Padel elbow: why this padel injury is so common on the Costa del Sol and how to treat it

By Flora Muijzer | Physiotherapist & Sports Performance Specialist, Riviera del Sol & Marbella, Costa del Sol

Reading time: approx. 6 minutes

It starts as a dull ache on the outside of your elbow after a long padel session. You shake it off, ice it, and book another court for the weekend. Then one day the ache is there before you even pick up the racket, and gripping your coffee cup hurts too.

This is padel elbow, and you are far from alone. Research shows the elbow is the single most injured area in padel, accounting for roughly a third of all injuries in the sport. The good news is that, with the right physiotherapy plan, it responds well to treatment and full recovery is realistic.

Padel is one of the biggest sports in Spain at the moment.

In this guide, you'll find:

• The most common causes of padel elbow

• How we diagnose the root cause at Physio Flora

• Our physiotherapy treatment options for padel elbow

• Three physiotherapist-approved exercises to start today

• Answers to the questions our patients ask most

What is padel elbow and why padel causes it

Padel elbow is a form of lateral epicondylalgia. This means the tendons on the outside of your elbow become irritated and painful. It is the same family of injury as tennis elbow. However, the way padel loads the arm makes it especially common among players on the Costa del Sol.

Padel has exploded in popularity here, with new courts opening across Marbella, Mijas, Fuengirola, and Estepona every year. As a result, more players of all levels are picking up a racket without building up tolerance gradually. This sudden jump in playing frequency is one of the biggest drivers of padel elbow.

Common causes of padel elbow on the Costa del Sol

• Using the wrist instead of the body on smashes. Many players snap the wrist on the bandeja or remate instead of rotating through the shoulder and trunk. This overloads the forearm extensor tendons.

• Off-center hits. Padel rackets are stiff and solid, so a mistimed shot sends vibration straight through the arm rather than absorbing it.

• The wrong racket or grip size. A racket that is too heavy, too stiff, or has the wrong grip diameter increases strain with every shot.

• A sudden increase in playing frequency. Weekend warriors who go from once a week to several sessions often develop symptoms within weeks.

• Limited forearm and shoulder strength. Without enough conditioning, the tendons absorb load that the muscles should be sharing.

  
  

Because of this combination of factors, padel elbow tends to develop gradually rather than from a single bad shot. Most patients describe weeks of low-level discomfort before it becomes a daily problem.

How we diagnose the root cause at Physio Flora

When you come in with elbow pain, we start with a thorough clinical assessment rather than jumping straight to treatment. This typically includes:

• Palpation and movement testing to confirm the exact tendons involved.

• Resisted wrist extension testing, which reproduces the pain in genuine cases of padel elbow.

• Grip strength assessment, since grip strength often drops noticeably on the affected side.

• A look at your technique and equipment, including racket weight, grip size, and your smash and volley mechanics.

• A check of the shoulder and trunk, since weakness further up the chain often forces the elbow to absorb extra load.
  

This assessment matters because padel elbow can sometimes mimic nerve irritation or referred pain from the neck. As a result, ruling out these other causes early helps us build a treatment plan that actually works, instead of treating the wrong problem.

Our physiotherapy treatment options for padel elbow

Treatment at Physio Flora is tailored to how long you have had symptoms and how irritated the tendon currently is. In addition, we always look beyond the elbow itself to the technique and strength factors driving the problem.

Manual therapy and Mulligan mobilisation. As a certified Mulligan therapist, Flora uses mobilisation with movement techniques that are specifically well-studied for lateral epicondylalgia. This approach often reduces pain immediately during the session, which allows you to start loading the tendon sooner.

Dry needling. Targeted dry needling of the forearm extensor muscles helps release the tightness that frequently builds up around an irritated tendon.

Shockwave therapy. For padel elbow that has become chronic and has not responded to rest, shockwave therapy stimulates the tendon's own healing response. This is often the turning point for players who have been struggling for months.

Sports massage. Releasing tension through the forearm, wrist extensors, and upper arm supports the other treatments and improves comfort between sessions.

Progressive strength and technique guidance. We build a graded loading programme for the tendon while also addressing the swing mechanics or equipment choices that caused the overload in the first place. This combination is why our patients tend to stay pain-free, rather than seeing symptoms return after a few more matches.

Three physiotherapist-approved exercises to start today

Try these gently, and stop if any exercise sharply increases your pain.

1. Isometric wrist extension hold. Rest your forearm on a table with your hand hanging off the edge, palm down. Push the back of your hand upward into a light resistance band or your other hand, and hold for 30 to 45 seconds. Repeat four times. This is a safe starting point even when the elbow is still irritated.

2. Eccentric wrist extension. Hold a light dumbbell with your palm facing down and your forearm supported. Use your other hand to lift the weight up, then slowly lower it over three to four seconds. Complete three sets of 12 to 15 slow repetitions. This eccentric loading is one of the most evidence-based exercises for tendon recovery.

3. Forearm extensor stretch. Extend your arm in front of you with the elbow straight. Gently pull your hand downward and toward your body until you feel a stretch along the top of your forearm. Hold for 20 to 30 seconds and repeat three times on each side.

   
   

Answers to the questions our patients ask most

Is padel elbow the same as tennis elbow? They are the same underlying condition, lateral epicondylalgia. However, padel elbow is often driven more by racket vibration and smash technique than by a classic tennis backhand.

How long does padel elbow take to heal? Mild cases often improve within four to six weeks with the right loading programme. More chronic cases, especially those present for several months, can take three months or longer.

Can I keep playing padel while it heals? This depends on severity. In many cases, we recommend modifying frequency and intensity rather than stopping completely, since some tendons respond well to controlled loading. We will guide you on what is safe for your specific stage.

Will a different racket help? Often, yes. A lighter, more flexible racket with a properly sized grip can meaningfully reduce the load on your forearm. We are happy to advise during your assessment.

Do I need an injection or surgery? Rarely. The vast majority of padel elbow cases resolve fully with physiotherapy, progressive loading, and addressing the technique or equipment factors involved.

Padel elbow does not have to mean giving up the sport you love.

At Physio Flora, we combine thorough clinical assessment with evidence-based treatment and a genuine understanding of the active, outdoor lifestyle that brings people to, and keeps people on, the Costa del Sol. We see patients from Riviera del Sol, Marbella, Fuengirola, Estepona, Benalmádena, Mijas Pueblo, and across the region.

No referral needed. English-language consultations. Appointments available this week.

Website: www.physioflora.es

Phone: +34 711 059 592

Email: hello@physioflora.es

Clinic locations:

Riviera del Sol (Urb Balcon del Golf, c/ Topacio 2, local 1-2, 29649, Riviera del Sol, Mijas)

Marbella (The Clubhouse Marbella, c/ Juan Belmonte, Nueva Andalusia)

Your forearms carry every smash and volley, so give them the recovery plan they deserve.

Physio Flora · English, Dutch, German and Spanish-speaking physiotherapy on the Costa del Sol · Specialising in racket sport injuries and tendinopathy