Why your elbow hurts after every padel match — and how to fix it

You started playing two years ago. You loved it. You played three times a week. Then somewhere around month nine, the outside of your elbow started talking. First a twinge after long matches. Then a hot ache the morning after. Now it’s loud enough that you brace your right arm when you pick up a coffee cup.

You don’t have a freak injury. You have lateral epicondylitis — the same condition tennis players have been getting since racquets had wooden frames. The catch with padel is that it loads the tendon differently than tennis does, which is why most of the “rest it” advice you’ll read online undertreats it.

This is the long version of what’s happening in there, why padel is the most common cause amateurs see today, and the three-week protocol that gets most players back on court pain-free.

What lateral epicondylitis actually is

The tendons that extend your wrist and fingers — pull them backwards, away from your palm — all attach to a small bony bump on the outside of your elbow called the lateral epicondyle. The biggest of those tendons belongs to a muscle called extensor carpi radialis brevis, ECRB for short.

ECRB does two unglamorous jobs: it stabilises your wrist when you grip something, and it pulls your wrist back when you decelerate a swing. That second job is the one that kills it.

Every time you hit a forehand or a smash, the racquet handle wants to twist out of your hand. ECRB clamps down to hold it. Every time you catch a deep ball at full reach, ECRB fires hard to stop your wrist from collapsing under the impact. Over thousands of swings, the enthesis — the point where tendon meets bone — accumulates microscopic damage faster than your body can repair it. The tendon doesn’t inflame much (that’s the “-itis” part of the name, which is medically misleading). It degenerates. The collagen fibres get disorganised, the tissue loses its tensile capacity, and pain shows up as a load tolerance issue.

That’s why rest alone rarely fixes it. Resting a degenerating tendon for six weeks gives you a six-weeks-weaker tendon that fails the moment you play again.

Why padel hits this tendon harder than tennis

Three reasons:

1. The grip is shorter. A padel racquet is roughly 45 centimetres long. A tennis racquet is closer to 68. Shorter lever, more wrist torque per shot. Your wrist extensors absorb more of the deceleration force per swing than they would in tennis.
2. Bandeja and víbora. These two shots — overhead defensive smashes hit with slice — load the wrist extensors at end-range while the elbow is high and the shoulder is rotated. It’s a vulnerable position that doesn’t exist in tennis with the same frequency.
3. The walls. Padel players hit far more shots off the back wall than tennis players hit off the baseline. That means more late, off-balance, reaching strikes — exactly the shots that make ECRB fire hard to save the wrist.

Most amateur players also grip too tight. Watch a club-strong player rally and you’ll see their hand relax between shots. Watch most 35-50 year-olds returning to sport after a decade and the grip is white-knuckled cradle-to-grave. That sustained low-grade contraction is a steady drip of micro-damage to the same tendon.

A 30-second self-test

Three quick checks. You’ll know if it’s lateral epicondylitis within a minute.

• Resisted middle-finger extension. Hold your hand out, palm down. Have someone push your middle finger down while you resist. If that reproduces the sharp pain on the outside of your elbow, that’s ECRB.
• Coffee cup grip. Pick up a full mug with the affected arm. Sharp pain on the outside of the elbow as you lift it confirms the diagnosis.
• Resisted wrist extension. Make a loose fist, palm down. Have someone push your knuckles down while you resist. Pain on the outside of the elbow, again, confirms.

If all three are negative but you still hurt, it might be something else — radial tunnel syndrome, biceps tendinopathy, or even a referred neck issue. That’s when you see someone. If two of three are positive, you have what most padel players have.

The three-week fix

The protocol that works for most players is built around a single principle: tendons heal when you load them progressively, not when you avoid them. The exercise that does the heavy lifting here is the eccentric wrist extension, sometimes called the Tyler twist when done with a rubber bar.

Three weeks, three phases.

Week 1 — calm the tendon

You’re not stopping padel completely unless the pain is at rest or above 4 out of 10 with grip. But you’re cutting volume by half and you’re skipping bandejas and overhead smashes for seven days.

Daily:

• Eccentric wrist extension, 3 × 15. Sit at a table, forearm resting on the table, hand off the edge, palm down. Hold a 1-2 kg weight. Use your other hand to lift it into wrist extension. Lower it slowly — 4 to 5 seconds — back to neutral. Use the other hand to lift again. Only the lowering is loaded.
• Forearm and wrist flexor stretch, 3 × 30 seconds. Arm straight, palm up, gently pull the fingers back with the other hand. You should feel a pull along the inside of the forearm.
• Shoulder external rotation isometric, 3 × 20 seconds. Elbow at your side, 90 degrees of bend, fist pushing outward into a wall or door frame, no movement. This recruits the deeper rotator cuff which often loses tone alongside an elbow problem.

