glance seems safer for the elbow. But a few padel-specific factors tip the balance.

1. A tight-grip habit

New players and those coming from tennis hold the racket tightly all the time. In padel, however, the racket should be held loosely except at the moment of impact. A constantly tight grip keeps the extensor tendon under tension throughout the point. Our continental grip article explains the technique of a relaxed grip.

2. Hitting from the wrist

When balls come off the glass and quick reactions are needed at the net, players use the wrist instead of the body and arm. The wrist “flick” puts load directly on the extensor tendon. The correct kinetic chain starts from the legs and is transferred to the racket through torso rotation; our wrist usage article focuses on this topic.

3. Racket and grip choice

Stiff (high-density EVA core, carbon face), heavy and head-heavy (diamond-shaped) rackets increase vibration and the grip force required. A thin grip makes your fingers close more and leads to a tighter grip. We covered this topic in detail in our racket stiffness and elbow health article.

4. A sudden increase in volume

The most classic mistake of padel beginners: playing once a week in the first month, then jumping to four sessions a week in the second month with Americano, league play and lessons. Tendons don't adapt as quickly as muscles; load should increase gradually. The training load management article provides guidance on this.

5. Weak shoulders and trunk

If the shoulder, shoulder blade and trunk don't generate enough force, the forearm makes up the difference. That's why tennis elbow is often not an “elbow problem” but the result of missing strength elsewhere in the chain. For this reason, in our conditioning program, shoulder and core work is included to protect the elbow.

Risk factors: know yourself

Factor	Increases risk	Reduces risk
Grip	Constantly tight, “death grip” hold	Loose throughout the point, tightening at contact
Source of the stroke	Wrist and forearm	Leg-hip-trunk rotation
Racket	Stiff, heavy, head-heavy	Soft/medium core, balanced, medium weight
Grip	Thin, worn, slippery	Built up with 1–2 overgrips, dry
Volume	Sudden jump from 1 to 4 times a week	Gradual increase, rest days
Strength	Weak forearm, shoulder, shoulder blade	2 preventive strength sessions a week
Daily life	Long hours at the keyboard, heavy carrying	Breaks, ergonomics, forearm stretching

Prevention: a 15-minute weekly forearm program

The core principle of tendon health is to load the tendon gradually and in a controlled way, not to rest it completely. The exercises below are preventive for healthy players. If you already have pain, set the exercise dose with a physical therapist or doctor.

1. Eccentric wrist extension — Light dumbbell (0.5–1.5 kg), forearm on a table, palm down. Lift the wrist up with your other hand, then lower it with the working hand in a controlled 3–4 seconds. 3×12, 3 times a week. This is the most studied exercise for tennis elbow.
2. Eccentric wrist flexion — Same movement, palm up. 3×12.
3. Grip squeeze and release — Soft ball or grip trainer. 3×15, squeeze for 2 seconds, release over 3 seconds.
4. Forearm supination-pronation — Rotate your palm while holding a hammer or the end of a light dumbbell. 3×10 each direction.
5. Finger extension (rubber band) — Open your fingers against the band. 3×15. Balances the extensors.
6. Shoulder external rotation and face pulls — With a band, 3×15. Strengthens the upper link of the chain.

Do this program on a separate day or after a match, not as part of your warm-up ; for the warm-up itself, light wrist circles and stretching are enough.

Technique fixes: the first 4 things a coach will check

• Grip pressure: On a 1–10 scale, 3 while waiting for the ball and 6–7 at impact. If it's constantly 9, your elbow pays the price.
• Backhand preparation: Late preparation makes the racket “catch up” from behind with the wrist. Turn early and hit with the shoulder.
• Patience on glass rebounds: Instead of meeting the ball early, wait for it to come off the glass and hit with your body; wall play technique directly protects the elbow.
• Use your body, not your arm, on the bandeja and smash: On overhead shots, the shoulder blade and trunk rotation should be engaged; “chopping” with the arm tires both the shoulder and the elbow. See shoulder injuries.

Daily life: the load off the court

Tennis elbow doesn't only develop on the court. A player in Maslak who uses a keyboard and mouse all day, holds the phone in one hand for long periods or always carries a sports bag with the same hand arrives at the court with an already tired forearm. The 90 minutes you spend on court come on top of a 40-hour week of desk work. Simple measures: use the mouse in a position that keeps your wrist neutral, do a 30-second forearm stretch every hour, carry your bag on both shoulders or switch sides, and don't carry heavy bags with your racket hand. These small changes let the tendon save its recovery budget for the court.

Equipment: racket, grip and elbow brace

For players who have pain or are at risk, equipment choices make a meaningful difference. A round or teardrop-shaped racket of medium weight, with a balance not shifted toward the head and a soft or medium-density core, reduces vibration and requires less grip force. Increasing grip thickness with one or two overgrips keeps the fingers from closing too much. Our racket selection guide and our grip article will help you decide.

An elbow brace (counterforce strap) can spread some of the tension on the tendon and provide comfort while playing, but it doesn't eliminate the causes. It can be used as temporary support but shouldn't be seen as a permanent solution. Since racket rentals are available at Sky, you can try different rackets to find the one that suits your elbow; our courts page has more information.

If the pain has started: what to do and what not to do

The steps below offer a general approach; your personal plan is set by your doctor and physical therapist.

Do

• Reduce load, don't stop completely: Cut back your weekly court time, limit the shots that hurt most (usually the backhand and hard volleys), but keep doing forearm exercises at a light dose. Complete rest weakens the tendon.
• Early assessment: If the pain lasts more than two weeks or you feel it in daily activities, see a doctor. The O’Athletic Sky sports physiotherapists at Skyland can identify the source of the load with stroke analysis and create a progressive loading program; why this matters is explained in our physiotherapy article.
• Review your equipment: Racket stiffness, grip thickness, grip pressure.
• Work the rest of the chain: Shoulder, shoulder blade, trunk. You can build strength in other areas while the elbow rests.

Don't

• Take painkillers and play at full load — it silences the signal and makes the problem worse.
• Use a hard massage gun or deep pressure on the elbow — it irritates a sensitive tendon.
• Stop using it entirely for weeks — tendons heal with load, not with immobility.
• Decide on your own to try injections or treatments you've seen online — these decisions are made with your doctor.

Returning to the court: a gradual protocol

Once the pain subsides, your return to the court should also be gradual. A sample approach: week one, mini-court rallies and soft forehands only; week two, back-court rallies and loose-grip backhands; week three, light volleys and the bandeja; week four, a controlled match. At any stage, if the pain doesn't return to baseline within 24 hours, go back to the previous stage. During this period, add forearm stretching to your post-match cool-down and stretching add forearm stretches to your routine. For a general framework, we have an article on the return-from-injury protocol. Sports massage at O’Spa Sky can help reduce tension around the forearm and shoulder; however, the massage is applied to the surrounding muscles, not directly to the tendon area.

Conclusion

Tennis elbow isn't a padel player's destiny; it's the result of technique, equipment and load management. A relaxed grip, hitting from the body, the right racket and 15 minutes of forearm work a week provide enough protection for most players. Having a coach, a sports physical therapist and a spa in the same complex at Skyland Istanbul makes it easy to act fast when a problem starts: in Sarıyer, you can walk a few steps after your lesson to get a stroke analysis and try out equipment on the court. If you have symptoms, consult your doctor first; then our coaching team, review your technique. That's the path to staying on the court for many years.

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