Pickleball/ Padel Elbow Is Real: Why Bangkok’s Fastest Growing Sports Is Filling Physio Clinics

Written By Sivakorn (Nuy) Aekapun, Senior Physiotherapist

The reason padel and pickleball hurt so many elbows is not that they are hard. It is that they are easy. They are simple to pick up and gentle enough that you never feel wrecked afterward, so you play three or four times a week without a second thought, far more volume than anyone would ever put into tennis. Your arm is doing a brand new repetitive movement, a lot, on tissue that has never trained for it. That is the perfect recipe for tennis elbow.

Because that is what this is. If your outer elbow aches every time you grip, pour, or shake a hand, you have common extensor tendinopathy, the same overload of the tendons on the outside of the elbow that racket players have dealt with for decades. The sport is new, the injury is not.

Here is how to treat it: load the tendon, do not rest it into weakness, and skip the steroid injection that most people reach for first. The rest of this explains why.

Why the easy sport is the one that gets you

Padel and pickleball are two of the fastest growing sports in Asia, with courts opening across Bangkok hotels and gyms. Low barrier to entry is their whole appeal, and also their trap. A hard sport limits its own dose because your body forces a rest day. An easy, addictive one does not, so the weekly and monthly volume climbs quietly until the tendon is the first thing to object.

The hard numbers so far are on padel, and they fit the pattern. A systematic review of padel injuries found the elbow was the single most common site, ahead of the knee, shoulder, and lower back, with tendon and muscle injuries the most reported types (British Journal of Sports Medicine, 2023). A 2025 study from a German trauma center sharpened it two ways: professional players, the ones logging the most hours, get injured significantly more than casual players, and players who do not also play another racket sport injure their elbow significantly more often than those who do (Journal of Sports Medicine and Physical Fitness, 2025). More volume, and a less prepared arm. Pickleball, with its lighter paddle and even lower barrier to entry, drives the same tendon the same way. That is the padel or pickleball newcomer exactly.

The biomechanics do the rest. In both sports the backhand is repetitive and the light paddle is gripped hard, especially by nervous beginners. Every shot asks the wrist extensors to brake the paddle eccentrically, lengthening under load, which is the exact stress that overloads the extensor tendon at the elbow. Do that for two hours, four times a week, on an arm that has never done it, and the tendon complains.

How to actually treat it

Tennis elbow is a tendon problem, so it responds to what tendons respond to: controlled load, not rest and not aggression.

Modify, do not stop. Full rest feels right and makes the tendon weaker. Cut your padel or pickleball volume, loosen your grip, check that your paddle is not too heavy or too head-heavy, but keep the arm moving.

Load the tendon. Slow, progressive strengthening of the wrist extensors is the most evidence-backed treatment for lateral epicondylitis. Eccentric and isometric work rebuilds the tendon's capacity to take force. This is the part that lasts.

Be patient. Tendons remodel over weeks to months, not days. Pain easing is not the same as the tendon being ready for full play.

The steroid shortcut, and why it backfires

The old default for tennis elbow was a corticosteroid injection. It is fading for good reason. Steroid shots give real short-term relief in the first weeks, then perform worse over the medium term. In one controlled trial, corticosteroid injection had a 50 percent success rate at 52 weeks, against far higher rates for autologous blood injection and shockwave therapy, with a high recurrence rate (Journal of Hand Surgery European Volume, 2010). A separate analysis found symptoms peaked around three months then deteriorated by six, with recurrence in nearly half of steroid patients, and evidence that the injection can degrade the very tendon it is meant to calm (Cochrane review data, cited 2015).

Short-term comfort, worse long-term healing. For a tendon you want to trust on court for years, that is the wrong trade.

How we would approach this at Bodytune Physio

Every case is different, and the plan below is illustrative, not a fixed protocol. What it shows is the pathway.

Assess. A physiotherapist confirms it is the extensor tendon and not the neck, the wrist, or a nerve referring pain to the elbow. We check grip strength, the exact painful movements, and how far the load tolerance has dropped.

Plan. We build a plan around your padel or pickleball schedule, not against it, with a clear load progression and realistic timelines so you know what each week should feel like.

Treat. Depending on what we find, treatment may include high power laser to stimulate the tendon and manage pain, PMS to support the surrounding muscle, or manual techniques at the elbow and wrist. These calm symptoms so you can do the loading work that actually heals it. Not every tool suits every case.

Exercise and Mobilize. The core of recovery is progressive extensor loading you continue at home, advanced as the tendon can take more, until the arm handles a full session again.

Bodytune Physio operates at Sukhumvit Soi 16, rated 5.0 across 91 Google reviews. Book an assessment on 080 398 9988.

FAQ

Is padel or pickleball elbow the same as tennis elbow?

Yes. All three are common extensor tendinopathy, an overload of the tendons on the outside of the elbow. Padel and pickleball just produce it faster in new players because of the repetitive backhand, the tight grip, and the sheer volume people play.

How do you treat tennis elbow?

The most effective treatment is progressive strengthening of the wrist extensor tendons, combined with reducing the aggravating load rather than resting completely. Manual therapy and clinic modalities can ease pain so you can do the loading work.

Should I get a steroid injection for tennis elbow?

Usually no. Corticosteroid injections relieve pain short term but lead to worse outcomes and higher recurrence over six to twelve months, and can delay tendon healing. Loading-based rehab gives better lasting results.

How long does tennis elbow take to heal?

Tendons remodel over weeks to months. Many people feel meaningful improvement within six to twelve weeks of consistent loading, but returning to full play too early is the most common reason it comes back.

Can I keep playing padel or pickleball with tennis elbow?

Often yes, at reduced volume and with a lighter grip, as long as pain stays low and settles quickly. Complete rest tends to weaken the tendon. A physiotherapist can set the right playing dose while you rehab.

References

Internal links

Sivakorn (Nuy) Aekapun, Senior Physiotherapist
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