The elbow is the single most common site of injury in padel — and across the research base, the proportion sits between 30% and 74% of all injuries, depending on the study and population[1][2]. In senior players, lateral epicondylitis — the medical name for what most people call "tennis elbow" or, increasingly, "padel elbow" — accounts for around 37% of all reported injuries, compared to roughly 10% in junior players[2].
This article is a conservative, research-grounded look at what padel elbow actually is, why padel is so good at producing it, and the prevention principles that the sports-medicine literature consistently supports. It is not a treatment plan and not a substitute for a clinical assessment. If you already have pain, see a physiotherapist.
What padel elbow actually is.
Lateral epicondylitis is a tendinopathy — a degenerative change in tendon tissue, rather than the acute inflammation the older name "tendinitis" implies. The tendon most often affected is the extensor carpi radialis brevis (ECRB), which originates on the lateral epicondyle of the humerus (the bony bump on the outside of your elbow) and inserts into the wrist[3].
This tendon is loaded every time you:
- Grip a paddle
- Extend your wrist to stabilise an impact
- Decelerate the racquet head after a shot
Padel loads it repeatedly, often eccentrically (the muscle resists a force while lengthening), and over hours of play in a typical week. That is precisely the loading pattern that produces tendinopathy.
The pain pattern is recognisable: a localised ache on the outside of the elbow that worsens with grip, lifting, or backhand-type movements, and that often radiates down the forearm. Onset is usually gradual — one cross-sectional study of 364 amateur padel players found that 85.7% of elbow and forearm injuries developed gradually, not suddenly[4].
That gradual onset is good news. It means there is a window, often weeks long, in which early intervention is highly effective. Most padel players ignore that window.
Why padel produces it more than tennis.
A 2025 systematic review compared injury epidemiology across padel, tennis, and squash. The numbers are stark:
| Sport | Overall prevalence | Most-injured site |
|---|---|---|
| Padel | 85.4% | Elbow · 30–74% |
| Tennis | 39–46% | Ankle · 4–24% |
| Squash | 58% | Ankle · 6–27% |
Padel has the highest overall injury prevalence of the three, and tendon injuries (44–49%) and muscle injuries (27–34%) dominate[5].
Four features of padel explain this:
1. The paddle. Solid foam-and-fibreglass construction is heavier at the head than a strung racquet, and transmits more shock into the forearm on every impact.
2. The overhead game. The bandeja, the víbora, and the smash all load the wrist into extension at the moment of impact, with the elbow positioned to absorb the shock. Padel is overwhelmingly an overhead sport.
3. The walls. Defensive shots off the back glass — often hit late, often from awkward positions, often with a closed-down racquet face — load the elbow in positions it is not strong in.
4. The volume. Padel is social. Many serious amateurs play three to five times per week, which is far more frequent than recreational tennis. Tendons need recovery time to adapt; without it, microdamage accumulates faster than it repairs[6].
The four mechanisms behind every case.
The injury-prevention literature consistently identifies the same risk factors for overuse tendinopathy in racket sports[6][7]. In padel specifically, four mechanisms dominate.
1. Overuse and inadequate recovery
Fatigue is the single largest cause of padel injury — responsible for approximately 43% of training injuries and 56% of competition injuries in the systematic review data[1]. A fatigued tendon is a tendon that cannot absorb load efficiently. Playing through fatigue is the most reliably documented way to develop an overuse injury.
2. Insufficient forearm and grip strength
The ECRB is a small muscle being asked to do a large job. When it is undertrained relative to the loads the sport places on it, it fails. The strongest body of evidence for any tendinopathy treatment — and by extension, for prevention — is for eccentric loading of the wrist extensors[8][9].
3. Poor scapular and shoulder control
This one surprises people. The elbow is often the symptom, not the cause. When the shoulder blade does not stabilise the arm properly during overhead shots, the elbow and wrist compensate. Over time, that compensation overloads the wrist extensors. Addressing the elbow without addressing the shoulder is, in most cases, a temporary fix.
4. Inadequate warm-up
Tendons are viscoelastic. Cold tendons are stiffer and less able to absorb impact. The injury-prevention literature is consistent on this point: structured warm-up programs reduce sport injury rates by approximately 36%[10]. Most padel players do a few air-swings and call it a warm-up. That is not what the research means by a structured warm-up.
What the research says actually works.
Sports-medicine evidence for the prevention and management of lateral epicondylitis converges on four principles. None of them are exotic. All of them are boring. Boring is what works.
Principle 1 — Eccentric loading of the wrist extensors
A 2014 systematic review of randomized controlled trials concluded that programs incorporating eccentric exercise produced consistent improvements in pain, function, and grip strength for lateral epicondylitis[8]. A 2020 systematic review with meta-analysis reached the same conclusion[9]. This is the single most evidence-supported intervention in the entire field.
The mechanism: eccentric loading appears to promote tendon remodelling, increasing collagen synthesis and improving the tendon's ability to handle exactly the kind of load that injured it.
The principle does not require a gym. It requires a small amount of resistance, a slow tempo, and consistency.
Principle 2 — Build the grip and forearm before the season demands it
Grip endurance — not maximum grip strength — is the relevant capacity for padel. Forearms need to tolerate hours of repeated submaximal contraction, not a single heavy lift. The training principle is high reps, moderate load, with attention to both flexors and extensors.
Principle 3 — Train the shoulder, not just the elbow
Specifically: scapular control, rotator cuff endurance (external rotators are usually the weak link), and posterior shoulder mobility. A shoulder that controls itself well during the bandeja takes load away from the elbow.
Principle 4 — Warm up the structure you are about to load
A padel warm-up that does not include wrist extensor mobilisation, gradual grip activation, and overhead shoulder preparation is not preparing the body for padel. It is preparing the body for jogging.
When to stop self-managing.
If you have pain, the prevention conversation is over and the treatment conversation has started. See a sports physiotherapist if:
- Pain has lasted more than two weeks
- You have lost strength in your grip (a kettle, a door handle, opening a jar)
- Pain wakes you at night, or is present at rest
- Pain is sharp, rather than the dull, gradual ache typical of tendinopathy
A clinical assessment is faster, cheaper, and more effective than three months of internet self-diagnosis.