Tennis Elbow from Pickleball? Denver PTs Share Tips for Relief and Prevention

Rise RSP
Jun 11
3 min read

Pickleball has exploded in popularity across Colorado, especially here in the Denver metro area. It’s fast, fun, and social — but it can also be hard on your elbows.

If you’ve noticed pain on the outside of your elbow after playing, you might be dealing with lateral epicondylitis, better known as tennis elbow. And yes, despite the name, it doesn’t just happen to tennis players.

At Rise Rehab and Sport Performance, we see a growing number of active adults dealing with pickleball-related elbow pain. The good news? You don’t have to give up your favorite sport. With the right approach, you can recover fully — and prevent it from coming back.

What Is Tennis Elbow, Really?

Tennis elbow is a common overuse injury of the tendons on the outside of your forearm, particularly the extensor carpi radialis brevis (ECRB). These muscles help extend your wrist and stabilize your grip — both heavily used in pickleball.

Common Symptoms:

Pain or burning on the outside of the elbow
Grip weakness (especially with paddles, water bottles, etc.)
Tenderness over the lateral epicondyle
Pain that increases with wrist extension or lifting objects

It often starts subtly and worsens over time, especially if you keep playing through discomfort.

Why Pickleball Causes Elbow Pain

Pickleball combines quick, repetitive wrist and forearm motions with rapid changes in direction. It also encourages extended rallies with smaller paddles and harder balls than tennis, which can place more strain on your elbow tendons.

Contributing Factors:

Poor technique ("wristy" shots or lack of shoulder involvement)
Weakness in the shoulder or core leading to compensation at the elbow
Overgripping or using the wrong paddle size/weight
Limited forearm or shoulder mobility

Why Rest Alone Isn't the Answer

While taking a break may reduce your symptoms temporarily, rest doesn’t address the root causes of tennis elbow. Tendons need load to heal — just not too much, too soon.

At Rise, we take a progressive approach that includes:

Tendon loading exercises to rebuild resilience
Manual therapy to improve tissue quality and reduce guarding
Movement retraining to improve shot mechanics
Strengthening the kinetic chain (especially shoulder and scapular control)

What Denver PTs Recommend Instead of Just Resting

1. Isometric Wrist Extension Holds

Helps reduce pain and stimulate tendon healing without excessive load.

Sit with your forearm supported, palm down
Extend your wrist against gentle resistance (like a light band)
Hold for 30–45 seconds, 3–5 times daily

2. Eccentric Wrist Extension

Builds tendon strength and tolerance to load.

Use a light dumbbell (1–3 lbs)
Lift with assistance, then slowly lower your wrist over 3–5 seconds
2–3 sets of 8–12 reps

3. Forearm and Shoulder Mobility Drills

Poor mobility can increase strain on the elbow.

Wrist flexor/extensor stretches (gentle, 30s holds)
Thoracic spine extension on foam roller
Shoulder CARs (controlled articular rotations)

4. Scapular and Rotator Cuff Strengthening

A strong shoulder supports better paddle control and reduces elbow stress.

Sidelying external rotation with towel support
Prone Y/T/I lifts
Resistance band scapular rows

5. Technique Tune-Up

Your movement patterns matter.

Avoid "wrist flicks" in serves and volleys
Use your legs and shoulders more during overheads and drives
Consider a lesson from a coach to clean up inefficient mechanics

How to Prevent Tennis Elbow from Pickleball

Warm up before playing: light cardio and dynamic upper body drills
Check your grip size and paddle weight with a coach or specialist
Don’t overdo it: gradually increase playing time, especially after time off
Cross-train: include strength work, mobility, and cardio outside of pickleball