Shoulder Pain in Padel: Why the Elbow Often Pays the Price

Padel places heavy demands on the shoulder. When shoulder capacity is reduced, pain does not always stay where the problem begins. Instead, the elbow often becomes the site of symptoms — particularly on the dominant side. This pattern is common in padel players and reflects how force is transferred through the arm during play. Understanding this relationship helps explain why treating the elbow alone often fails to resolve symptoms.

Padel Is a Shoulder-Dominant Sport

Padel involves frequent overhead and mid-range shoulder activity, rapid acceleration and deceleration of the arm, and repeated rotational loading through the trunk. While the strokes may appear compact, the cumulative demand on the shoulder is significant.

When the shoulder is working well, load is distributed efficiently through the entire upper limb. When it is not, stress is shifted distally — often toward the elbow and forearm.

The Shoulder–Elbow Connection

The shoulder and elbow are not independent joints. They function as part of a kinetic chain, transferring force from the trunk to the hand and racket.

If shoulder strength, control, or endurance is reduced, the body compensates by increasing effort elsewhere. The forearm and elbow often absorb this extra demand, particularly during repeated gripping, volleying, and reactive shots. Over time, this compensation increases tendon load at the elbow.

Padel places heavy demands on the shoulder. When shoulder capacity is reduced, pain does not always stay where the problem begins.

Why Elbow Pain Develops Without Elbow Injury

Many padel players with elbow pain have no history of direct elbow trauma. Instead, symptoms develop gradually as the elbow compensates for reduced proximal support.

This often occurs alongside:

• Shoulder fatigue late in matches

• Reduced shoulder rotation or strength

• Poor scapular control under load

• Increased grip tension to maintain shot control

In this context, elbow pain is not the primary problem — it is the consequence of altered load transfer.

Shoulder Capacity Matters More Than Shoulder Pain

Importantly, shoulder dysfunction does not always present as shoulder pain. Some players report elbow symptoms while the shoulder feels merely “tight,” fatigued, or unreliable rather than painful.

Reduced shoulder capacity may involve:

• Weakness or poor endurance of the rotator cuff

• Limited thoracic or shoulder mobility

• Reduced control of the shoulder blade

• Nervous system protection following previous shoulder issues

These changes can be subtle but still significantly affect how force is managed.

Why Treating the Elbow Alone Often Fails

Local elbow treatment may temporarily reduce pain, but if shoulder-related load issues are not addressed, symptoms commonly return once playing intensity increases.

This is why many players experience a cycle of:

• Short-term relief

• Return to play

• Recurrence of elbow pain

Without restoring shoulder capacity, the elbow continues to absorb forces it is not designed to manage repeatedly.

Local elbow treatment may temporarily reduce pain, but if shoulder-related load issues are not addressed, symptoms commonly return once playing intensity increases.

Rehabilitation Needs to Look Upstream

Effective management of elbow pain in padel players often requires addressing the shoulder and trunk alongside local elbow care.

This typically involves:

• Improving shoulder strength and endurance

• Restoring efficient shoulder blade control

• Enhancing trunk rotation and force transfer

• Reducing excessive grip reliance during strokes

• Gradually rebuilding tolerance to match volume

  
  

This approach improves load distribution rather than simply calming symptoms.

The Role of Load and Fatigue

As matches progress and fatigue sets in, compensation patterns become more pronounced. Shoulder endurance declines first, particularly in players with high weekly volumes or limited recovery. The elbow then works harder to maintain shot quality, increasing tendon strain. This is why elbow pain often worsens later in matches or during tournament periods.

Key Takeaway

In padel players, elbow pain is often the downstream result of reduced shoulder capacity rather than an isolated elbow problem. The elbow “pays the price” when the shoulder cannot manage repeated load effectively. Addressing shoulder strength, control, and endurance — alongside sensible load management — is essential for resolving elbow symptoms and preventing recurrence. Treating the elbow alone is rarely enough.

References:

Kibler, W.B. and Sciascia, A. (2010) ‘Current concepts: scapular dyskinesis’, British Journal of Sports Medicine, 44(5), pp. 300–305.

Pluim, B.M., Miller, S., Dines, J. et al. (2016) ‘Upper extremity injuries in tennis players: diagnosis, treatment, and prevention’, British Journal of Sports Medicine, 50(11), pp. 651–658.

Gabbett, T.J. (2016) ‘The training–injury prevention paradox: should athletes be training smarter and harder?’, British Journal of Sports Medicine, 50(5), pp. 273–280.

Malliaras, P., Barton, C.J., Reeves, N.D. and Langberg, H. (2013) ‘Achilles and patellar tendinopathy loading programmes’, British Journal of Sports Medicine, 47(4), pp. 245–252.

Lewis, J. (2016) ‘Rotator cuff related shoulder pain: assessment, management and uncertainties’, Manual Therapy, 23, pp. 57–68.