Padel Elbow

"My elbow's killing me — and the only thing I've changed is I started playing padel."

Brussels has had a padel boom. New courts have opened in Etterbeek, Woluwe, Forest and Anderlecht; office leagues run on weeknights; couples and friend groups have replaced Friday drinks with Friday matches. With the volume of new players has come a very predictable injury — and it's the most common new presentation in the clinic this month.

Padel elbow is the same condition as tennis elbow (lateral epicondylitis), but the mechanism is slightly different. The smaller racket, the wall play, and the explosive volleys at net produce a lot of decelerating, off-axis loading on the wrist extensors. After 4–8 weeks of regular play, the tendons that attach those muscles to the outer elbow start to complain.

What Is Padel Elbow?

Lateral epicondylitis — irritation and degeneration of the common extensor tendon at the outside of the elbow. Despite the "-itis" name, it's not classical inflammation; it's a tendinopathy, where the tendon's structure has started to break down faster than it can repair under repetitive load.

Typical Symptoms

Why Padel Elbow Happens

The mechanism

The wrist extensors (a group of muscles on the back of the forearm) attach to the outside of the elbow via the common extensor tendon. Every time you stabilise the racket on impact — particularly on backhand and overhead volleys — these muscles fire eccentrically. Hundreds of impacts per match, multiplied across two or three sessions a week, accumulates load faster than the tendon can adapt.

The padel-specific factors

• Heavy or head-heavy rackets. Many beginners pick a "powerful" head-heavy racket, which increases the moment-arm at impact and loads the wrist extensors harder.
• Wrong grip size. A grip that's too small forces the forearm to clamp harder to keep control, dramatically increasing extensor load.
• String tension too high. Stiffer strings transmit more vibration to the elbow.
• Wall play. Volleys off the back wall require quick, decelerating wrist actions that load the lateral elbow specifically.
• Sudden volume increase. Going from zero to three matches a week is the single biggest predictor in clinic.
• Cold-weather indoor padel. Insufficient warm-up before going straight into hard rallies — common in winter and on weeknight after-work sessions.

The Brussels factor

Most new padel players in Brussels are 30- to 50-year-old professionals who haven't done racket sports for years (or ever). Combine that with desk-bound forearm muscles already shortened by typing and mouse use, and the elbow is dealing with a tendon that wasn't ready for any of this.

Timeline: What to Expect

How Osteopathy Treats Padel Elbow

Assessment

The first 10–15 minutes are spent on the loading story — when did you start, how often you play, what racket and grip size, where the pain is worst. Movement testing of the elbow, wrist, shoulder and cervical spine identifies which structures are restricted and which are overloading.

Soft-tissue release

The wrist extensors, brachioradialis and supinator carry tension that pulls on the common extensor origin. Soft-tissue work along the forearm, combined with friction at the tendon itself once acute irritation has settled, reduces local sensitivity and allows the tendon to load more cleanly.

Joint mobilisation

The radio-humeral joint, the wrist, and frequently the cervical spine and first rib all influence how load travels through the arm. Restoring full range at each of these takes the strain off the elbow attachment.

Loading rehab

The single most important intervention for tendinopathy is graded eccentric loading. You'll leave with two or three exercises (typically eccentric wrist extensions and isometric grip holds) that take 5–10 minutes a day. Done consistently, this is what actually rebuilds the tendon.

Technique & equipment guidance

If the racket, grip, or tension is part of the problem, we'll talk it through. A small change here often saves a lot of rehab work — and a chat with a coach for a backhand check is one of the highest-yield investments most amateur players ever make.

Prevention for the Rest of the Season

Equipment

• Racket weight: 350–365 g for most amateur players. Avoid 380 g+ unless you really know what you're doing.
• Get the grip size measured at a specialist shop — most beginners are using one too small.
• Ask the shop to drop string tension by 1–2 kg if you've been getting elbow ache.

Warm-up

• 5 minutes of light cardio before stepping on court.
• Forearm circles and wrist mobility — 30 seconds each direction.
• Start the first 5 minutes of play with controlled mid-court rallies, not hard volleys.

Loading rules

• Two short eccentric wrist sessions a week. 3 × 15 reps with a light dumbbell or resistance band.
• Limit yourself to 2–3 matches a week if you're new — the tendon needs 48 hours between sessions to remodel.
• If a niggle lasts more than 48 hours after a match, drop the next session's intensity by half.

When to Book

• Outer-elbow pain that's lasted more than 7–10 days
• Pain in everyday tasks: lifting a kettle, mug, jar
• You've started avoiding backhand or volleys
• The same elbow gave you trouble after a previous burst of typing or DIY
• Grip feels noticeably weaker than the other side

Frequently Asked Questions