Pickleball Elbow Prevention: Rethinking Management Beyond Biomechanics

Pickleball Elbow Prevention: Rethinking Management Beyond Biomechanics

Pickleball, a game combining elements of tennis, badminton, and table tennis, has surged in popularity in recent years. With its rise, so has the incidence of pickleball-related injuries, with one of the most common "pickleball elbow." Traditionally, this condition has been attributed to biomechanical factors, but emerging evidence suggests a more nuanced understanding may be necessary. In this blog, we'll explore why pickleball elbow may not solely stem from biomechanics but rather from a complex interplay of lifestyle factors.

The Traditional Perspective

Historically, pickleball elbow, analogous to tennis elbow in tennis players, has been attributed to repetitive stress on the tendons of the elbow due to improper technique or overuse. Biomechanical analyses often focus on the mechanics of the sport, such as grip, racket angle, and swing mechanics. While these factors undoubtedly play a role, they may not fully explain the prevalence and persistence of pickleball elbow among players.

A Shift in Perspective: Load vs. Capacity Framework

A growing body of research suggests that understanding injuries like pickleball elbow requires a broader framework than just biomechanics. The load vs. capacity model offers valuable insights. This model posits that injuries occur when the load placed on a tissue exceeds its capacity to withstand that load. In the context of pickleball elbow, this means that factors contributing to the load on the elbow (e.g., repetitive motions, forceful impacts) and the body as a whole (e.g., stressors, sleep) must be considered alongside factors influencing the elbow's capacity to handle that load.

Lifestyle Factors Matter

While biomechanical factors may contribute to the load on the elbow, numerous lifestyle factors can influence the elbow's capacity to withstand that load. Here are some key considerations:

  1. Sleep: Inadequate sleep can impair tissue repair and increase susceptibility to injury. Players who consistently skimp on sleep may find themselves more prone to pickleball elbow.
  2. Stress: Chronic stress can lead to muscle tension and inflammation, exacerbating the risk of injury. High-stress levels, whether from work, personal life, or the competitive nature of the sport itself, may alter someone’s perception of pain/injury.
  3. Hydration: Proper hydration is essential for maintaining tissue health and elasticity. Dehydration can impair blood flow that is often needed for recovery.
  4. Nutrition: A balanced diet rich in vitamins, minerals, and protein is crucial for tissue repair and maintenance. Poor nutrition can compromise the body's ability to recover from the demands of pickleball.
  5. Training Volume: While sport-specific training is necessary for skill development and performance enhancement, overtraining or improper training can increase the risk of injury. It is not uncommon for avid players to spend 5+ days on a court per week for hours on end, the cumulative time spent playing mixed with the intensity of the games can contribute to overuse injuries. Players should prioritize rest, recovery, and appropriate training volume to prevent overuse injuries like pickleball elbow.
  6. Strength Training: Training the wrist, forearm, shoulder, and spine plays a pivotal role in reducing the risk of pickleball elbow. By focusing on strengthening and optimizing mobility throughout these regions, players can improve their overall biomechanics and mitigate excessive strain on the elbow tendons during gameplay. Incorporating targeted exercises such as wrist curls, forearm pronation/supination drills, various grip strength activities, shoulder stabilization routines, and spine mobility movements into regular training regimens enhances muscle strength and flexibility. Optimizing the strength and coordination of these areas not only minimizes the likelihood of developing pickleball elbow but also enhances overall performance and resilience on the court.


Pickleball elbow is a multifactorial condition influenced by a complex interplay of biomechanical and lifestyle factors. While addressing biomechanical issues such as technique and equipment may help mitigate the risk of injury, a comprehensive approach that considers lifestyle factors, training volume, and building tissue resilience is crucial for prevention and management. By prioritizing factors such as sleep, stress management, hydration, nutrition, and training, players can optimize their elbow's capacity to withstand the demands of the game and enjoy pickleball for years to come.
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