I was a very serious tennis player for almost 50 years and never suffered from “tennis elbow” until I started playing pickleball just over a year ago. I stubbornly refused to rest and after several months of rehabilitation, physical therapy and acupuncture, the problem finally resolved. Unlike tennis where the ball is soft and strings have give or flex when hitting the ball, this does not occur in pickleball due to the solid ball and paddle. I have treated numerous cases of lateral epicondylitis in my 35 years of practice, and it can be a very challenging condition to successfully treat.

What is Pickleball/Tennis Elbow?
Lateral epicondylitis is a painful condition of the elbow generally caused by repetitive motion and overuse, and it is commonly seen among pickleball players. It involves small tears or micro evulsions of the muscles and tendons on the lateral or outside of the elbow. The symptoms of pickleball elbow develop gradually and are not associated with a specific incident or injury. This condition is also commonly seen in individuals who aren’t involved in racket sports, such as cooks, carpenters, plumbers and painters. The muscles involved in this injury are the forearm extensors that attach to the lateral epicondyle and raise the hand and wrist. The signs and symptoms of pickleball elbow include pain, burning, point tenderness and swelling on the outside of the elbow. The symptoms are exacerbated by holding a paddle, shaking hands, lifting heavy objects, making a fist, turning a door handle and with backhand strokes.

Other causes of pickleball elbow include poor technique, improper body positioning, late strokes, weak forearm muscles and a strength imbalance between the flexion and extension muscles of the wrist.

Prevention
The following are ways to avoid pickleball elbow:

• Proper grip size is important and measured in two ways. 1. When gripping the paddle there should be enough room to place the index finger between the fingers and base of the thumb. 2. Measure the distance from the crease of your palm to the tip of your ring finger. This is the most accurate method to determine grip size.

• Gently stretch and exercise the arm and elbow muscles before playing.

• Pay attention to your stroke technique while playing and make sure you are not hitting shots with an unstable wrist. Using too much wrist during impact places tremendous stress on the elbow and wrist joints along with the surrounding soft tissue. If you are having problems or are unsure about your strokes, have a coach or experienced player watch you play and provide feedback. Try hitting with different paddles made from various materials to find the one that is most comfortable, has less impact and works best for you.

Treatment
Finally, if you do develop tennis elbow there are many options available for treating this problem:

• RICE: Rest, ice, compression and elevation. Ice is used over the affected area for 15/20 minutes several times a day. Players must modify the activity that causes the problem by changing the amount, frequency or intensity.

• (NSAIDs): Non-steroidal anti-inflammatory drugs such as Aspirin, Naprosyn, Ibuprofen etc. may also be used to reduce pain, inflammation and swelling.

• Lateral epicondyle bracing can also be an effective way to support and stabilize the affected elbow.

• Specific strengthening exercises for the forearm and wrist.

• Physical therapy modalities including: ultrasound, cold laser treatment, electrical muscle stimulation, massage, acupuncture and dry needling.

• Injections of steroids, autologous blood and platelet-rich plasma have also been shown to reduce inflammation and speed the healing process.

• Surgical intervention as a last resort, if conservative treatment fails after 6-12 months, should be considered.