Week 2 — build tolerance

Pain should already be lower at rest and on the coffee-cup test. Now you progressively load.

Daily:

• Eccentric wrist extension, 3 × 15 — but increase the weight by 0.5 to 1 kg.
• Heavy isometric grip, 5 × 30 seconds. Squeeze a tennis ball or a stress ball as hard as is tolerable. Tendons respond to high load held statically — it’s some of the most-studied tendinopathy work in the literature.
• Wrist supination / pronation with a hammer, 3 × 10 each direction. Hold a light hammer by the handle, forearm on a table, palm-down. Slowly rotate the hammer towards thumb-up, then towards little-finger-up. Slow controlled tempo.

Resume padel at half your usual volume. Skip overheads. Use a thicker, softer grip wrap if your handle has been worn down — the grip diameter matters more than most players realise.

Week 3 — return to load

Pain on the self-tests should be near gone. Now you stress-test the tendon under real load.

Daily:

• Eccentric wrist extension, 4 × 12 with the heaviest weight you can lower cleanly for 5 seconds. This is the doseable end of the protocol.
• Reverse curls, 3 × 10. Bar or dumbbells, palms facing down, slow tempo. Strengthens ECRB above the elbow as well.
• Carry work. Heavy farmer’s carries for 30 seconds, light enough that grip doesn’t fail. Builds wrist and grip endurance you’ll actually use on court.

Resume full padel volume by the end of week 3, including overheads — but pay attention to the morning after. A small ache that fades by lunchtime is fine. Sharp pain on the coffee-cup test the next day means dial back.

What most players get wrong

A few mistakes I see in every clinic week:

1. Stretching and not loading. Static stretches feel good and do almost nothing for tendinopathy. The fix is heavy slow load, not flexibility work.
2. Resting for too long. Six weeks of no padel doesn’t heal a degenerating tendon — it just lets it forget what load feels like. You come back, hit one hard bandeja, and you’re back to square one.
3. Buying a tennis elbow brace and calling it done. The brace works by changing where the tendon is loaded. It buys you a day or two of relief. It does nothing structural. Use it as a short-term tool, not a treatment.
4. Ignoring the grip. A worn grip is twice as slippery as a fresh one, which means you grip twice as tight. New overgrip every six weeks if you play three times a week.
5. Treating only the elbow. Most padel elbow pain has a thoracic spine and shoulder component. If your upper back doesn’t rotate, your elbow does the rotating for it. We cover this in detail in the seven-minute warm-up.

When to see someone

The protocol works for most cases of lateral epicondylitis that have been around for less than six months. If you’ve been in pain for longer than that, or you have:

• Sharp pain at rest (without movement),
• Numbness or tingling in the hand,
• Weakness when picking up light objects (a kettle, a phone),

go see a sports physio or a hand-and-elbow specialist. Long-standing tendinopathy sometimes needs imaging to rule out a partial tear, and a few cases benefit from shockwave therapy or a single image-guided injection. The vast majority don’t.

Frequently asked

Should I stop playing while I rehab?

Not entirely. Pull back to half-volume, skip overheads, and respect a pain ceiling of 3 out of 10 during play. Total rest weakens the tendon further and tends to extend recovery, not shorten it.

Will an elbow strap or sleeve help?

Yes, in the short term. A counterforce brace just below the elbow redistributes load on the tendon and reduces pain during play. It does not heal anything. Use it for the first two weeks, then wean off.

How is this different from golfer’s elbow?

Tennis elbow (lateral epicondylitis) is on the outside of the elbow and involves the wrist extensors. Golfer’s elbow (medial epicondylitis) is on the inside and involves the wrist flexors. Padel players get both, but tennis elbow is roughly four times more common because of the shot mechanics. We go deeper in tennis elbow vs golfer’s elbow.

Can I take ibuprofen?

For three to five days at the start if pain is keeping you awake, sure. Beyond that, the evidence says chronic NSAID use slows tendon remodelling. The protocol above is your medicine.

How long until I’m fully pain-free?

Eight to twelve weeks for a clean return to full volume, depending on how long you’ve been in pain before starting. The sharp daily pain is usually gone within ten days of starting the protocol. Don’t confuse that with healed — keep loading for the full eight weeks.

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If you’ve had this for a while and you want a coach watching your progression, Padel Mobility has a three-week elbow protocol with daily check-ins and a one-on-one assessment. The articles here are the public version. The platform is the supervised version.