particular , the extensor carpi radialis brevis ( ECRB ), has been shown to be most affected and the source of the pain in most individuals . Repeated stress secondary to poor positioning can lead to aggravation and irritation of the tendon of the ECRB , which is why the pain is felt at the elbow .
So , what should you do when you feel pain in your elbow during or after playing pickleball ?
It ’ s imperative to STOP the activity causing the pain . This is the hardest part for pickleball players ! However , the only way to treat it is to eliminate the stress placed on this area . In most cases , the pain starts because a player has bad mechanics in his or her swing when hitting a backhand , excessively relying on his or her wrist , and causing repetitive trauma to the extensor muscles and ECRB . However , rest and ice alone will not address the underlying cause of the problem .
It ’ s important to address potential contributing factors that could be causing the excessive stress on the wrist . We do this by performing a thorough total body evaluation . During this evaluation , it is important to perform a whole-body movement screen to ensure that other parts of the body — neck , shoulder , shoulder blades , spine , etc .— are moving appropriately . If any link in the chain is compromised , it can lead to problems somewhere else . Once everything is cleared , then looking at specific elbow movements and wrist positioning during pickleball play is the next piece of the puzzle . Most ( not all ) players who experience pickleball elbow demonstrate faulty mechanics when hitting a backhand , which leads to pickleball elbow . Consulting a doctor of physical therapy and a certified pickleball instructor is the best approach to addressing body impairments and swing mechanics .
You ’ re in luck … this is what I do ! As a doctor of physical therapy , 5.0 + rated pickleball player and teaching professional , I have the tools necessary to address the root cause of the problem instead of putting a Band-Aid on it and hoping it goes away . The treatment course should look like this : 1 . Stop activity — Control pain with heat , ice , gentle massage
2 . Full body assessment to address other potential problem-causing / contributing areas and restore adequate mobility , in preparation for strength and stability exercises
3 . Rehab Phase 1 ( as early as possible )— manipulation of elbow and wrist , dry needling , trigger point and fascia release , compression therapy , Cho-Pat ® strap
4 . Rehab Phase 2 — strengthening of forearm musculature focusing on eccentric exercises and stability training of areas identified during the movement screen
5 . Address faulty swing mechanics in order to avoid excessive stress on forearm and elbow , and improve strokes 6 . Return to play
Finally , there are two important concepts to keep in mind when discussing pickleball elbow :
1 . The paddle – Let ’ s get something out of the way . Just because a friend tells you he bought a new paddle and that it fixed his pickleball elbow doesn ’ t mean it will work for you . The weight or type of paddle has little effect on the condition ( for most people ). Tennis rackets are much heavier and longer than pickleball paddles , and plenty of people play without elbow issues . The underlying problem is usually the mechanics that need to be addressed . Of course , when your elbow is already hurting , using a lighter paddle may decrease your pain ( since the force placed on the elbow is lower ). However , this is more of a “ Band-Aid ” option in the long run .
2 . Footwork – This is probably the most overlooked portion of treating pickleball elbow . Proper positioning on the court prior to hitting the ball is the key to having your elbow and wrist in a sound position to hit the ball . This can only be accomplished by addressing mobility , footwork , and anticipation skills on the court . If we only address the problem on a local level , without addressing all contributing factors , the problem will unfortunately return or persist .
To learn more , contact The Pickleball Doctor at
noe @ moveitpt . com . Dr . Noe Sariban is the owner of Move It Physical Therapy in Chapel Hill , NC . Free 10-minute consults are available to see if it ’ s a good fit , and virtual sessions are available if you are not in the area . Movement screens can be performed virtually , and Noe can provide you with the appropriate guidance to make sure you are ready to play this sport we all love ! •
Noe Sariban is a Doctor of Physical Therapy and owner of Move It Physical Therapy in Chapel Hill , NC . He is a certified pickleball teaching professional through the IPTPA , an Engage sponsored athlete , and the Team Engage physical therapist . Visit
thepickleballdoctor . com for more information on injury prevention and rehabilitation tips . You can also like his Facebook page ,
facebook . com / pickleballdoctor , for updates and new information .
MAY / JUNE 2022 | MAGAZINE 87