Pickleball Elbow Is Becoming One of the Most Common Injuries I See
A few years ago, most people had never heard of pickleball. Today, it’s one of the fastest-growing sports in Tucson, and with that growth has come a steady stream of elbow injuries.
Patients often come into my clinic describing pain on the outside of the elbow that started after playing pickleball, tennis, golf, or even after a home improvement project. Sometimes it feels like a dull ache. Other times it’s sharp enough that gripping a coffee mug, opening a jar, shaking hands, or lifting a grocery bag becomes surprisingly painful.
Many people assume they have “tennis elbow,” but they’re often unsure what that actually means or what to do about it.
The good news is that most cases respond very well to conservative treatment when addressed early. Acupuncture, dry needling, targeted exercise, and other regenerative approaches can often help reduce pain, improve function, and get you back on the court without relying solely on medications.
What Is Pickleball Elbow?
Pickleball elbow is usually a form of lateral epicondylitis, more accurately called lateral elbow tendinopathy.
The pain develops where the forearm extensor tendons attach to the outside portion of the elbow. These muscles are responsible for gripping, lifting, and stabilizing the wrist during activities such as:
- Pickleball
- Tennis
- Golf
- Weight training
- Cycling
- Manual labor
- Repetitive computer use
Despite the “-itis” ending, many chronic cases are not primarily inflammatory. Instead, the tendon develops small areas of degeneration from repetitive overload that outpaces the body’s ability to repair itself.
Think of it less like a sprained ankle and more like a rope that has gradually become frayed from repeated use.
Why Does Pickleball Cause Elbow Pain?
Pickleball combines several factors that place stress on the forearm tendons:
- Repetitive gripping of the paddle
- Backhand strokes
- Sudden acceleration and deceleration
- Frequent play without adequate recovery
- Changes in paddle weight or grip size
- Rapid increases in playing frequency
Here in Tucson, many active adults are playing several times per week, often while also hiking, cycling, golfing, or strength training. The cumulative load can eventually exceed what the tendon can tolerate.
The result is pain, stiffness, reduced grip strength, and sometimes lingering symptoms that persist for months.
How Does Chinese Medicine View Pickleball Elbow?
Traditional Chinese medicine uses different language, but many of the observations overlap surprisingly well with modern sports medicine.
In Chinese medicine, chronic elbow pain is often viewed as a combination of:
- Local stagnation of blood and circulation
- Muscle and connective tissue dysfunction
- Reduced nourishment reaching injured tissues
- Repetitive strain overwhelming the body’s recovery capacity
Translated into modern terms, we’re looking at impaired tissue healing, altered pain signaling, muscle tension, and tendon overload.
The goal of treatment is not simply to numb symptoms. It’s to improve tissue function, reduce pain, restore normal movement patterns, and support the healing process.
How Acupuncture May Help Pickleball Elbow
Acupuncture has been studied extensively for musculoskeletal pain conditions and may help through several mechanisms.
Research suggests acupuncture can:
- Reduce pain sensitivity
- Improve local blood flow
- Influence inflammatory signaling
- Relax protective muscle guarding
- Improve nervous system regulation
- Support recovery of injured soft tissues
In practice, treatment usually extends beyond placing needles directly where it hurts.
I often evaluate:
- Forearm muscle tension
- Wrist mobility
- Shoulder mechanics
- Neck involvement
- Grip patterns
- Overall movement quality
It’s not uncommon for a patient to point to the elbow as the problem when the shoulder, upper back, or forearm muscles are contributing significantly to the issue. Orthopedic acupuncture is also used to integrate functional assessment and treatment of your injury for optimal results.
Dry Needling and Motor Point Therapy for Pickleball Elbow
For many active patients, dry needling can be an excellent addition to treatment.
The forearm muscles frequently develop trigger points and areas of excessive tension that continue pulling on the injured tendon attachment.
Dry needling may help:
- Reduce muscle tightness
- Improve range of motion
- Decrease pain
- Improve muscle recruitment
- Reduce mechanical stress on the tendon
Motor point acupuncture and electroacupuncture can also be useful in more stubborn cases, especially when symptoms have been present for several months.
Many patients notice improved grip strength and reduced pain with daily activities after several treatments.
What About Cortisone Injections?
This is one of the most common questions I hear.
Cortisone injections can sometimes provide short-term pain relief. However, research has shown that long-term outcomes are often less favorable than many people expect.
For chronic tendon injuries, the goal is usually not just reducing pain temporarily. We also want to improve tendon quality and function.
Depending on the situation, other options may include:
- Physical therapy
- Acupuncture
- Dry needling
- Prolotherapy
- Platelet-rich plasma (PRP)
- Progressive strengthening programs
Every case is different, but many active adults prefer to explore conservative options before considering more invasive procedures.
How Long Does Treatment Take?
Should I Stop Playing Pickleball Completely?
Usually not.
Complete rest is rarely the answer.
Instead, we often adjust the amount of stress being placed on the tendon while allowing healing to occur.
This might involve:
- Temporarily reducing playing frequency
- Modifying paddle grip size
- Improving stroke mechanics
- Using a forearm strap
- Performing tendon strengthening exercises
- Addressing shoulder and wrist mobility deficits
The goal is typically to keep you active while avoiding repeated aggravation.
Who Is a Good Candidate for Acupuncture Treatment?
Acupuncture and related therapies are often appropriate for:
- Recent pickleball elbow injuries
- Chronic tennis elbow
- Recurrent forearm pain
- Grip weakness
- Sports-related overuse injuries
- Patients seeking conservative treatment options
Medical evaluation becomes more important if symptoms include:
- Significant weakness
- Numbness or tingling
- Neck pain radiating into the arm
- Sudden traumatic injury
- Persistent symptoms that fail to improve
Occasionally what appears to be tennis elbow is actually nerve irritation originating from the neck or another underlying condition.
What Does a Typical Treatment Plan Look Like?
In my Tucson clinic, treatment often combines several approaches depending on the individual:
| Therapy | Purpose |
|---|---|
| Acupuncture | Pain reduction and tissue recovery |
| Electroacupuncture | Additional stimulation for chronic cases |
| Dry needling | Muscle tension and trigger point treatment |
| Cupping | Improve tissue mobility and circulation |
| Home exercises | Tendon strengthening and long-term recovery |
| Injection therapies | Selected cases requiring additional support |
Most patients receive individualized recommendations based on their activity level, goals, and severity of symptoms.
Practical Next Steps
If you’re dealing with pickleball elbow, don’t wait until you can barely grip your paddle.
Early treatment is often simpler, faster, and less expensive than trying to manage a chronic tendon injury months down the road.
Start with the basics:
- Reduce aggravating activities temporarily
- Address grip and technique issues
- Begin appropriate strengthening exercises
- Consider conservative therapies such as acupuncture and dry needling
If symptoms persist despite these efforts, or if you’re noticing weakness, numbness, or worsening function, it’s worth getting a more thorough evaluation.
The sooner we understand what’s driving the pain, the sooner we can create a plan to get you back on the court and doing the activities you enjoy.
