Padel Elbow, and How to Fix It

The short answer

Padel elbow is tendon pain where the forearm muscles attach to the elbow, caused by the wrist snap and the vibration that padel puts through a solid racket. It behaves like tennis elbow but it is not caused by the same thing, and that matters for how you treat it. The restriction is almost always in the forearm, two or three inches below the point that hurts.

Where it hurts, and which one you have

Two versions, and padel produces both.

• Outside of the elbow. The wrist extensors, same site as tennis elbow. Usually from backhands and from bracing the wrist against the ball.
• Inside of the elbow. The wrist flexors, same site as golfer's elbow. In padel this often comes from the serve and the smash, and from heavy topspin.

Press firmly on the bony point and then press into the muscle below it. If the muscle is sorer than the bone, that tells you where the work needs to happen.

Why padel does this more than tennis

I see more elbows from padel than from tennis, and the players are usually fitter and playing fewer hours. Four things about the sport account for it.

• The racket has no strings. A padel racket is a solid perforated face. There is no string bed to absorb and spread the impact, so more of it arrives at your forearm.
• The handle is short. You cannot spread load up the arm the way a longer tennis grip lets you. The wrist does more of the work.
• The walls change the shots. Balls come off the glass at awkward heights and you end up reaching and flicking from positions you would never choose. Those are the shots that load a tendon badly.
• It is social, so people play through it. Nobody cancels a four at nine in the morning because of a slightly sore elbow. Three weeks later it is a problem.

There is a wider piece on padel injuries in the Algarve that covers shoulders, knees and the rest.

Does a padel elbow brace work?

A lot of people search for this, so here is a straight answer. A forearm strap, the band that sits a few centimetres below the elbow, does help while you play. It changes where the load sits on the tendon and takes some of it off the attachment.

It does nothing for the underlying restriction. If you wear a strap for three months and never treat the forearm, you have managed a symptom for three months. Use it to keep playing while you fix the actual problem, not instead of fixing it.

Why treating the sore spot does not work

The painful bit is where the tendon attaches to the bone. The reason it is being pulled is that the muscle it belongs to has lost the ability to slide and lengthen properly, further down the forearm. Working on the attachment point presses on something already irritated and leaves the cause untouched.

This is the single most common reason people arrive having had six sessions somewhere else with no change. They were treated where it hurt.

How I treat it

Active Release Technique on the forearm, with your wrist moving through flexion and extension while I hold tension on the restricted structure. Treating the tissue while it moves gets at the restriction where it actually limits you. I am certified in full-body ART®, upper limbs in 2017, and this is one of the problems it handles best.

Alongside that, trigger point work through the forearm and often the triceps, and a look at the shoulder blade. A shoulder that is not controlling the arm properly makes the forearm work harder on every shot, and treating the elbow without checking it is why some elbows keep coming back.

There is more on the method on the Active Release Technique page, and elbow work sits inside a normal sports massage session. If your elbow came from tennis rather than padel, the tennis elbow post goes into that side of it.

What you should be doing between sessions

Treatment on its own gets you comfortable. Loading the tendon is what makes it hold.

• Slow eccentric wrist work. Light weight, lower it slowly, three seconds down. This is the part most people skip and it is the part that actually rebuilds the tendon.
• Grip checks. If you are strangling the handle between shots, your forearm never gets a break. Most players grip harder than they need to and have no idea.
• Stop the wall flicks for a bit. Not the sport, just the worst shot. If a particular reach off the glass is the one that stings, leave it for two weeks.

How long it takes

If you have had it for three weeks, expect two or three sessions and a noticeable change in the first. If you have had it for eight months and played through all of it, four to six, and the tendon work between sessions stops being optional.

If three sessions produce no change at all, the problem is not soft tissue and I will tell you that rather than keep booking you in.

When to see a doctor instead

Get it looked at medically rather than massaged if the elbow locks or catches, if you cannot straighten it fully, if it swelled up quickly, or if you have pins and needles in the hand. Those point at something other than a tendon.

Booking

I treat padel players at the clinic in Almancil and travel to villas across the Algarve, including the courts at The Campus in Quinta do Lago. Clinic sessions are €37 for 30 minutes, €52 for 45 and €60 for the hour, and an elbow is fine in 45. Mobile visits are €140 per hour. WhatsApp 925 382 490 and tell me which side of the elbow it is.