Padel Elbow: Prevention and Treatment for Malaysia's Fastest Growing Racquet Sport

Padel has taken Malaysia by storm. Over the past few years, padel courts have sprung up across the Klang Valley, from dedicated facilities in Petaling Jaya and Mont Kiara to clubs in Subang Jaya and Puchong. The sport's accessibility, social nature, and fast-paced gameplay have attracted thousands of new players, many of whom come from backgrounds in tennis, squash, or badminton. However, with this surge in participation has come a corresponding rise in a familiar complaint: elbow pain. At Kinesio Rehab in Putra Heights, we have seen a marked increase in padel players presenting with lateral and medial elbow tendinopathy, conditions collectively referred to as padel elbow. With proper understanding, technique adjustment, and targeted rehabilitation, this condition is both treatable and preventable.

Why Padel Creates Unique Elbow Stress

While padel shares similarities with tennis and squash, it introduces biomechanical demands that create distinct patterns of elbow stress. The padel racket is solid, without strings, which means it does not absorb vibration in the same way a strung racket does. Every ball contact transmits impact forces directly through the racket frame, into the handle, and up through the wrist and forearm into the elbow. This vibration effect is compounded by the fact that padel rallies tend to be longer than in tennis, with more ball contacts per game, increasing the cumulative load on the forearm tendons.

The enclosed court design also plays a role. Glass wall plays are a defining feature of padel, requiring players to hit balls rebounding off the back and side walls. These shots often demand awkward wrist positions and require rapid adjustments in grip and swing path. The wrist frequently moves into extreme extension or flexion during these wall returns, placing additional stress on the tendons that attach at the elbow. Players new to padel are particularly susceptible because they have not yet developed the anticipatory timing and relaxed grip that experienced players use to manage these demanding shots.

Lateral vs Medial Elbow Pain in Padel

Padel elbow typically presents in one of two forms. Lateral epicondylalgia, commonly known as tennis elbow, affects the outside of the elbow where the wrist extensor muscles attach. This is the more common presentation and is often associated with backhand shots, wall returns, and any stroke where the wrist is extended against resistance. Players typically report a burning or aching pain on the outer elbow that worsens during play and may linger when gripping objects, turning door handles, or lifting a cup.

Medial epicondylalgia, or golfer's elbow, affects the inside of the elbow where the wrist flexor muscles attach. In padel, this condition is often linked to the overhead smash and aggressive forehand strokes. The powerful wrist flexion and pronation required to generate topspin on smashes loads the medial forearm tendons heavily. Players who rely on wrist snap rather than shoulder rotation for power are particularly prone to medial elbow pain. Both conditions involve tendon degeneration rather than acute inflammation, which is an important distinction because it guides the treatment approach.

The Overhead Smash and Grip Technique Factor

The overhead smash is one of the most satisfying shots in padel, but it is also one of the most demanding on the elbow. A well-executed smash generates power primarily from the legs, core rotation, and shoulder, with the wrist acting as a guide rather than the primary force generator. However, many recreational players in our local padel community generate smash power predominantly from the wrist and forearm, a technique flaw that dramatically increases load on the elbow tendons. Learning to initiate the smash from the legs and transfer energy through a kinetic chain that progresses from the ground up through the hips, trunk, and shoulder significantly reduces elbow stress.

Grip technique is equally critical. An excessively tight grip creates constant tension in the forearm muscles, restricting blood flow to the tendons and accelerating fatigue. The grip should be firm at the moment of ball contact but relaxed between shots. Additionally, grip size matters. A handle that is too small forces the fingers to overwork to maintain control, while a handle that is too large requires excessive force to wrap around. Both scenarios increase forearm muscle load. We recommend that players experiment with grip sizes and use an overgrip to fine-tune the feel and diameter of the handle.

Treatment Protocols That Work

When padel elbow develops, the temptation for many players is to rest completely and then return to play once the pain subsides. While initial load reduction is important, complete rest alone is insufficient and often leads to recurrence. The tendon needs graduated loading to stimulate the cellular repair processes that restore its structural integrity. This is where eccentric exercise becomes central to rehabilitation.

An effective treatment programme for padel elbow typically includes:

• Eccentric wrist exercises: Slow, controlled lowering of a light weight through wrist extension or flexion, performed daily, stimulates tendon remodelling and increases load tolerance over time
• Isometric holds: Sustained wrist extension or flexion against resistance for 30 to 45 seconds provides immediate pain relief and serves as an excellent warm-up before playing
• Manual therapy: Soft tissue mobilisation of the forearm muscles, combined with joint mobilisation of the elbow and wrist, reduces muscle tightness and improves tissue extensibility
• Counterforce bracing: A strap worn just below the elbow distributes force across a broader area of the tendon, reducing peak stress at the attachment point during play
• Graduated return to play: A structured programme that progressively increases playing duration and intensity, monitored through a pain response scale, ensures the tendon adapts without re-injury

When to Rest and When to Play Through

One of the most common questions padel players across the Klang Valley ask is whether they can continue playing with elbow pain. The answer depends on the severity. If your pain during play remains below a 3 out of 10 on a pain scale and does not increase the day after playing, modified play is generally acceptable. This means reducing session duration, avoiding overhead smashes, focusing on controlled rallies, and performing your eccentric exercises before and after play.

However, if your pain exceeds 4 out of 10 during play, increases significantly the following day, or you notice weakness in your grip strength, it is time to step back from padel temporarily and focus on your rehabilitation programme. Continuing to play through significant pain risks converting a mild tendinopathy into a severe, chronic condition that may take six months or longer to resolve. The padel community in Malaysia is wonderfully social, and the fear of missing out on games is understandable, but a few weeks of modified activity now is far preferable to months of forced absence later. At Kinesio Rehab, we help padel players navigate this balance with individualised treatment plans that keep them as active as possible while ensuring their tendons heal properly.