As more people start playing pickleball, the injuries specific to the sport are becoming more consistent. A common complaint found among pickleball players is Pickleball Elbow (similar to Tennis Elbow). Pickleball elbow is referred to as Lateral Epicondylitis in the medical field. It is caused by overuse of the forearm muscles due to bad mechanics, leading to pain, micro-tearing, inflammation, and weakness. This condition can be debilitating, as it can affect a person’s ability to perform daily activities as well as their recreational activities.

HOW DOES THIS INJURY OCCUR?
The forearm has multiple muscles that run from the hand/wrist up to the elbow. In this case, the muscles that lead to Pickleball Elbow are the extensor muscles of the forearm, which attach to the outside of the elbow (lateral epicondyle). Of all muscles, the Extensor Carpi Radialis Brevis (ECRB) has been shown to be most affected and the source of the pain in most individuals. Repeated stress secondary to poor mechanics during the backhand motion leads to progressive micro-tearing and degeneration of the tendon. If you are experiencing Pickleball Elbow pain, it is imperative to STOP the activity that causes the pain. This is the hardest part for pickleball players! However, the only way to treat this problem is to take away the stress placed on the area. In most cases, the pain starts because the player has bad mechanics in the swing when hitting a backhand, excessively relying on the wrist and causing repetitive trauma to the extensor muscles and ECRB.

THE TREATMENT COURSE SHOULD LOOK LIKE THIS:
1.Stop activity – Control pain, heat, ice, massage

2.Rehab Phase 1 – Manipulation of elbow andwrist, dry needling, trigger point and fasciarelease, compression therapy, cho-pat strap

3.Rehab Phase 2 – Strengthening of forearm musculature focusing on eccentric exercises

4.Find a Coach – Fix your swing mechanics in order to avoid excessive stress on your forearm and elbow, and improve your strokes

5.Return to play

It is important to understand why this injury seems to happen in order to correct it and/or prevent it from getting worse. Taking the appropriate steps toward your recovery is your best chance to being back on the courts faster!

When pickleball players find themselves in a defensive position, they will likely be hitting on their backhand side. Therefore most volleys during an exchange at the net will involve a backhand motion. In addition, repetitive dinking on the backhand side can also be the culprit in causing Pickleball Elbow. Most people between the 2.0 and 4.5 level are more comfortable with their forehand than their backhand, and will exhibit poorer mechanics when hitting a backhand than a forehand. All of these factors contribute to a repetitive motion and stress being placed on the elbow, which ultimately leads to injury.

In addition, a lack of mobility and proper footwork can also be problematic, as players may be prone to opponents being able to dink “behind” them. If players let a dink get a little behind them on the backhand side, then the only way to return to ball in play is to utilize a shot that involves a lot of “wrist action,” once again placing excessive stress on the wrist and elbow.

When you start experiencing pain in the lateral elbow, it is imperative to stop playing immediately. Don’t wait three to four weeks hoping the problem will just magically go away. It will only get worse. The pain is a sign that there is something wrong, and playing through it is not beneficial. Instead, think about the long run and big picture; stop playing for the time being and take away the excessive stress placed on the elbow.

Second, consult a physical therapist who has experience with tennis players or pickleball players. He/she will be able to perform a thorough examination and determine the best course of action for you. The initial phase of your recovery will involve pain control, manual therapy interventions targeted at decreasing your inflammation, muscle tightness, and joint restrictions. Once the pain has been controlled and other impairments addressed, it is time for muscle re-education and strengthening in order to normalize the muscle balance in the shoulder, elbow, and forearm.

Once your physical therapist determines you are ready for discharge and return to pickleball, it is important that you consult a certified pickleball instructor. He/she will be able to look at the way you hit the ball and fix possible flaws in your mechanics in order to ensure that what caused the injury is addressed. In addition, the instructor can address dinking techniques, footwork, and movement efficiency, which will reduce the overall stress placed on your body when you play.

Finally, people often ask me if the weight of the paddle makes a difference, and whether they should get a lighter or heavier paddle. While changing your paddle may have an effect on Pickleball Elbow, and some people may say that their pain went away after switching, it should not be the main factor. Many top players play with paddles of all kinds of weights (ranging from 7 oz. to 10 oz.) successfully and without pain, as their mechanics are sound. Pickleball Elbow can occur no matter what weight your paddle is, so addressing the root cause is the main objective if you have pain.

If you have any questions, you can contact the Pickleball Doctor at thepickleballdoctor@gmail.com.

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Noe Sariban is a Doctor of Physical Therapy, Certified Pickleball Teaching Professional through the IPTPA, and a USAPA-rated 5.0 player sponsored by Engage Pickleball. Please visit www.thepickleballdoctor.com for more information on injury prevention and rehabilitation tips. Noe started his website to provide pickleball players around the world with a reliable and free source of information. Please like his Facebook page, www.facebook.com/pickleballdoctor, for updates and new information.