Tennis Elbow in Padel Players: Why It Happens and What Actually Helps

Despite its name, tennis elbow is one of the most common upper-limb complaints seen in padel players. Many are surprised by the diagnosis, particularly if they have never played lawn tennis or experienced elbow pain before. In padel, tennis elbow rarely results from a single incident. Instead, it develops gradually as the result of repeated load, reduced recovery, and changes in movement demand. Understanding this process is key to managing symptoms effectively and staying on court.

What Tennis Elbow Really Is

Tennis elbow, more accurately termed lateral elbow tendinopathy, involves pain around the outer elbow linked to the forearm extensor tendons. These tendons help control grip, wrist position, and force transmission through the arm.

Importantly, this condition is not inflammatory in most cases, nor is it a sign that the tendon is “tearing.” It reflects a tendon struggling to tolerate the load placed upon it.

Tennis elbow is not inflammatory in most cases, nor is it a sign that the tendon is “tearing.” It reflects a tendon struggling to tolerate the load placed upon it.

Why Padel Places Unique Stress on the Elbow

Padel differs from lawn tennis in ways that matter for the elbow. The sport involves:

• A high volume of repetitive strokes

• Sustained rallies with limited rest

• Frequent grip changes and reactive shots

• Off-centre ball contact during wall play

• A strong reliance on wrist and forearm control

These demands place continuous stress on the forearm tendons, particularly when playing frequency increases quickly or recovery is insufficient.

Why Symptoms Develop Gradually

Most padel players do not recall a specific moment when elbow pain started. Instead, they often describe:

• Mild elbow discomfort after matches

• Stiffness the following day

• Pain when gripping the racket or lifting objects

• Symptoms that settle with rest but return quickly on play

This pattern suggests load intolerance, not acute injury. The tendon is signalling that current demand exceeds its ability to adapt.

Why Rest Alone Rarely Solves the Problem

Short periods of rest may reduce pain temporarily, but prolonged avoidance often reduces tendon capacity further. When play resumes, symptoms return — sometimes more quickly than before. Tendons require appropriate, progressive loading to recover. Removing load entirely for too long reduces strength and tolerance, making recurrence more likely.

The Role of Strength in Recovery

Effective management of tennis elbow focuses on restoring the tendon’s ability to tolerate load. This typically involves structured, progressive strengthening of the forearm, wrist, and supporting muscles.

Strength training helps by:

• Improving tendon load tolerance

• Reducing reliance on protective gripping strategies

• Supporting force transfer through the arm

• Reducing sensitivity over time

Exercise-based rehabilitation is strongly supported in the management of tendinopathy (Malliaras et al., 2013).

Short periods of rest may reduce pain temporarily, but prolonged avoidance often reduces tendon capacity further.

Why Technique and Load Still Matter

While technique is rarely the sole cause of tennis elbow, changes in playing style, racket choice, or grip tension can influence load. Increased playing frequency, competition, or tournament schedules often expose underlying capacity issues rather than create them.

Addressing load management — how often, how hard, and how long someone plays — is therefore essential alongside rehabilitation.

The Nervous System’s Contribution

Persistent elbow pain is influenced not only by tendon tissue, but also by nervous system sensitivity. After repeated irritation, pain can persist even when tendon structure is relatively healthy.

Education and graded exposure to load help recalibrate this sensitivity, restoring confidence and reducing over-protective responses.

Where Hands-On Treatment Can Help

Hands-on treatment, including sports massage or acupuncture, may help reduce muscle guarding and sensitivity around the forearm and elbow. However, these approaches do not replace rehabilitation.

Their value lies in supporting comfort and engagement with strengthening, not in fixing the tendon in isolation.

When to Seek Further Assessment

Assessment is recommended if elbow pain:

• Persists despite reduced play

• Is worsening or spreading

• Significantly limits grip strength

• Affects daily activities such as lifting or typing

Early guidance helps prevent long-term tendon sensitivity and prolonged time away from sport.

Key Takeaway

Tennis elbow in padel players is rarely about damage or inflammation. It reflects a tendon struggling to keep up with the demands placed upon it.

With appropriate load management, progressive strengthening, and informed support, most padel players can return to play comfortably and reduce the risk of recurrence. The goal is not to avoid load, but to build tolerance and resilience — keeping players confident and on court.

References (Harvard Style)

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.

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.

Rio, E., Kidgell, D., Purdam, C. et al. (2015) ‘Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy’, British Journal of Sports Medicine, 49(19), pp. 1277–1283.

Bialosky, J.E., Bishop, M.D., Price, D.D., Robinson, M.E. and George, S.Z. (2009) ‘The mechanisms of manual therapy in the treatment of musculoskeletal pain’, Manual Therapy, 14(5), pp. 531–538.